骨肉瘤的^(31)P磁共振波谱观察

Investigation of Osteosarcoma with ^(31)P Magnetic Resonance Spectroscopy

目的利用31P磁共振波谱(MRS)在体分析骨肉瘤与正常骨骼、肌肉组织磷脂代谢特点,探讨31PMRS结合常规MRI在骨肉瘤定性诊断中的价值。资料与方法对31名健康自愿者的33个部位、18例骨肉瘤行常规MRI与31PMRS检测。对两组各代谢物比值行独立样本t检验,分析骨肉瘤组织细胞膜磷脂代谢指标磷酸单酯(PME)/β-三磷酸腺苷(β-ATP)、磷酸二酯(PDE)/β-ATP等比值变化特点,组织能量磷酸肌酸(PCr)/总31P代谢物(T31P)、ATP/T31P、无机磷(Pi)/β-ATP及细胞内pH值变化特点。结果骨肉瘤组PME/β-ATP、Pi/β-ATP、PDE/β-ATP、PCr/T31P、低能磷酸盐(LEP)/T31P、ATP/T31P、PCr/β-ATP、(PCr+ATP)/Pi及pH值均数分别为1.08±0.19、0.85±0.40、0.98±0.38、0.28±0.09、0.30±0.07、0.42±0.09、2.75±1.25、9.45±3.84、7.35±0.24,对照组各比值均数分别为0.07±0.06、0.34±0.12、0.43±0.26、0.43±0.03、0.10±0.03、0.46±0.03、3.63±0.65、24.53±10.14、7.06±0.08,除ATP/T31P外,其余比值与对照组均存在明显差异(P值均<0.01)。对MRI征象分析结果提示:单独依靠MRI对骨肉瘤符合率为12/18例,而结合31PMRS结果,诊断符合率为16/18例。结论骨肉瘤组细胞膜磷脂代谢指标较对照组明显升高,高能磷酸盐显著降低,细胞内pH值轻度升高。结合常规MRI,这些特征性改变有利于对骨肉瘤病变的早期诊断和治疗监测。

Objective To explore the value of ^31P magnetic resonance spectroscopy （^31p MRS） for differential diagnosis of osteosareoma, by analyzing the metabolism changes of osteosarcoma in vivo combined conventional MRI. Materials and Methods Conventional MRI and ^31p MRS were performed on 18 osteosarcoma patients and 31 healthy volunteers. The data were analyzed by independent-samples t-test, including the ratios of PME/β-ATP, PDE/β-ATP, PCr/T ^31 p, ATP/T ^31 p, Pi/β- ATP et al. Results The mean values of the metabolites ratios in osteosarcoma group were：PME/β-ATP：1. 08 ± 0. 19, Pi/β-ATP ：0.85 ± 0.40, PDE/β-ATP ：0.98 ± 0.38, PCr/T ^31 p： 0.28 ± 0.09, LEP/T 31 p： 0.30 ± 0.07, ATP/T 31 p： 0.42 ± 0.09, PCr/13-ATP ：2.75 ± 1.25, （ PCr ＋ ATP）/Pi ：9.45 ± 3.84, and pH value was 7.35 ± 0.24. The means of the metabolites ratios in control group were ： PME/β-ATP ： 0.07 ± 0. 06, Pi/β-ATP ： 0.34 ± 0. 12, PDE/β-ATP ： 0.43 ± 0.26, PCr/T ^31p ： 0.43 ± 0.03,LEP/T ^31p：0.10 ±0.03,ATP/T ^31p：0.46 ±0.03,PCr/β-ATP：3.63 ±0.65, （PCr ＋ ATP）/Pi：24.53 ± 10.14,and the pH value was 7.06 ± 0.08. The results of Osteosarcoma group were different significantly from control group （P 〈 0.01 ） , except the ratio of ATP/T 31 p. The accuracy of diagnosis by MRI for osteosarcoma was 12/18, however,it was 16/18 by Combining 31pMRS. Conduslon The significant increasing of the mean values of PME/（3-ATP,PDE/（J-ATP,LEP/T ^31P,pH value and the decreasing of NTP,PCr in malignancy group can be of great value in diagnosis of osteosarcoma. Combined conventional MRI with ^31PMRS would be a simple,non-invasive and effective diagnostic method.