氢质子磁共振波谱对脑低级别胶质瘤与病毒性脑炎的鉴别诊断价值

Differential diagnostic value of Hydrogen proton magnetic resonance spectroscopy on brain low-grade glioma and viral encephalitis

目的探讨氢质子磁共振波谱(1H-MRS)对病毒性脑炎和脑低级别胶质瘤的鉴别诊断价值。方法使用飞利浦3.0 T MR系统对低级别胶质瘤(胶质瘤组)20例,病毒性脑炎(脑炎组)25例进行常规MRI平扫和增强扫描,所有病例均在病灶区及相应正常脑实质区设置感兴趣区进行1H-MRS成像。利用Function Tool软件对波谱数据进行分析,分别检测病灶侧和对侧相应正常脑区MRS的N-乙酰天门冬氨酸(NAA)、肌酸(Cr)、胆碱(Cho)值,并进行比较。结果两组正常侧与相应部位病灶侧的Cho/Cr、Cho/NAA、NAA/Cho、NAA/Cr比较差异有统计学意义(均P<0.01)。两组间病灶侧Cho/Cr、Cho/NAA、NAA/Cho比较差异有统计学意义(均P<0.01)。两组间正常侧Cho/Cr、Cho/NAA、NAA/Cho、NAA/Cr比较差异无统计学意义(均P>0.05)。Cho/Cr的ROC曲线下面积为0.926,其中Cho/Cr取界值为2.46时,鉴别脑低级别胶质瘤与病毒性脑炎的灵敏度为91.7%,特异度为88.9%。结论1H-MRS对病毒性脑炎和脑低级别胶质瘤的鉴别诊断有重要临床价值,其中以Cho/Cr比值鉴别二者的参考价值最大。

Objective To explore the differential diagnostic value of Hydrogen proton magnetic resonance spectroscopy（1H-MRS） on brain low-grade glioma and viral encephalitis. Methods Twenty patients with brain lowgrade gliomas（ gliomas group） and 25 patients with viral encephalitis（ encephalitis group） were given conventional MRI scan and enhanced scan by Philips 3. 0 T MR system. All cases were set interested area in lesion site and normal by single vovel proton spectroscopic imaging. The spectral data was analyzed by Function Tool software,ipsilateral and contralateral normal brain MRS of N-acetyl aspartate（ NAA）,creatine（ Cr）,choline（ Cho） value were detected and compared. Results The differences of Cho / Cr,Cho / NAA,NAA / Cho,NAA / Cr between the normal side and the corresponding lesion side of the two groups were statistical significant（ all P 0. 01）. The differences of Cho / Cr,Cho / NAA,NAA / Cho of the lesion side between the two groups were statistical significant（ all P 0. 01）. The differences of Cho / Cr,Cho / NAA,NAA / Cho,NAA / Cr of the normal side between the two groups were no statistical significant（ all P 0. 05）. The area under the ROC curve of Cho / Cr was 0. 926; when Cho / Cr take the cutoff as2. 46,the sensitivity of identification between brain low-grade glioma and viral encephalitis was 91. 7%,and the specificity was 88. 9%. Conclusions1H-MRS has important clinical value for differential diagnosis of brain lowgrade gliomas and viral encephalitis. The ratio of Cho / Cr on identify the two disease has the largest reference value.