MR氢质子波谱成像在神经上皮组织肿瘤分级中的应用  

The clinical application of ^1H-MR spectroscopy in grading tumors of the neuroepithelial tissue

作　　者：刘玥[1] 孙波[1] 高培毅[1] 李少武[1] 戴建平[1] 

机构地区：[1]首都医科大学附属北京天坛医院神经影像中心

出　　处：《中华放射学杂志》2007年第3期227-231,共5页Chinese Journal of Radiology

摘　　要：目的研究MR氢质子波谱（^1H-MRS）成像在神经上皮组织肿瘤分级中的价值。方法52例颅内神经上皮组织肿瘤患者，低级别29例，高级别23例，均行MRI及^1H-MRS检查。结果52例中，Ⅱ级9例，Ⅲ级11例，Ⅳ级12例，将Ⅱ级列为低级别组，Ⅲ级、Ⅳ级为高级别组，脂质（Lip）[乳酸（Lac）]／肌酸（Cr）、Lip（Lac）／N-乙酰天门冬氨酸（NAA）、Lip（Lac）／胆碱化合物（Cho），Lip（Lac）在组间差异有统计学意义，低级别组各代谢物比值中位数分别为0．14、0．16、0．09、0．32，高级别组各代谢物中位数分别为1．64、1．24、0．87、1．68。Lip（Lac）／Cr≤0．425为低级别肿瘤，Lip（1ac）／Cr＞0．425为高级别肿瘤，诊断敏感度、特异度、阳性予测值、阴性预测值分别为87．0％、96．6％、95.2％、90．3％。常规MR图像诊断肿瘤级别敏感度、特异度、阳性予测值、阴性预测值分别为87．0％、82．8％、80．0％、88．9％。结论^1H-MRS在神经上皮组织肿瘤分级中有一定的价值，常规MR图像结合MRS可明显提高诊断准确率。Objective To evaluate the clinical application of ^1H magnetic resonance spectroscopy （^1H-MRS） by analyzing the metabolic state in grading tumors of the neuroepithelial tissue. Methods A total of 52 patients （34 male, 18 female, age from 16 to 56 years with mean age of 39 years ） were investigated by combined MRI/MRS on a 3.0 T scanner and confirmed to be tumors of neuroepithelial tissue （glioma） by postoperative pathology. Tumors were classified by WHO classification standard. Axial Tt-weighted and T2-weighted images were obtained, then multivoxel MRS was performed by using pointresolved spectroscopy （PRESS） with TR/TE = 2000/144 ms. Finally, contrast axial T1-weighted IR sequence was performed with TR/TE/TI = 2400/24/860 ms. Quantitative analysis was performed on variations of brain metabolites by MR imaging, anatomic images and metabolic images by Functool software （Version 4.0）. Results Fifty-two patients included 29 grade Ⅱ （13 astrocytoma, 7 oligodendroglioma, 9 oligoastrocytoma）, 11 grade Ⅲ （7 anaplastic astrocytoma, 2 anaplastic oligodendroglioma, 2 anaplastic oligoastrocytoma）, and 12 grade Ⅳ （11 glioblastoma, 1 gliosarcoma） tumors. The degree of tumor malignancy could be evaluated by ^1 H-MRS. The grade Ⅱ tumors were sorted to low-grade group and grade Ⅲ and Ⅳ were classified as high-grade group, and there was great difference between low-grage and highgrade group for the ratios of Lip（ Lac）/Cr, Lip（ Lac）/NAA, Lip（ Lac）/Cho, and Lip（Lac）. Median of those ratios was 0. 14, 0. 16, 0. 09, and 0. 32 in low-grade group, and 1.64, 1.24, 0. 87, and 1.68 in high-grade group, respectively. Statistical analysis demonstrated a threshold values of 0. 425 for Lip （Lac）/Cr to provide sensitivity, specificity, positive predictive value （PPV）, and negative predictive value （NPV） of 87.0%, 96.6%, 95.2%, and 90. 3%, respectively. Sensitivity, specificity, PPV, and NPV for grading glioma with conventional MR imaging were 87.0%, 82. 8%, 80.0%, and 88.

关 键 词：肿瘤 神经上皮 磁共振波谱学 病理学 

分 类 号：R739.4[医药卫生—肿瘤]