质子磁共振波谱在胶质瘤诊断中的应用

Use of ^1H magnetic resonance spectroscopy in the diagnosis of gliomas

目的探讨质子磁共振波谱（^1Hmagnetic resonance spectroscopy，^1HMRS）在胶质瘤诊断及分级中的应用。方法回顾分析我院2003年3月～2005年9月质子磁共振波谱检查并经病理证实的36例胶质瘤的临床资料，根据胶质瘤恶性程度不同分为A、B2组，其中A组为低恶性组（包括星形细胞瘤Ⅰ级和Ⅱ级、室管膜瘤、少突胶质细胞瘤等）21例，B组为高恶性组（包括星形细胞瘤Ⅲ级和Ⅳ级、多形性胶质母细胞瘤、间变型室管膜瘤、髓母细胞瘤）15例。观察氮乙酰门冬氨酸（Nacetylaspartate，NAA）、胆碱（choline，Cho）、肌酸（creatine，Cr）、肌醇（Ins）的共振峰及比值。大脑对侧对应正常脑组织的结果作内对照组。结果2组胶质瘤均表现为异常的。HMRS，与大脑对侧对应正常脑组织相比，A、B2组表现为NAA／Cr含量显著下降，Cho／Cr含量显著增高（P均〈0．05），cr总量变化不大，且无规律性（P〉0．05），Ins含量表现为轻度下降（P〉0．05）。A组NAA／Cr和NAA／Cho均显著高于B组（t=4．235，P=0．011；t=2．832，P=0．031），A组Cho／Cr显著低于B组（t=-2．323，P=0．042）。结论。HMRs可提高对胶质瘤诊断和分级的准确性。

Objective To evaluate ^1H magnetic resonance spectroscopy （^1H MRS） in the diagnosis and grading of glioma. Methods Clinical data of 36 cases of glioma diagnosed by ^1H MRS from March 2003 to September 2005 were retrospectively reviewed. According to the malignancy of glioma, these cases were divided into two groups： Group A （21 moderately malignant cases, including astrocytoma grade Ⅰ and Ⅱ , ependymoma, and oligodendroglioma） and Group B （ 15 highly malignant cases, including astrocytoma grade Ⅲ and Ⅳ, glioblastoma multiforme, anaplastic ependymoma, and medulloblastoma）. Each case was given a single voxel MRS simultaneously in both the lesion＇s region and the contralateral side. The peak values and the ratios of N-acetylaspartate （NAA）, choline （Cho）, creatine （Cr）, and inositol （Ins） were recorded. Results Compared with the contralateral side, ^1H MRS exhibited abnormal findings in both groups, including significantly decreased NAA/Cr levels, increased Cho/Cr levels （P 〈 0.05 ） , invariant and ruleless Cr levels （ P 〉 0.05） , and slightly decreased Ins （P 〉 0.05 ）. The NAA/Cr and NAA/Cho in the Group A were significantly higher than those in the Group B （ t = 4. 235, P = 0. 011 ; t = 2. 832, P = 0.031 ） , and the Cho/Cr in the Group A was significantly lower than that in the Group B （ t = - 2. 323, P = 0. 042）. Conclusions 61 H magnetic resonance spectroscopy can improve the diagnostic accuracy of glioma.