氢质子MR波谱对脑结核瘤、胶质瘤及脑转移瘤的鉴别诊断价值  

Value of 1H-MR spectroscopy in differentiating diagnosis of intra-axial tuberculo- ma, high-grade glioma, and metastatic brain tumor

作　　者：彭娟[1] 罗天友[1] 吕发金[1] 欧阳羽[1] 方维东[1] 吴景全[1] 

机构地区：[1]重庆医科大学附属第一医院放射科,重庆400016

出　　处：《第三军医大学学报》2009年第12期1213-1216,共4页Journal of Third Military Medical University

基　　金：重庆市教委科学技术研究项目(KJ080303)~~

摘　　要：目的探讨多体素二维氢质子MR波谱(2D protonmagnetic resonance spectroscopy,2D1H-MRS)对脑结核瘤、高级别胶质瘤和脑转移瘤的鉴别诊断价值。方法对16例脑结核瘤、15例高级别胶质瘤和21例脑转移瘤患者术前或接受治疗前行常规MRI和2D1H-MRS检查,1H-MRS采用点分辨表面线圈法(PRESS)序列(TR1000ms,TE144ms)。统计分析3种疾病瘤体实质部分胆碱/肌酸(Cho/Cr)、胆碱/N-乙酰天门冬氨酸(Cho/NAA)、胆碱/对侧相应正常脑实质区肌酸(Cho/Cr-n)比值,记录3种疾病是否有脂质(Lip)或乳酸(Lac)峰出现。结果脑结核瘤、高级别胶质瘤和脑转移瘤瘤体Cho/Cr比值分别为(1.90±0.85)、(3.84±2.23)和(3.78±2.38);Cho/NAA值分别为(1.80±0.95)、(3.94±2.52)和(3.18±2.40);Cho/Cr-n值分别为(0.97±0.11)、(2.71±0.56)和(2.42±0.54)。Cho/Cr、Cho/NAA、Cho/Cr-n比值在3种疾病间两两比较有统计学差异(P<0.05,P<0.01)。3种疾病瘤体Lip和Lac阳性率比较差异无统计学意义(P>0.05)。结论多体素2D1H-MRS结合临床资料对脑结核瘤、高级别胶质瘤和脑转移瘤的鉴别诊断有一定的临床应用价值。Objective To explore the value of multivoxel 2D proton magnetic resonance spectroscopy （1H-MRS） in differentiating diagnosis of intra-axial tuberculoma from high-grade glioma and metastatic brain tumor. Methods The conventional MR imaging and 2-D 1 H-MR were performed in 52 cases （ 16 cases with intra-axial tuberculoma, 15 cases with high-grade glioma, and 21 cases with metastatic brain tumor） before treatment or operation. 1H-MR was performed using PRESS sequence （TR1000 ms, TEl44 ms）. The ratios of Cho/Cr, Cho/NAA, and Cho/Cr-n from the solid part of the mass were calculated and analyzed in the three groups. The presence of lipid or lactate peak was also recorded. Results There was significant difference in the ratio of Cho/Cr in the mass of intra-axial tuberculoma, high-grade glioma, and metastatic brain tumor [ （ 1.90 ± 0.85）, （3.84 ± 2.23 ） and （ 3.78 ± 2.38 ）, respectively, P 〈 0.05 ]. There was also significant difference in the ratio of Cho/NAA in the mass of intra-axial tuberculoma, high-grade glioma, and metastatic brain tumor [ （ 1.80 ± 0.95 ）, （3.94 ± 2.52 ）, and （3. 18 ± 2.40 ）, respectively, P 〈 0.05 ]. Significant difference was also found in the ratio of Cho/Cr-n in the mass of intra-axial tubereuloma, high-grade glioma, and metastatic brain tumor [ （0.97 ±0.11 ）, （2.71 ±0.56）, and （2.42 ±0.54）, respeetively, P 〈0. 01 ]. No significant difference was found in the positive expression of lipid or lactate in the mass of the three groups （P 〉 0. 05）. Conclusion Combined with clinical data, multivoxel 2-D 1H-MRS is quite effective in differen- tiating diagnosis of intra-axial tuberculoma from high-grade glioma and metastatic brain tumor.

关 键 词：结核瘤 脑内 胶质瘤 脑肿瘤 磁共振波谱 

分 类 号：R445.2[医药卫生—影像医学与核医学] R447[医药卫生—诊断学]