~1H-MRS在颅脑常见肿瘤诊断中的临床应用研究

Clinical Study of ~1H-MRS in the Diagnosis of Cerebral Neoplasms

目的评估氢质子磁共振波谱(~1H-MRS)在颅脑常见肿瘤诊断及鉴别诊断中的应用价值。方法分析经手术病理证实的61例颅内高级别胶质瘤、转移瘤及脑膜瘤三组病例~1H-MRS特点,并测量所有病例的瘤核心、瘤周水肿区、对侧正常脑白质感兴趣区的胆碱(Cho)、乙酰天门冬氨酸(NAA)、肌酸(Cr)代谢产物的峰值,计算Cho/NAA、Cho/Cr、NAA/Cr三种参数的比值,分别比较三组病例各参数之间的差异。结果三类肿瘤瘤核心及胶质瘤瘤旁水肿Cho/Cr、Cho/NAA均大于对侧正常脑白质(P<0.01),NAA/Cr均小于对侧正常脑白质(P<0.01),脑膜瘤瘤核心NAA/Cr比胶质瘤、转移瘤明显减低(P<0.01),Cho/NAA比胶质瘤、转移瘤明显增高(P<0.01);胶质瘤瘤旁区Cho/Cr、Cho/NAA比脑膜瘤、转移瘤明显增高(P<0.01),NAA/Cr比脑膜瘤、转移瘤明显减低(P<0.01)。结论作为常规MRI的有力补充,瘤核心及瘤周水肿区的~1H-MRS对颅内胶质瘤、脑膜瘤及转移瘤的诊断及鉴别诊断具有积极的临床意义。

Objective To explore the value of 1H-MRS in the diagnosis and differential diagnosis of different intracranial neoplasms. Methods MRI and 1H-MRS was performed in 61 patients confirmed to be high grade glioma, meningioma and solitary metastases. For each case, the NAA, Cr and Cho was measured in enhanced region, peritumoral region and contralateral normal-appearing white matter （CNAWM）, the Cho/NAA, Cho/Cr, NAA/Cr was calculated and compared among three ROIs respectively. Results Compare＇ to the normal region, the Cho/Cr, Cho/NAA in enhanced region of three lesions and peritumoral ofglioma were higher （P〈0.01）, NAA/Cr were lower （P〈0.01）. In enhanced region, NAA/Cr in meningioma was lower than glioma and metastases （P〈0.01） and Cho/NAA was higher than them （P〈0.01）. In peritumoral region, Cho/Cr, Cho/NAA in glioma were higher than meningioma and metastases（P〈0.01） and NAA/Cr was lower than them（P〈0.01）. Conclusion As a supplement of routine MRI, 1H-MRS plays an important role in the differential diagnosis of different intracranial neoplasms.