2D^1H-MRS对脑低级星形细胞瘤、病毒性脑炎和脑梗死的鉴别诊断价值

Value of 2D^1H-MRS in the differential diagnosis of low-gradeastrocytomas,viral encephalitides and cerebral infarctions

目的探讨多体素2D1H-MRS对脑低级星形细胞瘤、病毒性脑炎和脑梗死的鉴别诊断价值。方法21例脑低级星形细胞瘤在手术前、26例病毒性脑炎和25例脑梗死病例在急性或亚急性阶段接受了常规MRI和2D1H-MRS检查。脑低级星形细胞瘤病例均经手术病理证实,病毒性脑炎和脑梗死病例均经临床治疗及随访证实。统计分析胆碱/肌酸(Cho/Cr)、N-乙酰天门冬氨酸/胆碱(NAA/Cho)、胆碱/对侧相应正常脑实质区肌酸(Cho/Cr-n)和胆碱/对侧相应正常脑实质区胆碱(rCho)比值。结果Cho/Cr、NAA/Cho及Cho/Cr-n比值在脑低级星形细胞瘤与脑梗死之间的差别有显著性,但在脑低级星形细胞瘤与病毒性脑炎之间的差别没有显著性。rCho在脑低级星形细胞瘤与脑梗死之间以及脑低级星形细胞瘤与病毒性脑炎之间的差别都有高度显著性。病毒性脑炎与脑梗死比较,除大多数脑梗死见高大的Lac峰可以鉴别两者之外,其余各项指标均无鉴别诊断价值。结论多体素2D1H-MRS对脑低级星形细胞瘤、病毒性脑炎和脑梗死的鉴别诊断有重要的临床应用价值。

Objective To explore the value of multivoxel 2D^1H MRS in the differential diagnosis of low-grade astrocytomas, viral encephalitides and cerebral infarctions. Methods The conventional MR imaging and multivoxel 2D^1 H-MRS were performed in 72 cases （21 cases with low-grade astrocytomas, 26 cases with acute or subacute viral encephalitides,and 25 cases with acute or subacute cerebral infarctions） before treatments or operations. The diagnosis was confirmed surgically and pathologically in cases with low-grade astrocytomas and was made clinically in cases with viral encephalitides or cerebral infarctions. The ratios of Cho/Cr,NAA/Cho,Cho/Cr n and rCho were calculated and analyzed. Results Significant difference was found on the ratios of Cho/Cr, NAA/Cho,Cho/Cr-n between the low-grade astrocytomas and cerebral infarctions, but no significant difference was found between the low-grade astrocytomas and viral encephalitides. There was significant difference on the ratio of rCho between the low-grade astrocytomas and cerebral infarctions or viral encephalitides. There is no value of the ratios mentioned above to differentiate viral encephalitides from cerebral infarctions, except Lac peak which increased markedly in most cerebral infarctions. Conclusion Multivoxel 2D^1H-MRS plays an important role in the differential diagnosis of low-grade astrocytomas, viral encephalitides and cerebral infarctions.