1H—MRS在高级别脑胶质瘤与脑转移瘤鉴别诊断中的应用

Comparative study of high-grade gliomas and brain metasmses with multivoxel proton magnetic resonance spectroscopy

目的探讨T1H-MRS在高级别脑胶质瘤与脑转移瘤中诊断及鉴别诊断的价值。方法选取经手术病理或临床确诊的30例高级别脑胶质瘤与脑转移瘤患者。采用美国GE公司SignaEXCITEHD3．0T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144ms,序列扫描。采用Functool软件包后处理，分别测定瘤体区、瘤周区及健侧相应区域的胆碱／肌酸（Cho／Cr）、胆碱／氮一乙酞天门冬氨酸（Cho／NAA）、氮一乙酞天门冬氨酸／肌酸（NAA／Cr）比值的变化，并对结果利用SPSS13．0软件包进行统计学分析。结果高级别胶质瘤和转移瘤瘤体区Cho／NAA值比较差异有统计学意义（P〈0．05），而Cho／Cr、NAA／Cr值分别比较差异无统计学意义（P〉0．05）；瘤周区Cho／Cr、Cho／NAA值比较差异有统计学意义（P〈0．05），NAA／Cr值比较差异无统计学意义（P〉0．05）。结论。H—MRS在鉴别诊断高级别胶质瘤和转移瘤中有重要价值，对瘤周区的Cho／Cr、Cho／NAA值的检查是鉴别胶质瘤和转移瘤的重要手段，特别对于单发脑转移瘤更具鉴别意义。

Objective To investigate the value in MR spectrum in differential diagnosis between high grade gliomas and metastases. Methods 30 eases of patients who confirmed by histopathologie findings or clinlcal follow-up were collected. Using a GE Signa EXCITE HD 3.0T super conduct MR unit, all the cases of patients were performed conventional MR scan and muthi-voxel with 2-D mutlti-voxel PRESS 144 ms. Functool software was used for post-processing of spectrum. 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 result was used as the statistical method by SPSS13.0 software. Results In the solid part of masses,there were significant differences between high grade gliomas and metastases in the ratios of Cho/NAA （ P 〈 0. 05 ） , but no differences in the ratios of Cho/Cr, NAA/Cr;In pcritumoral edema,there were significant differences in the ratios of Cho/Cr,Cho/NAA （ P 〈 0. 05 ）, but no significant differences in the ratios of NAA/Cr （ P 〈 0. 05 ）. Conclusion 1 H-MRS is very important and useful in the evaluation of differential diagnosis between high grade gliomas and metastases. The inspections of the ratios of Cho/Cr, Cho/NAA of gliomas and metastases pcritumoral edema are important methods, especially for solitary metastases.