MRI和磁共振波谱在肝性脑病的应用价值

Application value of MRI and proton magnetic resonance spectroscopy in hepatic encephalopathy

目的探讨MRI和磁共振波谱(1H-MRS)在肝性脑病中的应用价值。方法对6例肝性脑病患者行MRI和1H-MRS检查,检测基底节MRS的N-乙酰天门冬氨酸(NAA)、肌酸(Cr)、胆碱(Cho)、谷氨酰胺复合物(Glx)、肌醇(mI)的峰值,计算Cho、mI、NAA与Cr的比值,并与5名正常对照者比较。结果 MRI检查显示,6例肝性脑病患者双侧基底节T1WI均出现高信号,其中1例累及内囊、2例累及尾状核、1例累及中脑被盖;5例患者T2WI未见明显异常信号,1例患者因并发弥漫性脑水肿T2WI出现广泛高信号影。1H-MRS显示,肝性脑病组双侧基底节Cho峰、mI峰、Cho/Cr和mI/Cr显著低于正常对照组,Glx峰显著高于正常对照组(P<0.01～0.005);两组NAA/Cr比较差异无统计学意义。结论 MRI显示双侧基底节T1WI高信号是肝性脑病特征性改变。1H-MRS能准确地反映其脑代谢物质水平的变化。

Objective To investigate the application value of MRI and proton magnetic resonance spectroscopy （1H-MRS） in hepatic encephalopathy （HE）. Methods MRI and t H-MRS examination were applied in 6 HE patients. The peaks of N-acetyl aspartate （NAA） , Creatine （Cr） , Cholines （Cho） , glutamine compounds （Glx） , myo-inositol （mI） in basal nuclei were measured, and the ratio of Cho, mI, NAA and Cr were computered. The results were compared with 5 normal controls. Results MRI was showed that there were high signal on T1WI in bilateral basal nuclei in all the 6 HE patients, including involved internal capsule in 1 case, caudate nucleus in 2 cases, tegmental in 1 case. There were no obvious abnormal signal on T2WI in 5 cases, but widely high signal on T2WI in 1 case caused by diffuse cerebral edema. ^1H-MRS was showed that the peaks of Cho, mI, ratio of Cho/Cr and mI/Cr in HE group were significantly lower than those in normal control group, the peak of Glx was significantly higher than normal control group, （ P 〈 0. 01 - 0. 005 ）. There was no statistical significance in NAA/Cr between the two groups. Conclusions MRI shows that high signal on T1 WI in bilateral basal nuclei is the characteristics of HE. ^1H-MRS can reflect metabolism changes more aceutately.