磁共振新技术在脑泡型包虫病诊断和边界界定中的应用——脑泡型包虫病边缘带^1H—MRS和DWI定量指标相关性研究

The correlation study of ^1H-MRS and DWI quantitative index in the marginal zone of cerebral alveolar echinococcosis

脑泡型包虫病（Cerebral alveolar echinococcosis,CAE）像恶性肿瘤样呈浸润性生长,肿块周边的小泡球蚴生存繁衍扩展,并向周围组织呈蟹爪样蔓延,对人体危害极大。由于CAE临床表现特异性不大,部分病例影像特征不典型,包虫病免疫学检查存在假阴性和假阳性现象,所以该病术前误诊率较高。而且常规影像学不能很好地显示病灶的实际范围,导致手术范围不准确。CAE的诊断问题及浸润带界定不准确的问题直接关系着患者的手术成败,是临床亟待解决的两大难题。本研究利用磁共振扩散成像、磁共振灌注成像、磁共振质子波谱成像等磁共振新技术，对脑泡状棘球蚴病患者的感兴趣区（包括脑泡状棘球蚴病灶主体和周围浸润带）进行研究，与可获得的病理标本进行对照研究，对脑泡状棘球蚴病进行诊断与鉴别诊断，并且进一步界定病灶的边界，为外科制定合理的手术方案、精准定位提供客观的、有价值的影像信息。在包虫痛高发的新疆地区具有重要的现实意义和良好的应用前景。

Objective To explore the correlation of ^1 H-MRS main compound concentration ratio and quantitative indicators of DWI-brain apparent diffusion coefficient （ADC value） in the marginal zone of cerebral alveolar echinococcosis. Methods Collected 11 cases （23 lesions） diagnosed as cerebral alveolar echinococcosis during July, 2009-March, 2013 in our hospital, applied 3.0T superconductive MRI apparatus to conduct whole brain conventional MR scan, enhanced scan, multi-voxel ^1 H-MRS and DWI checks, DWI gradient sensitive factor b value were chosen 1 000 s/mm^2. Multi voxel ^1 H-MRS Cho/Cr, NAA/Cho, NAA/Cr, Lip/Cr ratios and corresponding ROI ADC value in CAE lesion parenchyma zone, marginal zone （beside the enhanced border within 10 mm range）, control zone were measured. Correlating analysis of ^1H-MRS compound concentration ratio and ADC value was proceeded. Results ADC value and NAA/ Cho, NAA/Cr ratios in the marginal zone of cerebral alveolar echinococcosis lesion were negatively correlated （r =-0.89, - 0.71 respectively）, and Cho/Cr, Lip/Cr ratio was positively correlated （r = 0.73, 0.81, respectively）. Conclusion DWI and ^1 H-MRS in combination, could not only contribute to guide cerebral alveolar echinococcosis surgery, but also provide valuable information for further study of its biological behavior.