氢质子磁共振波谱对胶质瘤放疗后复发和放射性脑损伤的鉴别价值

Value of proton magnetic resonance spectroscopy in differentiating recurrence from radiation encephalopathy after radiotherapy for brain gliomas

目的探讨氢质子磁共振波谱(1H-MRS)对胶质瘤放疗后复发和放射性脑损伤的鉴别诊断价值。方法选择胶质瘤术后均行放射性治疗的病人27例,经常规MRI复查不能区分胶质瘤放疗后复发或放射性脑损伤,均采用1H-MRS检查,对比分析胶质瘤放疗后复发或放射性脑损伤的相应脑组织N-乙酰天门冬氨酸(NAA)、肌酸(Cr)和胆碱(Cho)等的代谢规律。结果经1H-MRS诊断,胶质瘤放疗后复发14例,放射性脑损伤9例,胶质瘤放疗后复发合并放射性脑损伤4例。1H-MRS影像表现:脑胶质瘤放疗后复发:Cho上升,NAA下降,Cho/Cr比值升高;放射性脑损伤:Cho、NAA、Cr均较低。结论1H-MRS对判断脑胶质瘤放疗后脑损伤或肿瘤复发有重要意义。

Objective To evaluate the value of proton magnetic resonance spectroscopy（1H-MRS） in the differential diagnosis of recurrence and radiation encephalopathy after radiotherapy for brain gliomas.Methods Twenty seven patients with brain glioma recurrence or radiation encephalopathy after radiotherapy were selected.Because the final diagnosis could not be verified by magnetic resonance imaging（MRI）,1H-MRS examination was performed to analyze the changes of metabolites in the affected brain tissues,such as N-acetylaspartate（NAA）,creatine（Cr）,choline（Cho）,et al.Results According to the outcomes of 1H-MRS examination,14 patients were diagnosed as having tumor recurrence,9 radiation encephalopathy and the other 4 had brain glioma recurrence with radiation encephalopathy.The characteristics of 1H-MRS in differential diagnosis were as follows：Cho content increase,NAA content decrease and Cho/Cr ratio increase in glioma recurrence,while the expressions of Cho,NAA and Cr were all kept at a low level in radiation encephalopathy.Conclusion 1H-MRS examination is helpful for determining tumor recurrence or radiation encephalopathy after radiotherapy.