多体素^1H-MRS对脑胶质瘤、转移瘤及脑脓肿的鉴别诊断研究

Differential Diagnosis Research on Cerebral Glioma,Metastase and Abscess with ^1H-MRS

目的探讨多体素氢质子磁共振波谱(1H-MRS)在脑胶质瘤、单发转移瘤、体积较大脑脓肿鉴别诊断中的应用价值及胶质瘤瘤体周围的微观结构的改变。资料与方法搜集脑胶质瘤26例、单发转移瘤9例、大体积脑脓肿4例,均行1H-MRS检查。比较脑胶质瘤与单发转移瘤瘤体及瘤周胆碱(Cho)/N-乙酰天门冬氨酸(NAA)、Cho/肌酐类物质(Cr)、NAA/Cr值的差别,并做统计学分析;用HE染色、免疫组织化学、电镜检查等重点观察胶质瘤瘤周微观结构改变。结果各个级别的胶质瘤与单发转移瘤瘤体之间Cho/NAA值分别为3.14±1.61和2.46±0.83,Cho/Cr值分别为2.57±0.93和2.90±1.93、NAA/Cr值分别为0.96±0.53和1.21±0.80,差异均无明显统计学意义(P值均>0.05);而瘤周之间的上述比值为1.74±0.98和0.98±0.23,1.72±0.51和1.09±0.35,1.11±0.30和1.11±0.25,除NAA/Cr外均有明显统计学意义(P值<0.05)。脑脓肿内部出现特征性波谱,扩散加权成像(DWI)上脓腔显示为高信号。胶质瘤瘤周在光镜及电镜下发现已有瘤细胞浸润。结论使用多体素1H-MRS结合常规MRI可鉴别胶质瘤、单发转移瘤、不典型脑脓肿,胶质瘤的瘤细胞可以通过毛细血管转移浸润至瘤周。

Objective To evaluate the value of ^1H-MRS in differential diagnosis on gliomas, solitary metastases and cerebral abscesses. Materials and Methods 26 cases of cerebral gliomas, 9 cases of solitary metastases and 4 cases of cerebral abscess were collected. All cases were performed MR spectroscopy successfully. The Cho/NAA, Cho/Cr, NAA/Cr value of tumor and peritumoral region were compared respectively between gliomas and solitary metastases. The results were analyzed statistically. The microstructure of peritumoral region was observed by means of HE staining, immunohistochemistry, electron microscope. Results The Cho/NAA of gliomas and metastases was 3.14±1.61 and 2.46±0.83 respectively; the Cho/Cr was 2.57±0.93 and 2.90±1.93 respectively; the NAA/Cr was 0.96±0.53 and 1.21 ± 0.80 respectively. No significant difference was found for all ratios mentioned above between the two groups （P 〉 0.05 ）. The Cho/NAA in peritumoral regions of the two groups was 1.74 ± 0.98 and 0.98 ± 0.23 respectively, the Cho/Cr was 1.72 ± 0.51 and 1.09 ± 0.35 respectively ; NAA/Cr was 1.11 ± 0.30 and 1.11 ± 0.25 respectively, All ratios had significant differences except NAA/Cr （P 〈 0.05 ）. There were characteristic spectroscopy and hyperintensity in cerebral abscess cavity on DWI sequence. The infiltration of glioma cells were found in the peritumoral regions with the light and electron microscope examination. Conclusion Combining with routine MRI scan, ^1H MRS can differentiate the glioma, solitary and atypical cerebral abscess.