3D-ASL结合~1H-MRS在常见脑肿瘤术前诊断中的临床应用研究

Study on clinical application of 3D-ASL combined with ~1H-MRS in the preoperative diagnosis of common brain tumors

目的探讨三维动脉自旋标记(3D arterial spin labeling,3D-ASL)结合氢质子磁共振波谱(~1H magnetic resonance spectroscopy,~1H-MRS)成像在颅脑常见肿瘤诊断中的临床应用价值。方法选择经术后病理证实的35例肿瘤病例(其中13例胶质瘤,12例脑膜瘤,10例转移瘤),测量肿瘤在3D-ASL血流灌注图中最大肿瘤血流量(tumor blood flow,TBF)与对侧正常脑白质、脑灰质、肿瘤镜像区脑血流量(brain tumor flow,CBF),同时测量波谱图肿瘤瘤核心及对侧正常脑实质感兴趣区的胆碱(Cho)、N-乙酰天门冬氨酸(NAA)、肌酸(Cr)峰值及其比值,结合术后病理诊断进行分析。结果高级别胶质瘤与脑膜瘤、转移瘤灌注值差异无统计学意义(P>0.05),低级别胶质瘤与其他肿瘤灌注值差异有统计学意义(P<0.01);~1H-MRS波谱图显示胶质瘤、转移瘤瘤核心、瘤周及脑膜瘤瘤核心的Cho/Cr、NAA/Cr、Cho/NAA代谢物比值大于正常脑实质,脑膜瘤瘤核心Cho/NAA代谢物比值大于其他两种肿瘤,胶质瘤瘤周代谢物比值大于其他两种肿瘤。结论 3D-ASL与~1H-MRS均可作为常规磁共振成像(magnetic resonance imaging,MRI)的重要补充,两者结合使用对颅脑常见肿瘤的诊断及鉴别诊断有积极临床应用参考价值。

Objective To explore the clinical value of3D arterial spin labeling(3D-ASL)combined with1H magnetic resonance spectroscopy(1H-MRS)in the diagnosis of common brain tumors.Methods35cases of tumors confirmed by postoperative pathology(13cases of glioma,12cases of meningioma,and10cases of metastatic tumor)were selected.Tumor blood flow(TBF)in3D-ASL perfusion images and cerebral blood flow(CBF)in contralateral normal white matter,gray matter and tumor mirror area were measured.At the same time,cholinergic(Cho),N-acetylated aspartate(NAA),creatine(Cr)peak and their ratios in the region of interest of the tumor and the normal brain parenchyma on the contralateral side were measured.Combined with postoperative pathological diagnosis,the above-mentioned situations were analyzed.Results There was no statistically significant difference in the perfusion value of high grade glioma with meningioma and metastatic tumor(P>0.05),while there was statistically significant difference between low grade glioma and other tumor perfusion values(P<0.01).1H-MRS spectroscopy showed that the ratio of Cho/Cr,NAA/Cr and Cho/NAA metabolites in the cores and peritumoral areas of glioma,metastatic tumor and meningioma was greater than that of the normal brain parenchyma,the ratio of Cho/NAA metabolites in the core of meningiomas was significantly greater than that of the other two tumors,and the ratio of metabolites in peritumoral area of gliomas was greater than that of the other two tumors.Conclusion3D-ASL and1H-MRS can be used as an important supplement to conventional magnetic resonance imaging(MRI).The combination of both of them can be used as reference for the diagnosis and differential diagnosis of common brain tumors.