MRI和磁共振波谱在肝性脑病的应用价值

目的探讨MRI和磁共振波谱(1H-MRS)在肝性脑病中的应用价值。方法对6例肝性脑病患者行MRI和1H-MRS检查,检测基底节MRS的N-乙酰天门冬氨酸(NAA)、肌酸(Cr)、胆碱(Cho)、谷氨酰胺复合物(Glx)、肌醇(mI)的峰值,计算Cho、mI、NAA与Cr的比值,并与5名正常对照者比较。结果 MRI检查显示,6例肝性脑病患者双侧基底节T1WI均出现高信号,其中1例累及内囊、2例累及尾状核、1例累及中脑被盖;5例患者T2WI未见明显异常信号,1例患者因并发弥漫性脑水肿T2WI出现广泛高信号影。1H-MRS显示,肝性脑病组双侧基底节Cho峰、mI峰、Cho/Cr和mI/Cr显著低于正常对照组,Glx峰显著高于正常对照组(P<0.01～0.005);两组NAA/Cr比较差异无统计学意义。结论 MRI显示双侧基底节T1WI高信号是肝性脑病特征性改变。1H-MRS能准确地反映其脑代谢物质水平的变化。

Application value of MRI and proton magnetic resonance spectroscopy in hepatic encephalopathy

Objective To investigate the application value of MRI and proton magnetic resonance spectroscopy(1H-MRS) in hepatic encephalopathy(HE).Methods MRI and 1H-MRS examination were applied in 6 HE patients.The peaks of N-acetyl aspartate(NAA),Creatine(Cr),Cholines(Cho),glutamine compounds(Glx),myo-inositol(mI) in basal nuclei were measured,and the ratio of Cho,mI,NAA and Cr were computered.The results were compared with 5 normal controls.Results MRI was showed that there were high signal on T1WI in bilateral basal nuclei in all the 6 HE patients,including involved internal capsule in 1 case,caudate nucleus in 2 cases,tegmental in 1 case.There were no obvious abnormal signal on T2WI in 5 cases,but widely high signal on T2WI in 1 case caused by diffuse cerebral edema.1H-MRS was showed that the peaks of Cho,mI,ratio of Cho/Cr and mI/Cr in HE group were significantly lower than those in normal control group,the peak of Glx was significantly higher than normal control group,(P<0.01-0.005).There was no statistical significance in NAA/Cr between the two groups.Conclusions MRI shows that high signal on T1WI in bilateral basal nuclei is the characteristics of HE.1H-MRS can reflect metabolism changes more aceutately.