1H-MRS在细菌性脑脓肿中的应用研究

目的 回顾性分析细菌性脑脓肿氢质子磁共振波谱（^1H-MRS）特征，评价^1H-MRS在细菌性脑脓肿诊断和疗效监测中的应用价值。资料与方法 经病理组织学证实的细菌性脑脓肿20例，17例^1H-MRS有能分辨的信噪比（SNR），点分辨波谱（PRESS）序列采集病灶中心，比较分析代谢物出现概率。结果 （1）17例细菌性脑脓肿：耳源性2例，肺源性3例，心源性2例，隐源性5例，其他5例。（2）15例细菌性脑脓肿有氨基酸（AA）峰，敏感性88．23％，特异性100％。另2例仅有乳酸（Lac）或脂质（Lip）峰。9例乙酸盐（Ace）峰，敏感性52．3％；7例琥珀酸盐（Sue）峰，敏感性41．2％；6例丙氨酸（Ah）峰，敏感性35．3％；Lip峰和胆碱（Cho）、氮-乙酰天门冬氨酸（NAA）、肌酸（Cr）／磷酸肌酸（PCr）峰各3例。（3）8例平均治疗38d后^1H-MRS复查，从峰和Ace峰降低或消失，仅剩Lae峰。（4）细菌性脑脓肿有两种波谱模式：一种是除了从峰、Lac峰，还有Ace峰、Sue峰或Ah峰（12例）；另一种是仅有从、Lac峰，而没有Ace峰、Sue峰或Ala峰（3例）。结论 从峰是细菌性脑脓肿特征性的峰；^1H-MRS能反映细菌性脑脓肿的疗效；脓肿不同波谱模式可能提示不同的细菌感染。

The Study of 1H-MRS in Bacterial Brain Abscess

Objective To retrospectively analyze the ~1HMRS features of bacterial brain abscess, and to evaluate its value in the diagnosis and the monitoring of the curative effect.Materials and Methods 20 cases of bacterial brain abscess were confirmed by pathological results, in which 17 cases were acquired successful spectroscopy. Single-voxel PRESS (TE 135/270ms) sequence was performed, metabolite were analyzed.Results (1) 17 cases of bacterial brain abscess, 2 cases were otogenous, 3 cases were caused by lung disease, 2 cases were cardiogenic, 5 cases were unclear, the others were 5 cases. (2) 15 cases showed AA peak, sensitivity was 88.23%, specificity was 100%, 2 cases showed only Lac peak, no AA peak. 9 cases showed Ace peak, sensitivity 52.3%; 7 cases showed Suc peak, sensitivity 41.2%; 6 cases showed Ala peak, sensitivity 35.3%; Lip, Cho, NAA, Cr/PCr peak were detected in 3 cases respectively. (3) 8 cases were followed up after treatment of 38 days, AA peak and Ace peak were decreased or disappeared, only Lac peak was presented. (4) The total spectroscopy was divided into two types: 12/15 cases showed AA, Lac, and Ace or Suc or Ala peak; 3/15 cases showed only AA and Lac peaks.Conclusion AA is characteristic peak of bacterial brain abscess, ~1 H-MRS can be used to monitor curative effect for bacterial brain abscess and predict the etiology according to different spectroscopy type.