质子磁共振波谱在脑内环状强化病变鉴别诊断中的应用

Clinical application of proton magnetic resonance spectroscopy in differential diagnosis of intracranial lesions with ring-like enhancement

目的:研究质子磁共振波谱(1HMRS)在脑内环状强化病变鉴别诊断中的临床应用价值。方法:28例经病理证实或临床明确诊断的脑内环状强化病灶患者,其中高级别胶质瘤6例,转移瘤10例,脑脓肿12例,均行多体素1HMRS检查,测量比较病灶中心、强化环、灶周水肿区及正常对照组(病灶对侧正常脑组织)的代谢物浓度比值。结果:高级别胶质瘤与转移瘤病灶中心NAA/Cho、Cho/Cr、NAA/Cr比值比较差异无显著性(P>0.05),NAA峰出现几率差异有显著性(P<0.05)。高级别胶质瘤瘤周区域与转移瘤的瘤周区域和正常对照组NAA/Cho、Cho/Cr比值及Cho相对含量比较差异有显著性(P<0.05),脑转移瘤瘤周区域和正常对照组比较差异无显著性(P>0.05)。脑脓肿有特征性细胞液AA峰。脑脓肿Cho/Cr0(Cr0表示病灶对侧正常脑组织内Cr含量)比值较高级别胶质瘤和转移瘤明显降低(P<0.05),上述结果与病理检查结果相符。结论:1HMRS分析能够提高脑内环状强化病变诊断的准确率。

Objective To study the value of clinical application of 1H proton magnetic resonance spectroscopy（1H MRS） in the differential diagnosis of intracranial lesions with ring-like enhancement. Methods 28 cases were diagnosed of intracranial lesions with ring-like enhancement by clinical examination and pathologic test.A total of 28 ratios cases included 6 cases high grade glioma,10 cases of metastatic carcinoma（n=10） and 12 cases of brain abscess,after examined with 1HMRS,the ratios of various metabolites in focal center,enhancement ring,perifocal edema region and normal control group were detected and compared.Results The ratios of NAA/Cho,Cho/Cr and NAA/Cr in focal center had no significantly differences between high grade glioma and metastatic carcinoma（P〉0.05）. The peak of NAA was significantly different between high grade glioma and metastatic carcinoma（P〈0.05）. The ratios of NAA/Cho and Cho/Cr in the perifocal regions of high grade glioma and metastatic carcinoma were significantly different compared with normal brain （P〈0.05）. The relative content of Cho was not significantly different between perifocal regions of metastatic carcinoma and normal brain（P〉0.05）. The peak of AA was characteristic of brain abscess. The ratio of Cho/Cr0 in brain abscess was significantly lower than those in high grade glioma and metastatic carcinoma（P〈0.05） （Cr0 denoted the Cho content of contralateral normal brain region）.These resutls accorded with the result of pathological examination. Conclusion 1HMRS can improve the diagnostic accuracy of intracranial lesions with ring-like enhancement.