长TE ~1H-MRS在颅内不典型淋巴瘤与瘤样脱髓鞘病变鉴别中的作用  

The Role of Long TE ~1H-MRS Differentiating Intracranial Atypical Lymphoma from Tumefactive Demyelinating Lesions

作　　者：陈兵[1] 石洋洋 李辉[3] 李春花[2] 李斌[2] 蓝海菲 万亚平[2] 朱凯[1] 马文东[1] 

机构地区：[1]宁夏医科大学总医院放射科,银川750004 [2]宁夏医科大学,银川在读研究生750004 [3]宁夏医科大学总医院心脑血管病医学放射科,银川750004

出　　处：《临床放射学杂志》2015年第7期1040-1044,共5页Journal of Clinical Radiology

基　　金：2009年度宁夏自然科学基金项目(编号:NZ09220);2011年度宁夏自然科学基金项目(编号:NZ11270)

摘　　要：目的探讨氢质子磁共振波谱(1H-MRS)成像技术在颅内不典型淋巴瘤与瘤样脱髓鞘病变(TDLs)中的鉴别诊断价值。方法搜集经病理确诊的37例颅内淋巴瘤和19例临床或立体定位活检确诊TDLs的完整影像学资料。使用单体素点分辩波谱(PRESS)序列扫描1H-MRS(TE=144 ms),计算Cho/Cr比值和Cho/NAA比值,目视估测Lip-Lac峰与肌酸(Cr)峰的高度比,分成5个等级。比较颅内淋巴瘤与TDLs的1H-MRS分析结果。使用受试者工作特征曲线(ROC)对Cho/Cr、Cho/NAA及Lip-Lac在两种疾病的鉴别诊断效能进行评价。结果颅内不典型淋巴瘤和TDLs的Cho/Cr、Cho/NAA比值及Lip-Lac峰的等级存在显著性差异。Cho/Cr比值>2.39,Cho/NAA比值>1.73及Lip-Lac峰等级>3级时提示为颅内淋巴瘤。Cho/NAA比值对两种疾病鉴别诊断效能最高,曲线下面积(AUC)值为0.883。结论长TE1H-MRS对颅内不典型淋巴瘤和TDLs的鉴别有很大的临床价值,特别是增加Cho/NAA比值是常规MRI的有益补充。Objective This study is aimed to investigate the 1H-MRS to differentiate Intracranial Atypical Lymphoma from tumefactive demyelinating lesions. Methods Collection of 37 cases of pathologically confirmed intracranial lympho- ma and 19 cases of clinically or stereotactic biopsy tumefactive demyelinating lesions of the imaging data was done. Retro- spective analysis Single voxel （TE = 144 ms） ^1H-MRS scans with the use of the point resolved spectroscopy sequence. The Cho/Cr and Cho/NAA area ratios were calculated. The lipid and lactate peak was visually categorized into 5 grades on the basis of comparison with the height of the Cr peak. To Compare the intracranial lymphoma and the tumefactive demyelinating lesions with ill-MRS findings, ROC curves was used to evaluate the diagnostic efficiency of Cho/Cr,Cho/NAA and Lip lac peak level in differential diagnosis of intracranial lymphoma and TDLs. Results Intracranial lymphoma and tume- faetive demyelinating lesions Cho/Cr,Cho/NAA and Lip lac peak level exists significant difference. It is more likely to be intracranial lymphoma when the Cho/Cr ratio was 〉 2.39, the Cho/NAA ratio was 〉 1.73, and a high lipid and lactate peak grade （ grade 〉 3 ）. The ratio of Cho/NAA is the best to evaluate the diagnosis efficiency in differential diagnosis of intracranial atypical lymphoma and TDLs. The AUC is 0. 883. Conclusion Long TE 1H-MRS for differentiating intracranial atypical lymphoma and tumefactive demyelinating lesions have great clinical value, especially added Cho/NAA ratio is a useful complement to conventional MRI.

关 键 词：磁共振波谱成像 颅内淋巴瘤 瘤样脱髓鞘病变 

分 类 号：R739.4[医药卫生—肿瘤] R445.2[医药卫生—临床医学]