磁共振波谱成像在颅脑肿瘤中的应用研究

The Applied Research of Magnetic Resonance Spectroscopy Imaging in Cerebral Neoplasms

目的:探讨增强后多体素氢质子磁共振波谱(1H-MRS)对颅内常见肿瘤的鉴别诊断价值。方法:48例颅内常见肿瘤患者行增强后多体素1H-MRS检查,其中胶质瘤19例,单发转移瘤13例,脑膜瘤16例。测量计算3种肿瘤瘤体强化区、水肿边缘区及对侧正常脑组织的代谢物N-乙酰天门冬氨酸(NAA)、胆碱(Cho)、肌酸(Cr)的含量和它们比值Cho/Cr、NAA/Cr、NAA/Cho,并进行比较分析。结果:胶质瘤、转移瘤与脑膜瘤的瘤体强化区的Cho/Cr、NAA/Cr、NAA/Cho值分别为(2.76±1.46、1.02±0.69、0.41±0.20)、(2.69±0.46、1.45±0.95、0.57±0.15)、(2.38±0.66、0.72±0.40、0.16±0.07);瘤体水肿边缘区的Cho/Cr、NAA/Cr、NAA/Cho值分别为(1.44±0.67、1.28±0.48、0.98±0.58)、(1.08±0.35、1.20±0.37、1.22±0.65)、(0.99±0.48、1.45±0.55、1.53±0.72)。与对侧正常组织对比,胶质瘤、转移瘤与脑膜瘤瘤体强化区与水肿区的NAA/Cr、NAA/Cho有显著性差异(P<0.05),Cho/Cr无显著性差异(P>0.05)。瘤体强化区中,胶质瘤与转移瘤之间NAA/Cho有显著性差异(P<0.05),胶质瘤与脑膜瘤之间Cho/Cr、NAA/Cr、NAA/Cho均有显著性差异(P<0.05),转移瘤与脑膜瘤间NAA/Cr、NAA/Cho有显著性差异(P<0.05)。瘤体水肿区中,胶质瘤与转移瘤之间Cho/Cr有显著性差异(P<0.05),胶质瘤与脑膜瘤之间Cho/Cr、NAA/Cho均有显著性差异(P<0.05),转移瘤与脑膜瘤间NAA/Cr有显著性差异(P<0.05)。结论:增强后多体素1H-MRS对颅脑肿瘤的鉴别诊断有重要的临床应用价值。

Objective： To explore the value of post contrast multi voxel 1H-MRS in the differential diagnosis of different intracranial neoplasms.Methods： Post contrast multi voxel 1H-MRS was performed in 48 cases with different intracranial neoplasms,including high grade gliomas（n=19）,solitary metastases（n=13）and meningioma（n=16）.The N-acetyl aspartate（NAA）,Choline（Cho）,Creatine（Cr）,Cho/Cr,NAA/Cr,NAA/Cho in enhanced region and peritumoral region of the gliomas,metastases and meningioma and normal region in the contralatateral brain tissue were measured and compared respectively.Results： The Cho/Cr,NAA/Cr,NAA/Cho in enhanced region of the gliomas,metastases and meningioma were（2.76±1.46,1.02±0.69,0.41±0.20）,（2.69±0.46,1.4 5±0.95,0.57±0.15）,（2.38±0.66,0.72±0.40,0.16±0.07）,respectively.The Cho/Cr,NAA/Cr,NAA/Cho in peritumoral region of the gliomas,metastases and meningioma were（1.44±0.67,1.28±0.48,0.98±0.58）,（1.08±0.35,1.20±0.37,1.22±0.65）,（0.99±0.48,1.45±0.55,1.53±0.72）,respectively.Compare to the normal region,the NAA/Cr,NAA /Cho in enhanced region and peritumoral of the gliomas,metastases and meningioma had significant differences（P〈0.05）,and Cho/Cr had no significant differences（P〈0.05）.In enhanced region,the ratios of NAA/Cho had significant differences between gliomas and metastases（P〈0.05）;the ratios of Cho/Cr,NAA/Cr,NAA/Cho had significant differences between gliomas and meningioma（P〈0.05）;the ratios of NAA/Cr,NAA/Cho had significant differences between metastases and meningioma（P〈0.05）.In peritumoral region,the ratios of Cho/Cr had significant differences between gliomas and metastases（P〈0.05）;the ratios of Cho/Cr,NAA/Cho had significant differences between gliomas and meningioma（P〈0.05）;the ratios of NAA/Cr had significant differences between metastases and meningioma（P〈0.05）.Conclusion： Post contrast multi voxel 1H-MRS plays an important role in the differential diagnosis of different intracranial neoplasms.