肿瘤周围的1 H-M RS 在常见颅脑肿瘤鉴别诊断中的价值

Study of 3T 1 HMR spectroscopy of peritumoral area in intracranial neoplasm

目的：探讨肿瘤周围的多体素氢质子磁共振波谱（1 H‐MRS）在脑星形细胞瘤、脑转移瘤等颅内常见肿瘤中的诊断及鉴别诊断价值。方法收集本院经手术、活检病理证实的颅脑肿瘤患者66例。其中低级别星形细胞瘤（Ⅰ～Ⅱ级）19例，高级别星形细胞瘤（Ⅲ～Ⅳ级）17例；脑转移瘤30例。采用美国 GE 公司3．0T MRI 扫描仪对所有患者行颅脑常规 MRI 及1 H‐MRS 检查。检测、计算、分析肿瘤周围及健侧相应区域的生化代谢物及其比值，包括 Cho／ Cr 、Cho／NAA 、NAA ／Cr 及 MI ，同时进行加以比较对照。结果高级别星形细胞瘤的瘤周水肿区 Cho／Cr 比值明显高于低级别星形细胞瘤、脑转移瘤（ P ＜0．05）；其 Cho／NAA 比值明显高于低级别星形细胞瘤及脑转移瘤（ P ＜0．05）。低级别星形细胞瘤瘤周 NAA／Cr 比值明显高于高级别星形细胞瘤（ P ＜0．05）。低级别星形细胞瘤与脑转移瘤比较各代谢物比值均无统计学意义。 MI 值各肿瘤间比较无统计学意义。结论肿瘤周围的 Cho／Cr 、Cho／NAA 比值对脑内低级别及高级别星形细胞瘤、脑转移瘤等的诊断及鉴别诊断具有较高的临床应用价值。

Objective To evaluate the clinical value of MR spectroscopy of peritumoral area in intracranial neoplasm （the brain astrocytomas ,metastatic tumors of the brain） .Methods Sixty‐six cases with brain neoplasm were collected from the Affiliated Hospital of Qingdao University .All the patients ,who were confirmed by pathology ,underwent proton MR Spectroscopy before stereotactic biopsy ,or operation .Results The Cho/Cr ratio of peritumoral area in high‐grade astro‐cytoma was significantly higher than that in low grade astrocytoma and brain metastatic tumors （ P ＆lt; 0 .05） ,and the Cho/NAA ratio was significantly higher than that of low‐grade astrocytic tumor and brain metastases （ P ＆lt; 0 .05） .The NAA/Cr ratio of peritumoral area in peritumoral NAA/Cr ratio was significantly higher than that in high‐grade astrocytoma （ P＆lt; 0.05） .The peritumoral metabolite ratios between low grade astrocytoma and brain metastases were not statistically sig‐nificant difference .The value of MI showed no statistical significant different between the four tumors .Conclusion MR spectroscopy of peritumoral area has significant value in detecting and differentiating brain tumors （such as the low grade astrocytoma ,high‐grade astrocytoma and metastatic tumors of the brain etc .） .