高级别胶质瘤与单发转移瘤的增强后多体素1H—MRS鉴别  

Differential diagnosis between high grade gliomas and solitary metastases with post-contrast multivoxel 1H-MRS

作　　者：王廷昱[1] 史克珊[1] 梁其州[1] 廖海燕[1] 韩向君[1] 

机构地区：[1]海口市人民医院及中南大学湘雅医学院附属海口医院,海南海口570208

出　　处：《中国临床医学影像杂志》2008年第12期842-845,854,共5页Journal of China Clinic Medical Imaging

基　　金：海南省自然科学基金指导性计划项目(80576)

摘　　要：目的:通过增强后多体素1H-MRS研究肿瘤强化区、强化边缘区的细胞代谢,探讨1H-MRS对高级别胶质瘤和单发转移瘤的鉴别诊断价值。资料与方法:27例颅内肿瘤患者,包括高级别胶质瘤(WHOⅢ～IV级)12例,单发转移瘤15例,行常规MRI和增强后多体素1H-MRS检查。10例年龄匹配的健康志愿者作对比。比较高级别胶质瘤和单发转移瘤强化区及强化边缘区胆碱/肌酸(Cho/Cr),N-乙酰天门冬氨酸/胆碱(NAA/Cho)、N-乙酰天门冬氨酸/对侧正常脑组织肌酸(NAA/Cr-n)比值,并进行比较分析。结果:增强后多体素1H-MRS提示高级别胶质瘤和单发转移瘤强化区均出现NAA/Cho和NAA/Cr-n降低,Cho/Cr升高,两种肿瘤强化区各项比值之间的比较,差异除NAA/Cho(P<0.05)外均无统计学意义(P>0.05)。各个高级别胶质瘤和单发转移瘤强化边缘区之间Cho/Cr比值分别为1.642±0.24和0.862±0.41,NAA/Cho比值分别为0.462±0.32和2.512±1.58,NAA/Cr-n比值分别为0.436±0.22和0.725±0.27,差异均有显著统计学意义(P<0.01)。结论:使用增强后多体素1H-MRS结合常规MRI,有助于提高对高级别胶质瘤和单发转移瘤的鉴别能力。Objective： To discuss post-contrast multivoxel 1H-MRS can be used to differentiate high grade gliomas and solitary metastases on the basis of the differences in metabolite levels in enhancing region and peritumoral region. Materials and Methods： Twenty-seven patients with brain tumor [12 high-grade gliomas （WHO Ⅲ-Ⅳ） and 15 solitary metastases] was performed with conventional MRI and post-contrast multivoxel 1H-MRS. Ten age-matched healthy volunteers underwent postcontrast IH-MRS for comparison. The Cho/Cr, NAA/Cho, NAA/Cr-n value of enhancing region and peritumoral region were compared respectively between gliomas and metastases. The results were analyzed statistically. Results： All the enhancing regions of the two kinds of tumor were characterized by reduced NAA/Cho, NAMCr-n and increased Cho/Cr, which had no sig- nificant difference （P〉0.05） except NAA/Cho （P〈0.05）. The Cho/Cr in peritumoral region of the gliomas and metastases was 1.642±0.24 and 0.862±0.41 respectively; the NAA/Cho was 0.462±0.32 and 2.512±1.58 respectively; the NAA/Cr-n was 0.436±0.22 and 0.725±0.27 respectively. All ratios had significant difference（P〈0.01）. Conclusion： Combining with conventional MRI scan, post-contrast multivoxel 1H-MRS can improve the differential diagnostic ability between high grade gliomas and solitary metastases.

关 键 词：肿瘤 神经上皮 肿瘤转移 磁共振波谱学 

分 类 号：R739.41[医药卫生—肿瘤] R445.2[医药卫生—临床医学]