氢质子磁共振波谱诊断60例脑胶质瘤  

Clinical applications of 1H-MRS in 60 patients with gliomas

作　　者：王丽君[1] 徐克[1] 郎志谨[2] 

机构地区：[1]中国医科大学附属第一医院放射科,辽宁沈阳110001 [2]大连医科大学附属第一医院放射科,辽宁大连116011

出　　处：《中国医学影像技术》2008年第10期1565-1568,共4页Chinese Journal of Medical Imaging Technology

摘　　要：目的观察脑星形细胞瘤肿瘤实质^1H-MRS与病理级别的相关性和与含少枝胶质细胞的胶质瘤的^1H-MRS鉴别诊断,以及高级别胶质瘤实质内不同强化成分的^1H-MRS特点。方法对经手术病理证实的星形细胞瘤组50例和少枝胶质细胞瘤或少枝星形细胞瘤组10例行二维多体素^1H-MRS扫描,并与20例健康志愿者对照进行半定量分析,记录Cho/ Cr、Cho/NAA最高值和NAA/Cr最低值。同时对强化不均匀高级别胶质瘤的显著强化和轻度强化区测定胆碱/正常区胆碱（Cho/nCho）、肌酸/正常区肌酸（Cr/nCr）和氮-乙酰天门冬氨酸/正常区氮-乙酰天门冬氨酸（NAA/nNAA）。统计学检验采用单因素方差和配对t检验。结果所有胶质瘤都表现为Cho峰升高和NAA的降低。单因素方差分析显示星形细胞瘤组Cho/Cr、Cho/NAA、NAA/Cr的组间差异显著（P〈0.001）,但Ⅲ、Ⅳ级星形细胞瘤间无显著差异（P〉0.05）。少枝胶质细胞瘤组比同级别星形细胞瘤组Cho/Cr和Cho/NAA更高（P〈0.05）,而NAA/Cr差异没有统计学意义（P〉0.05）。胶质瘤实质轻度或无强化区的Cho/nCho、Cr/nCr和NAA/nNAA高于显著强化区（P〈0.05）。结论^1H-MRS能有效判定星形细胞瘤级别,区分星形细胞瘤与含少枝细胞的胶质瘤。对高级别胶质瘤中轻度强化或无强化肿瘤实质的组织学检查可能为判断肿瘤级别提供有价值的信息。Objective To evaluate proton magnetic resonance spectrosepic imaging （^1 H-MRS） for grading of astrocytomas and for differentiation from oligodendrocytomas and oligoastrocytomas, and to observe the ^1H-MRS characters of different enhanced area of high grade gliomas. Methods Sixty patients of brain gliomas proved by pathology and 20 control subjects underwent proton MR spectroscopy. Patients with gliomas were divided into astrocytoma group （n=50） and oligodendroglioma group （n= 10）. Semiquantitively metabolite concentration rations for Cho/Cr, Cho/NAA and NAA/Cr were calculated using a user independent spectral fit program. The metabolite concentration rations for Cho/contra lateral Cho （Cho/nCho）, Cr/nCr and NAA/nNAA were calculated in the strongly, slightly enhanced and non enhanced parts in the high grade glioma. ANOVA and two sided paired Student t tests were used to test for statistical significance. Results Increased Cho and NAA was found in all the gliomas. The ratios of Cho/Cr, Cho/NAA and NAA/Cr showed a distinct difference （P〈0. 001） between the different grade of astroeytomas, but not between Ⅲ and Ⅳ grade astrocytomas （P〉0. 05）. The oligoastroeytoma or oligodendroglioma showed higher Cho/Cr and Cho/NAA （P〈0.05）. The slightly enhanced or non-enhanced areas of high grade glilma showed higher Cho/nCho, Cr/nCr and NAA/nNAA than the most obvious enhanced areas （P〈0.05）. Conclusion Proton MR spectroscopic imaging allows preoperative grading of gliomas and discrimination of the two most common kinds of gliomas. Pathological examination of slightly enhanced or non-enhanced areas of glioma may be helpful for tumor grading.

关 键 词：磁共振成像 胶质瘤 星形细胞瘤 少枝胶质细胞瘤 

分 类 号：R730.264[医药卫生—肿瘤] R445.2[医药卫生—临床医学]