磁共振扩散加权成像与氢质子波谱联合应用对脑内环形强化病变的鉴别诊断  

The value of DWI combined with ^1 H-MRS in the differential diagnosis of ring-enhanced intracerebral lesions

作　　者：阮志兵[1] 范光明[1] 沈金丹[1] 聂红眆 肖润[1] 陈海波[1] 张飘尘[1] 

机构地区：[1]贵阳医学院附属医院影像科,贵阳550004

出　　处：《放射学实践》2012年第12期1298-1303,共6页Radiologic Practice

摘　　要：目的:探讨磁共振扩散加权成像(DWI)与氢质子磁共振波谱(1 H-MRS)联合应用对常见脑内环形强化病变的鉴别诊断价值。方法:回顾性分析经手术病理证实或临床随访证实43例脑内环形强化病变的常规MRI图像、DWI信号特点、ADC值和多体素1 H-MRS波谱信息,比较DWI上信号特点、ADC值及1 H-MRS上AA峰、Cho峰、NAA峰、Cho/Cr、NAA/Cr、Cho/NAA的差别,并做统计学分析。结果:①DWI上12例脑脓肿(BA)患者9例(9/12)呈不同程度的高信号,ADC图呈低信号,1例(1/12)呈低信号,ADC图呈高信号,2例(2/12)呈混杂信号,平均ADC值为(0.521±0.183)×10-3 mm2/s;31例脑内囊性肿瘤(BCT)患者,28例(28/31)DWI上呈低信号,ADC图呈高信号,2例(2/31)呈混杂信号,1例(1/31)呈高信号,平均ADC值为(2.811±0.264)×10-3 mm2/s;BA与BCT的平均ADC值比较差异有统计学意义(P<0.01)。②1 H-MRS上12例BA内部出现特征性AA峰,脓肿壁Cho和NAA低于对侧,差异有统计学意义(P均<0.05),Cho/Cr、NAA/Cr、Cho/NAA差异无显著性意义(P均>0.05);31例BCT内均无AA峰,肿瘤壁Cho、Cho/Cr及Cho/NAA均较对侧正常组织明显升高,Cr及NAA较正常对照处明显减低,差异有显著性(P均<0.01)。结论:在常规MRI检查基础上,综合应用多体素1 H-MRS及DWI能对BA和BCT的鉴别诊断及判断肿瘤对肿瘤周围侵犯情况提供更多有价值的信息,是常规MRI检查序列的重要补充,能进一步提高MRI诊断准确率及临床指导作用。Objective：To investigate the value of diffusion weighted imaging （DWI） combined with proton magnetic resonance spectroscopy （^1H-MRS） in the differential diagnosis of conventional ring-enhanced intracranial lesions （brain ab- scess,BA） and （brain cystic tumor, BCT）. Methods ： Conventional MRI, DWI, ADC and ^1H-MRS manifestations were ana- lyzed retrospectively in 43 patients with ring-enhanced intracranial lesions confirmed by clinical or histopathology findings. Results：①On DWI,9 cases （9/12） of brain abscess showed hyper-intensity,1 case （1/12） hypo-intensity and 2 cases （2/ 12） mixed-intensity, the average ADC value being （0. 521 ±0. 183）×10^-3 mm2/s. Among 31 patients with brain cystic tumors,28 cases （28/31） showed hyper-intensity,1 case （1/31） hypo-intensity and 2 cases （2/31） mixed-intensity,the av- erage ADC value being （2. 811± 0. 264） ×10^-3 mm2/slthe average ADC value of BA and BCT had statistical significance （P〈0.01）. ②On 1 H-MRS, 12 cases with brain abscess showed AA peak, Cho and NAA of wall of abscess were significant- ly lower than those of normal control tissues （P〈0.05） ,but Cho/Cr,NAA/Cr and Cho/NAA showed no significant differ- ence （P〈0.05）. In all patients （31/31） with brain cystic tumors no AA peak was observed in the tumor. Cho and NAA of wall of tumor were significantly higher than those of normal control tissues （P〈0.01）. Conclusion：DWI combined with 1 H- MRS contributes to an accurate differential diagnosis of brain abscess and brain cystic tumor and contributes to an accurate evaluation of tumor encroaching extent, being an important supplement to the conventional MRI sequence. In short,it can improve the MRI diagnostic accuracy and clinical effects.

关 键 词：脑脓肿 脑肿瘤 磁共振成像 扩散加权成像 氢质子磁共振波谱 

分 类 号：R445.2[医药卫生—影像医学与核医学] R742[医药卫生—诊断学]