孤立性肺结节质子MR波谱的初步研究

Proton MR spectroscopy in solitary pulmonary nodules: a preliminary study

目的 研究孤立性肺结节氢质子波谱 (1 H MRS)的特征及其代谢物变化规律 ,探讨MRS在孤立性肺结节诊断中的应用价值。方法 应用SiemensVision 1 5T超导MR机对 6 9例孤立性肺结节行常规MR检查和MRS测量 ,观察记录所有孤立性肺结节MRS特征及各代谢物参数值。 1 0例手术标本行MRS检查 ,其结果并与术前MRS结果对照分析。结果 胆碱 (Cho)含量恶性结节组 (2 86±1 89)明显高于炎性结节 (0 87± 0 74 )、结核球 (0 97± 1 0 9)及错构瘤组 (0 4 2± 0 5 3) (P <0 0 1 )。胆碱与肌酸比值 (Cho/Cr)恶性结节组 (1 34± 1 1 3)亦明显高于其他 3组结节 (炎性结节 0 1 7± 0 1 8;结核球 0 4 7± 0 92 ;错构瘤 0 2 8± 0 1 7) (P <0 0 5 )。乳酸含量 (Lac)恶性结节组显著高于其他 3组结节(恶性结节 1 9 4 3± 9 2 1 ;炎性结节 5 70± 1 86 ;结核球 4 2 5± 1 4 3;错构瘤 4 5 3± 1 5 1 ) (P <0 0 0 1 )。 1 0例手术标本MRS检测结果与术前MRS检测结果行配对t检验 ,二者之间差异无统计学意义 (P >0 0 5 )。结论 活体肺结节MRS检测结果是可靠的。Cho升高、Cho/Cr值的增加和出现异常Lac峰是恶性结节的波谱特征 ,有助于良恶性肺结节的鉴别诊断。

Objective To study the characteristics and the regularities of the metabolites in solitary pulmonary nodules with proton MR spectroscopy, and to investigate the clinical value of MR spectroscopy in differentiating benign from malignant pulmonary nodules.Methods Sixty-nine patients with solitary pulmonary nodules underwent routine MRI and single-voxel MR spectroscopy using Siemens Vision 1.5 T MR system.MR spectroscopy characteristics and parameters of the metabolites were observed and recorded.Ten pathologic specimens were examined with single-voxel MR spectroscopy.The MR spectroscopy results of the pathologic specimens were compared with those of the solitary pulmonary nodules in vivo.Results The Cho peak (2.86±1.89) of the malignant nodules was higher than that of the inflammatory (0.87±0.74), tuberculous nodules (0.97±1.09), and hamartoma (0.42±0.53) (P<0.01).The Cho/Cr of the malignant nodules (1.34±1.13) was higher than that of inflammatory (0.17±0.18), tuberculous nodules (0.47±0.92), and hamartoma (0.28±0.17) (P<0.05).The Lac peak of the malignant nodules (19.43±9.21) was higher than that of the inflammatory (5.70±1.86), tuberculous nodules (4.25±1.43), and hamartoma (4.53±1.51) (P<0.001).There was no significant difference between the MR spectroscopy results of the pathologic specimens and those of the solitary pulmonary nodules in vivo (P>0.05).Conclusion MR spectroscopy is reliable in evaluating pulmonary nodules in vivo.The Cho peak, Cho/Cr, and Lac peak of the malignant nodules were higher than those of inflammatory, tuberculous nodules, and hamartoma.MR spectroscopy is helpful in differentiating benign from malignant pulmonary nodules.