二维磁共振波谱分析在评价颅内胶质瘤中的临床应用

目的探讨脑胶质瘤二维磁共振波谱分析(2D 1H-MRS)表现及其主要代谢物含量变化。方法选择120例幕上脑胶质瘤行常规MRI及2D-1H-MRS检查并定量检测其主要代谢物N-乙酰天门冬胺酸(NAA)、含胆碱化合物(Cho)、肌酸(Cr)、乳酸(Lac)和脂质(Lip)含量。采用t检验进一步探讨各级别胶质瘤代谢物含量的差异。结果120例接受常规MRI和2D-1H-MRS检查的病例按术后病理结果分为三组:星形细胞瘤(AS)40例,间变性星形细胞瘤(AA)40例,胶质母细胞瘤(GM)40例。随胶质瘤恶性程度的增加,NAA呈下降趋势,Cho呈上升趋势,Cr变化不明显或轻度下降,Lip-Lac呈升高趋势。在AS与AA、AS与GM、AA与GM间NAA含量差异显著(p<0.01)。在AS与GM间Cr含量差异显著(P<0.05),在AS与AA、GM间Cho含量差异显著(p<0.01)。在AS与AA、AS与GM、AA与GM间Cho/cr比值差异显著(p<0.01);在AS与AA、GM间及AA与GM间NAA/Cho比值差异显著(p<0.01,P<0.05);在AS与AA、GM间Lip/lac比值差异显著(p<0.01)。结论胶质瘤2D1H-MRS表现及其代谢物定量研究有助于胶质瘤临床诊断与肿瘤恶性度分级。

Clinical Application of 2D 1H-MRS in Evaluation of Human Intracranial Gliomas

Objective To investigate the manifestations of 2D proton magnetic resonance spectroscopy (2D-1H-MRS) of cerebral gliomas and to study its main metabolities quantitatively. Methods Routine magnetic resonance imaging(MRI) and 2D 1H-MRS were performed in 120 cases with supratentorial gliomas(67 male , 53 female , age range 17～75, average age 39±6.68 ). Main metabolities including N-acetyl aspartate(NAA), choline(Cho),creatine(Cr),lipid(Lip) ,lactate(Lac) were measured quantitatively. Student's t-test was used to explore the differences among the three different gradings of gliomas. Results All the patients tolerated conventional MRI and 2D 1H-MRS without producing motion artifacts. According to the diagnosis of postoperational pathology,they were divided into three groups: astrocytoma (AS,n=40),anaplastic astrocytoma(AA,n=40) and glioblastoma multiforms(GM,n=40).With the increasing of tumor grade,the relative contents of Cho ,Lip , Lac increased, whereas NAA decreased , with no obvious change for Cr. It is demonstrated that there were significant differences between AS and AA, AS and GM, AA and GM for NAA (p<0.01); between AS and GM for Cr(p<0.05); between AS and AA, AS and GM for Cho (p<0.01); between AS and AA, AS and GM, AA and GM for Cho/Cr ratio(p<0.01); between AS and AA, AS and GM(p<0.01),AA and GM(p<0.05)for NAA/cho ratio; between AS and AA, AS and GM for Lip/Lac(p<0.01). Conclusion The manifestations of 2D-1H-MRS of human cerebral gliomas and the quantitative analysis of its main metabolities were helpful to the clinical diagnosis and gradings for gliomas.