多体素1H-MRS在脑胶质瘤强化周围区域中的临床应用

Clinical application of multivoxel 1H-MRS in the peri-enhancement area of cerebral gliomas

目的:应用多体素氢质子磁共振波谱(1H-MRS)成像探讨脑胶质瘤强化周围区域1H-MRS代谢物改变特点,评价1H-MRS在确定胶质瘤浸润范围中的应用价值。方法:搜集经病理证实的脑胶质瘤24例,按WHO诊断标准分为低级别胶质瘤组(I、II级)和高级别胶质瘤组(III、IV级),按照MRI检查结果分为肿瘤强化周围区域有水肿组和肿瘤强化周围区域无水肿组。所有患者在术前行1H-MRS检查,检测不同区域代谢物的变化。结果:①低级别胶质瘤瘤周组织和对侧正常脑组织的Cho:Cr、NAA:Cho及NAA:Cr比值存在显著性差异(P<0.05);高级别胶质瘤瘤周组织和对侧正常脑组织的Cho/Cr、NAA/Cho比值存在显著性差异(P<0.05),但NAA/Cr值无显著性差异(P>0.05);低、高级别胶质瘤瘤周组织的各代谢物比值均无显著性差异(P>0.05);②肿瘤周围有水肿组瘤周组织和对侧正常脑组织的Cho/Cr、NAA/Cho及NAA/Cr比值存在显著性差异(P<0.05);肿瘤周围无水肿组瘤周组织和对侧正常脑组织的Cho/Cr、NAA/Cho比值存在显著性差异(P<0.05),但NAA/Cr值无显著性差异(P>0.05);肿瘤周围有水肿组和肿瘤周围无水肿组瘤周组织的各代谢物比值均无显著性差异(P>0.05)。结论:多体素1H-MRS可评价肿瘤强化周围区域肿瘤细胞浸润范围,对确定胶质瘤的边界具有一定意义。

Objective： To investigate the predictive value of muhivoxel proton magnetic resonance spectroscopy（1H-MRS） in discussing the metabolic changes in peri-enhancement area of brain gliomas. To evaluate the role of MRS in determining the boundary of gliomas. Methods： Twenty-four cases with glioma confirmed by pathology were studied. According to the WHO diagnostic criteria, all cases were categorized into two groups, low grade gliomas（grade Ⅰ, Ⅱ） and high grade gliomas（grade Ⅲ, Ⅳ）. According to MRI manifestations, all cases were categorized into two groups （peritumoral edema and non-edema groups）. All of them underwent 1H-MRS examination before operation. The variety of metabolite peaks were detected in different areas. Results： ①Significant differences were found in the ratios of Cho/Cr, NAA/Cho and NAA/Cr between peri-enhancement areas of low grade gliomas and normal brain tissues （P〈0.05）. Significant differences were found in the ratios of Cho/Cr and NAA/ Cho between peri-enhancement areas of high grade gliomas and normal brain tissues （P〈0.05）, but there were no significant differences in the ratios of NAMCr（P〉0.05）. There were no significant differences in the ratios of Cho/Cr, NAMCho and NAA/ Cr in the peri-enhancement areas of low grade gliomas and high grade gliomas （P〉0.05）. ②Significant differences were found in the ratios of Cho/Cr, NAMCho and NAMCr （P〈0.05） in peritumoral edema regions and normal tissue in contralateral hemispheres. Significant differences were found in the ratios of Cho/Cr, NAA/Cho （P〈0.05） between peritumoral non-edema regions and normal tissue in contralateral hemispheres, but not in the ratios of NAA/Cr （P〉0.05）. There were no significant differences in the ratios of Cho/Cr, NAA/Cho and NAA/Cr in the peritumoral edema and non-edema groups （P〉0.05）. Conclusion： Multi- voxel proton magnetic spectroscopy（1H-MRS） will be useful in defining the border of brain glioma.