颅内结核瘤的质子MR波谱研究

Proton MR Spectroscopy Study in Intracranial Tuberculomas

目的探讨质子MR波谱(1H-MRS)对颅内结核瘤的诊断价值。资料与方法回顾性分析26例颅内结核瘤患者术前或接受治疗前的1H-MRS表现,1H-MRS采用多体素2D1H-MRS,点分辨表面线圈法(PRESS)。比较结核瘤病灶实质和对侧正常脑组织的胆碱(Cho)、肌酸(Cr)、N-乙酰天门冬氨酸(NAA)、Cho/Cr,Cho/NAA、NAA/Cho差异有无统计学意义,观察有无脂质(Lip)峰或氨基酸峰(AAs)出现。结果颅内结核瘤实质部分Cho较对侧升高,差异无统计学意义(颅内结核瘤和对侧正常脑组织Cho分别为366.7±137.4,325.4±126.4,P>0.05),Cr、NAA、NAA/Cho低于对侧,差异有统计学意义(颅内结核瘤和对侧正常脑组织Cr分别为163.6±74.1,300.1±140.5,P<0.01;NAA分别为239.4±96.6,475.3±244.7,P<0.01;NAA/Cho分别为0.74±0.35,1.56±0.60,P<0.01),Cho/Cr、Cho/NAA高于对侧,差异有统计学意义(颅内结核瘤和对侧正常脑组织Cho/Cr分别为2.05±0.63,1.14±0.38,P<0.01;Cho/NAA分别为1.70±0.85,0.79±0.34,P<0.01),有15例(15/26)见Lip峰,所有病例坏死腔均未见AAs。结论1H-MRS能反映颅内结核瘤的病理特点,可为其诊断和鉴别诊断提供有用的信息。

Objective To investigate the diagnostic value of proton magnetic resonance spectroscopy（^1H-MRS）in intracranial tuberculomas.Materials and Methods The conventional MR imaging and multivoxel 2D ^1H-MRS were performed in 26 cases with intracranial tuberculomas before treatment or operation.^1H-MRS was performed using PRESS sequence.The Cho,Cr,NAA,Cho/Cr,Cho/NAA and NAA/Cho from the solid part of the intracranial tuberculomas and normal control tissues were calculated.The presence of lipid or AAs peak was also noted.Results On 1H-MRS,Cho of intracranial tuberculomas and nomal control tissues was no significant difference（Cho of intracranial tuberculomas and of normal control tissues were 366.7±137.4,325.4±126.4,P〈0.05）.Cr,NAA,NAA/Cho of intracranial tuberculomas were significantly lower than that of normal control tissues（Cr of intracranial tuberculomas and of normal control tissues were 163.6±74.1,300.1±140.5,P〈0.01;NAA were 239.4±96.6,475.3±244.7,P〈0.01;NAA/Cho were 0.74±0.35,1.56±0.60,P〈0.01.Cho/Cr,Cho/NAA of intracranial tuberculomas were significantly higher than that of normal control tissues（Cho/Cr of intracranial tuberculomas and of normal control tissues were 2.05±0.63,1.14±0.38,P〈0.01;Cho/NAA were 1.70±0.85,0.79±0.34,P〈0.01.There were 15 cases with lip peak on ^1H-MRS,AAs were not observed in all cases with necrotic area.Conclusion 1H-MRS can reflect pathological feature of intracranial tuberculomas and can be used as a supplementary tool for diagnosis and differential diagnosis.