质子MR波谱脂质峰升高在颅内疾病鉴别诊断的价值  

Elevated Lip signals on 1H-MR spectroscopy in differential diagnosis of intracranial lesions

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,400016

出　　处：《磁共振成像》2011年第1期50-54,共5页Chinese Journal of Magnetic Resonance Imaging

基　　金：重庆市科技攻关计划项目(编号:CSTC2009AC5146);重庆市卫生局医学科学技术研究项目(编号:2009-2-358)资助

摘　　要：目的探讨质子MR波谱(1H-MRS)脂质(Lip)峰升高在颅内疾病诊断和鉴别诊断中的临床应用价值。方法 125例患者,包括脑膜瘤20例、低级胶质瘤19例、高级胶质瘤15例、脑转移瘤21例、淋巴瘤4例、生殖细胞瘤3例、畸胎瘤2例、脑结核瘤26例、脑脓肿15例,在手术或接受其他治疗前行常规MRI及多体素2D1H-MRS检查,后者采用点分辨选择波谱(PRESS:TR1000ms,TE144ms)。测量上述病灶胆碱(Cho)、肌酸(Cr)、N-乙酰天门冬氨酸(NAA)浓度,并观察Lip峰出现情况,比较Cho/Cr、Cho/NAA以及Lip峰阳性率有无差异。结果几种疾病Lip峰阳性率比较差异有统计学意义(P<0.01)。淋巴瘤、生殖细胞瘤、畸胎瘤Lip峰阳性率最高,其次是高级胶质瘤、脑转移瘤、脑结核瘤和脑脓肿,低级胶质瘤与脑膜瘤Lip峰阳性率最低。良性病变组、低度恶性脑肿瘤组及高度恶性脑肿瘤组Cho/Cr、Cho/NAA各组差异有统计学意义(Cho/Cr分别为1.92±0.75、2.30±0.86、3.88±2.08,P<0.01;Cho/NAA分别为1.80±0.92、2.21±0.14、3.75±2.02,P<0.05),高度恶性脑肿瘤组的Cho/Cr、Cho/NAA最高,良性病变组最低,良性病变组与低度恶性脑肿瘤组之间未见统计学差异。结论 Lip峰升高反映了不同的病理变化,Lip峰结合Cho峰及常规MRI对颅内疾病的诊断和鉴别诊断具有重要临床应用价值。Objective：To investigate the clinical value of elevated Lip signals on proton MR spectroscopy（^1H-MRS） in the differential diagnosis of intracranial lesions.Materials and Methods：125 patients with intracranial lesions were examined by conventional MR imaging and multivoxel 2D ^1H-MRS before treatments or operations,including meningiomas（n=20）,low-grade gliomas（n=19）,high-grade gliomas（n=15）,metastases（n=21）,lymphomas（n=4）,germinomas（n=3）,teratomas（n=2）,intraaxial tuberculomas（n=26）,and brain abscesses（n=15）.^1H-MRS was performed using PRESS sequence（TR 1000 ms,TE 144 ms）.Concentrations of choline（Cho）,creatine（Cr）,and N-acetylaspartate（NAA） in the lesions were expressed as metabolite ratios.The ratios of Cho/Cr,Cho/NAA and positive ratio of Lip from the solid part of the lesions were calculated and analyzed.Results：There was significant difference on the positive ratios of lipid among the lesions（P〈0.01）.The positive ratios of lipid in lymphomas,germinomas,and teratomas were the highest and those of the low-grade gliomas and meningiomas were the lowest.Significant difference was also found on the ratios of Cho/Cr and Cho/NAA among the benign lesions,low-grade malignancy and high-grade malignancy（Cho/Cr were 1.92±0.75,2.30±0.86,and 3.88±2.08 respectively,P〈0.01;Cho/NAA were 1.80±0.92,2.21±0.14,and 3.75±2.02 respectively,P〈0.05）.The ratios of Cho/Cr and Cho/NAA of high-grade malignancy were the highest and those of benign lesions were the lowest.There was no significant difference on the ratios of Cho/Cr and Cho/NAA between the benign lesions and low-grade malignancy.Conclusion：Elevated Lip signals reveal different pathological characteristics.Lip combined with Cho/Cr,Cho/NAA and conventional MR imaging plays an important role in the differential diagnosis of intracranial lesions.

关 键 词：脑肿瘤 脑结核瘤 脑脓肿 磁共振波谱 

分 类 号：R445.2[医药卫生—影像医学与核医学] R739.41[医药卫生—诊断学]