获得性免疫缺陷综合征局灶性脑炎~1H-MRS分析

~1H-MRS of acquired immunodeficiency syndrome related focal encephalitis

目的探讨1H-MRS对获得性免疫缺陷综合征(AIDS)局灶性脑炎的诊断及鉴别诊断价值。方法对确诊的23例AIDS局灶性脑炎患者进行MR检查,以1H-MRS分析32个病灶,测量代谢物N-乙酰天门冬氨酸(NAA)、胆碱化合物(Cho)、肌酸(Cr)、肌醇(mI)峰下面积均值,观察乳酸(Lac)、脂质(Lip)峰出现的频数,计算NAA/Cr、Cho/Cr、mI/Cr、NAA/Cho、(Cho+mI)/NAA值。比较AIDS局灶性脑炎实性区、坏死区、水肿区及与相邻正常脑组织代谢物差异。结果 AIDS局灶性脑炎病变各区均出现NAA、Cho、Cr、mI峰。与相邻正常脑组织比较,NAA峰在病变各区均降低,Cho、mI峰在实性区略升高,在坏死及水肿区降低。Lac、Lip峰在病变各区均出现,在实性及坏死区出现频数明显高于水肿区,且Lip峰出现频数较Lac峰高。病变各区之间NAA/Cr、NAA/Cho、Cho/Cr、(Cho+mI)/NAA值差异有统计学意义(P<0.05);与相邻正常脑组织比较,病变各区Cho/Cr、(Cho+mI)/NAA值差异均有统计学意义(P均<0.05)。结论 1H-MRS能够发现AIDS局灶性脑炎的特征性物质及能量代谢变化,为定性、定量诊断和鉴别诊断提供依据。

Objective To observe the characteristics of 1H-MRS of acquired immunodeficiency syndrome（AIDS） related focal encephalitis.Methods Totally 23 patients with AIDS related focal encephalitis underwent 1H-MRS.Data of 32 lesions were acquired and areas of peaks of N-acetyl aspartate（NAA）,Creatine（Cr）,Choline（Cho）,Myo-inositol（mI）,Lactate（Lac） and Lipids（Lip） were measured in the parenchymatous tissue,necrosis,edema focus on infection and adjacent normal brain tissue,ratios of the metabolite NAA/Cr,Cho/Cr,mI/Cr,NAA/Cho,（Cho＋mI）/NAA were calculated.1H-MRS of the above areas were compared.Results NAA,Cho,Cr and mI peaks appeared in every lesion area.Compared to adjacent normal brain tissue,NAA peak decreased in every lesion area,Cho and mI peaks increased in parenchymatous tissue.In the zone of necrosis and edema,NAA,Cho and mI peaks decreased.Lac and Lip peaks were observed in every lesion area,the frequency in the zone of necrosis and the parenchymatous tissue was higher than that in the zone of edema,and the frequency of Lip peak was higher than Lac.There were significant differences in NAA/Cr,Cho/Cr,NAA/Cho,（Cho＋mI）/NAA among lesion areas（P0.05）.Compared with normal brain tissue,significant difference of（Cho＋mI）/NAA and Cho/Cr was found in every lesion area（P0.05）.Conclusion There are significant characteristics of 1H-MRS for AIDS related focal encephalitis.1H-MRS can provide evidences for the qualitative and quantitative diagnosis,as well as for differential diagnosis of AIDS related focal encephalitis.