二维磁共振波谱分析在评价颅内胶质瘤中的临床应用

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

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。

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. Resdts 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 muhiforms（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〈0.0i）. 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.