1H-MRS在瘤样炎性脱髓鞘病与低级别胶质瘤鉴别诊断中的应用

Application of 1H-MRS in differential diagnosis of tumor-like inflammatory demyelinating disease and low grade glioma

目的探讨氢质子磁共振波谱(1H-MRS)在瘤样炎性脱髓鞘病(TIDD)与低级别胶质瘤(LGG)鉴别诊断中的应用价值。方法选取12例经手术/活检病理证实或治疗后随诊证实的TIDD患者为病例组,10例经手术病理证实的LGG患者为对照组。采用3.0T磁共振(MRI)成像系统,所有患者手术和/或药物治疗前全部行横轴位T1WI-FLAIR、FSE-T2WI、T2WI-FLAIR及1H-MRS检查。结果与对侧正常脑组织相比较,TIDD组患者病灶侧Cho/Cr比值升高,NAA/Cr及NAA/Cho比值降低,差异有统计学意义(p<0.05)。与对侧正常脑组织相比较,LGG组患者病灶侧Cho/Cr比值升高,NAA/Cr及NAA/Cho比值降低,差异有统计学意义(p<0.05)。TIDD组与LGG组病灶区比较,Cho/Cr比值、NAA/Cho比值和Lac/Cr峰差异p<0.05,而NAA/Cr比值差异p>0.05。结论1H-MRS能够无创性检测脑组织代谢物含量。LGG患者比TIDD患者Cho/Cr比值增高、NAA/Cho比值降低及Lac/Cr峰降低。1H-MRS对TIDD和LGG的诊断和鉴别具有重要临床价值。

Objective To investigate the application of 1H-MRS in the differential diagnosis of tumor-like inflammatory demyelinating disease（TIDD） and low grade gliomas （LGG）. Methods 12 patients with TIDD were confirmed by operation, biopsy or followed up on MRI after drug treatment as patient group. 10 patients with LGG were confirmed by operation as control group. All patients were performed with axial T1WI-FLAIR, FSE-T2WI, TEWI-FLAIR and 1H-MRS on 3.0T MR system before operation, biopsy or medication. Results Compared with lateral normal area, Cho/Cr ratio increased, NAA/Cr ratio and NAA/Cho ratio declined in leision area of TIDD group.There were significant difference （p〈0.05）.Compared with lateral normal area, Cho/Cr ratio increased, NAA/ Cr ratio and NAA/Cho ratio declined in leision area of LGG group. There were significant difference （p〈0.05） .There were significant difference in Cho/Cr ratio, NAA/Cho ratio and Lac/Lip peak between TIDD group and LGG group （p〈0.05） ,but there were no statistic difference in NAA/Cr ratio between TIDD group and LGG group （p〉0.05）. Conclusions ^1H-MRS can detect metabolite content of brain tissue without invasion. The Cho/Cr ratio increases, NAA/Cho ratio and Lac/Lip peak decreases in patients with LGG than that in patients with TIDD.1H-MRS has important clinical value in the diagnosis and distinguish of TIDD and LGG.