3．0T^1H-MRS在颅内常见肿瘤中的应用研究

3.0T ~1H-MR Spectroscopy Imaging in the Evaluation of Intracranial Tumors

目的探讨3.0T氢质子磁共振波谱(1H-MRS)对颅内常见肿瘤诊断、鉴别诊断、评价治疗效果及在胶质瘤分级中的价值。资料与方法选取经手术病理或临床确诊的69例颅内肿瘤患者。采用GE Signa EXCITE HD 3.0T超导型MR扫描仪对所有患者行颅脑常规MRI扫描和二维多体素序列扫描。采用Functool软件包后处理,分别测定病变实质、病变周围及健侧相应区域的胆碱(Cho)/肌酸(Cr)、Cho/N-乙酰天门冬氨酸(NAA)、NAA/Cr比值及肌醇(MI)值的变化,并对结果进行统计学分析。结果(1)实质区:低级别胶质瘤的Cho/Cr值与高级别胶质瘤、转移瘤及脑膜瘤间差异有统计学意义(P<0.01);低级别胶质瘤与高级别胶质瘤、脑膜瘤的Cho/NAA比值分别比较有统计学意义(P<0.05),转移瘤与高级别胶质瘤、脑膜瘤的Cho/NAA比值分别比较有统计学意义(P<0.05);低级别胶质瘤NAA/Cr比值与高级别胶质瘤、转移瘤分别比较有统计学意义(P<0.05),转移瘤与脑膜瘤比较有统计学意义(P<0.05);低级别胶质瘤的MI值与高级别胶质瘤、转移瘤及脑膜瘤分别比较有统计学意义(P<0.05)。(2)瘤周水肿区:高级别胶质瘤Cho/Cr比值与另外三者比较差异有统计学意义(P<0.05),低级别胶质瘤Cho/Cr比值与转移瘤、脑膜瘤分别比较差异有统计学意义(P<0.01);低级别胶质瘤Cho/NAA比值与转移瘤、脑膜瘤分别比较差异有统计学意义(P<0.05),高级别胶质瘤与转移瘤、脑膜瘤分别比较有统计学意义;低级别胶质瘤与高级别胶质瘤NAA/Cr比值差异有统计学意义(P<0.05);各肿瘤瘤周水肿区MI值比较无统计学意义(P>0.05)。结论1H-MRS在鉴别诊断颅内肿瘤中有重要价值,可较准确显示肿瘤瘤周浸润情况,结合其他影像征象对胶质瘤分级诊断亦有重要价值。

Objective To reveal the value of MR spectrum in diagnosis, differential diagnosis, grading the malignancy and treatment effectiveness evaluation in frequent intracranial tumors. Materials and Methods Sixty-nine cases confirmed by histopathologic findings or clinical follow-up were collected. Using a GE Signa EXCITE HD 3.0T super conduct MR unit, all the cases performed conventional MR scan and muthi-voxel with 2-D mutlti-voxel PRESS 144ms. Functool software was used for spectrum post-processing. The ratios of NAA/Cr, NAA/Cho, Cho/Cr were measured in the solid part of masses, circum of tumors and contralateral parenchyma respectively. The results were analysed by SAS 8.2. Results （1） Solid part of masses ：There were significant differences （ P〈0.01 ） in the Cho/Cr of low-grade gliomas compared with high-grade gliomas, metastatic tumors and meningiomas. There were significant differences （ P〈0.05 ） in the Cho/ NAA of low-grade gliomas compared with, high-grade gliomas and meningiomas. Significant differences （ P 〈 0.05 ） were found in the NAA/Cr of low-grade gliomas compared with high-grade gliomas and metastatic tumors, as well as of metastatic tumors compared with meningiomas. Compared with high-grade gliomas, metastatic tumors and meningiomas, low-grade gliomas had significant differences in the value of MI（ P〈0.05 ）. （2） Peritumoral edema ：There were significant differences in Cho/Cr （ P 〈 0.05 ） among high-grade gliomas, low-grade gliomas, metastatic tumors and meningiomas. Significant differences were found in Cho/NAA（ P 〈 0.05 ）of low-grade gliomas compared with metastatic tumors and meningiomas, as well as of high-grade gliomas compared with metastatic tumors and meningiomas. Significant differences were found between low-grade gliomas and high-grade gliomas in the ratios of NAA/Cr（P 〈 0.05 ）. There were no significant differences in the ratio of MI（ P 〉 0.05 ） among the four tumors. Conclusion：^1H-MRS is a very important and useful tool in evaluating intracranial tumors. It has made it possible to estimate peritumoral edema and reflect the invasion of intracranial tumors and exactly evaluate the grade of gliomas combined with other images.