MRI及MRS对大脑胶质瘤病的诊断及鉴别诊断价值

目的评价MRI及MRS在大脑胶质瘤病的诊断和鉴别诊断中的价值。方法回顾性分析经活检、手术病理证实的6例大脑胶质瘤病患者的MRI和MRS表现特征,并与病理切片进行对照;常规行SE序列平扫及增强、DWI序列成像,其中3例行MRS研究,二维多体素、点分辨法PRESS、TE 144 m s。结果所有病例均侵犯2个脑叶或以上,同时伴胼胝体侵犯6例、基底节和丘脑侵犯4例、脑干侵犯2例。病变区呈长T2、稍长T1异常信号,T2WI、FLAIR上均为高信号,无坏死、钙化,受累区脑组织肿胀,占位效应轻。2例增强扫描见小结节状强化,4例无明显强化。3例MRS表现均有不同程度NAA降低,NAA/Cr比值降低,Cho上升,Cho/Cr和Cho/NAA的比值上升。结论MRI结合MRS对大脑胶质瘤病的诊断及鉴别诊断具有较大价值,结合临床、MRI及MRS是能够作出明确诊断的。

MR Imaging and MRS in Diagnosis and Differential Diagnosis of Cerebral Gliomatosis

Objective To investigate the role of MR imaging and MR spectroscopy(MRS) in diagnosis and differential diagnosis of gliomatosis cerebri.Methods MRI studies of 6 patients with gliomatosis cerebri confirmed with biopsy or operation were reviewed retrospectively.All patients underwent MR imaging,diffusion weighted imaging(DWI)and three of them underwent MR spectroscopy(single-voxel point resolved spectroscopy 2D PRESS TE 144 ms).Results Tumors involved at least two lobes of the brain in all patients,with involvements of the corpus callosum in 6 cases,basal ganglia and thalamus in 4,brain stem in 2.Wide spread invasion with iso-intensity or hypo-intensity on T1WI and hyper-intensity on T2WI and FLAIR were found,while no prominent necrosis and calcification were found.The area invaded by tumor showed swelling and no obvious space occupying effect.The tumors were seen as small nodular enhancement in 2 cases and no obvious enhancement in 4 cases on contrast-emhanced MRI.MRS showed Cho,Cho/Cr and Cho/NAA levels were elevated as well as NAA/Cr ratios and NAA levels were decreased in different degrees in the abnormal areas on T2WI.Conclusion MRI and MRS are valuable techniques for diagnosis and differential diagnosis of gliomatosis cerebri.Combining clinical information and MRI findings,as well as MRS can make a definitive diagnosis.