1．5T磁共振1H—MRS鉴别良恶性胸腔积液的初步研究

A preliminary study of 1H-MRS in diagnosis of benign and malignant pleural effusions

目的探讨磁共振波谱对良、恶性胸腔积液的鉴别诊断价值。方法收集行胸腔穿刺抽液的胸腔积液标本46例，其中原发病确诊为良性者20例（包括肺结核14例、肺炎6例），原发病确诊为恶性者26例（包括原发性肺癌18例、乳腺癌5例、肝癌2例、胃癌1例）。对胸腔积液标本进行离心处理，然后利用1．5T磁共振对胸腔积液标本进行波谱采集，分析良恶性胸腔积液的波谱特征。结果胸腔积液的波谱图中主要的代谢峰有乳酸、胆碱、肌酸、肌醇及脂质等。主要代谢物波峰下面积比较：乳酸：结核性（5．19±1．31）、炎性（6．08±1．56）和恶性胸腔积液（2．40±0．43）的乳酸峰下面积差异有统计学意义（F=8．45，P〈0．01）；胆碱：结核性（2．75±0．91）、炎性（3．27±1．21）和恶性胸腔积液（6．76±1．73）的胆碱峰下面积差异有统计学意义（F=2．98，P〈0．01）；肌醇：结核性（2．71±1．19j、炎性（2．25±0．81）和恶性胸腔积液（5．83±2．08）的肌醇蜂下面积差异有统计学意义（F=38．49，P〈0．01）。结核性和炎性胸腔积液中乳酸（t=-1．04，P〉0．05）、胆碱（t=-0．58，P〉0．05）和肌醇（t=1．19，P〉0．05）波峰下面积差异无统计学意义。结论良、恶性胸腔积液具有不同的波谱特征，利用磁共振波谱对良、恶性胸腔积液进行鉴别具有一定的临床应用价值。

Objective To investigate the feasibility of magnetic resonance spectroscopy （MRS） in the diagnosis of benign and malignant pleural effusions. Methods Samples of 46 cases of pleural effusion were collected in clinics after perfo：：~ing pleurocentesis. Among the obtained samples, 20 cases were benign pleural effusion（ 14 eases of tuberculosis and 6 cases of pneumonia） and 26 cases were malignant pleural effusion （ 18 cases of primary bronchogenic carcinoma, 5 cases of breast carcinoma, 2 cases of primary hepatic carcinoma, and 1 case of gastric carcinoma）. The effusion pleural samples were centrifuged and subjected to IH MRS examination using a 1.5T MR device. Results The main metabolites in the pleural effusion contain lactate, choline, creatine, myo-inositol（MI）, and fatty acids. Area of Lactate： pleural effusion from tuberculosis （5.19± 1.31）, pneumonia （6.08±1.56） and malignant pleural effusion （2.40±0.43） has statistic significance （F=8.45, P〈0.01）. Area of choline： pleural effusion from tuberculosis （2.75±0.91）, pneumonia （3.27±1.21） and malignant pleural effusion （6.76±1.73） has statistic significance （F=2.98, P〈 0.01）. Area of MI： pleural effusion from tuberculosis （2.71 ±1.19）, pneumonia （2.25 ±0.81） and malignant pleural effusion （5.83±2.08） has statistic significance （F=38.49, P〈0.01）. Area of lactate （t=-1.04, P〉 0.05）, choline （t=-0.58, P〉0.05） and MI （t=1.19, P〉0.05） between pleural effusion from tuberculosis （5.19±1.31 ） and pneumonia has no statistic significance. Conclusions Benign and malignant pleural effusions show different MRS characteristics. 1H MRS has certain clinical value in the differentiation of benign and malignant pleural effusions.