氢质子磁共振波谱鉴别恶性胶质瘤与单发性脑转移瘤的价值  

The value of 1 H-MRS in identification of malignant glioma and solitary brain metastases

作　　者：王子文[1] 段阳[1] 杨本强[1] 徐志华[1] 许在华[2] 林森[1] 

机构地区：[1]解放军沈阳军区总医院放射诊断科,110016 [2]解放军沈阳军区总医院神经外科,110016

出　　处：《中国临床实用医学》2017年第1期33-37,共5页China Clinical Practical Medicine

摘　　要：目的 探讨氢质子磁共振波谱（^1H-MRS）对鉴别恶性胶质瘤与单发性脑转移瘤的临床应用价值.方法 回顾性分析经手术病理证实的恶性胶质瘤24例及单发脑转移瘤15例患者临床资料.39例患者术前均行常规MRI平扫、增强及^1H-MRS扫描.检测肿瘤实质区、肿瘤边缘区、瘤周水肿区、对侧正常脑实质区N-乙酰天门冬氨酸（NAA）、胆碱（Cho）、肌酸（Cr）的变化,计算NAA/Cr、Cho/Cr及Cho/NAA的比值.对比分析肿瘤实质区、肿瘤边缘区、瘤周水肿区及对侧正常脑实质区NAA/Cr、Cho/Cr、Cho/NAA的比值.结果 恶性胶质瘤与单发性脑转移瘤之间^1H-MRS代谢产物进行比较分析,肿瘤实质区NAA/Cr比值分别为（0.96±0.42）、（1.66±1.10）,肿瘤边缘区NAA/Cr比值分别为（1.07±0.47）、（1.48±0.40）,Cho/NAA比值分别为（2.21±1.20）、（1.21±0.35）,瘤周水肿区NAA/Cr比值分别为（1.24±0.62）、（1.68±0.35）,Cho/Cr比值分别为（1.78±0.79）、（1.10±0.26）,Cho/NAA比值分别为（1.51±0.58）、（0.67±0.17）,差异有统计学意义（P均〈0.05）.结论 ^1H-MRS成像技术可以弥补常规MR成像的局限性,瘤周水肿区^1H-MRS代谢物比值对鉴别恶性胶质瘤及单发性脑转移瘤具有临床意义.Objective To investigate the clinical application value of ^1H-MRS in identification of malignant glioma and solitary brain metastases. Methods A retrospective study was performed on 24 cases of malignant glioma and 15 cases of solitary brain metastases confirmed by surgery and pathology. All 39 patients underwent conventional MRI, enhanced MR and ^1H-MRS imaging. To detect the changes of N-acetylaspartate （NAA）, choline （Cho） and creatine （Cr）, and achieved ratio of NAA/Cr, Cho/Cr and Cho/NAA in the tumor parenchyma, tumor margin, edema area and contralateral normal brain parenchy-ma. The ratio of Cho/NAA, Cho/Cr and NAA/Cr in tumor parenchyma area, tumor edge area, edema area and contralateral normal brain parenchyma were compared and analyzed. Results Comparison between the ratio of ^1H-MRS metabolite of malignant glioma and solitary brain metastases, in tumor parenchyma, the ra-tios of NAA/Cr were （0. 96 ± 0. 42） and （1. 66 ± 1. 10）;in tumor edge area, the ratios of NAA/Cr were （1. 07 ± 0. 47） and （1. 48 ± 0. 40）, the ratios of Cho/NAA were （2. 21 ± 1. 20） and （1. 21 ± 0. 35）; in peritumoral edema region, the ratios of NAA/Cr were （ 1. 24 ± 0. 62 ） , （ 1. 68 ± 0. 35 ） , the ratios of Cho/Cr were （1. 78 ± 0. 79）,（1. 10 ± 0. 26）, the ratios of Cho/NAA were （1. 51 ± 0. 58）, （0. 67 ± 0. 17）, and all the differences were statistically significant （all P〈0. 05）. Conclusion ^1H-MRS imaging technology can make up the limitations of conventional MRI. The ratio of ^1H-MRS metabolite in peritumoral edema has a significant clinical value in identification of malignant glioma and solitary brain metastases.

关 键 词：单发性脑转移瘤 恶性胶质瘤 磁共振成像 磁共振波谱成像 

分 类 号：R44[医药卫生—诊断学] R73[医药卫生—临床医学]