在体胆囊胆汁~1H-MRS成像对肝癌的诊断价值  

An initial study on the potential of ~1H-MRS imaging of in vivo gallbladder bile in the clinical application of liver cancer diagnosis

作　　者：陈小凤[1] 沈智威[2] 刘艳艳[2] 吴仁华[2] 于昭[1] 

机构地区：[1]广东省梅州市人民医院放射科,梅州514031 [2]汕头大学医学院第二附属医院放射科

出　　处：《功能与分子医学影像学（电子版）》2017年第2期1174-1182,共9页Functional and Molecular Medical Imaging(Electronic Edition)

摘　　要：目的探讨在体胆囊胆汁1H-MRS成像对肝胆疾病,尤其是肝癌的诊断价值。方法对11例健康志愿者,8例肝脏良性病变患者及6例肝癌患者行肝脏常规MRI扫描及胆囊胆汁1.5 T 1H-MRS扫描。肝脏常规图像结果由两名经验丰富的放射科医师在盲法下进行阅片、分析并获得一致意见。波谱数据利用LCModel软件进行后处理,观察各个代谢物波峰特点并分析、比较各个代谢物波峰下面积及波峰下面积的比值。结果 (1)利用1H-MRS可以检测人在体胆囊胆汁代谢物,所有频谱均可观察位于0.9 ppm的胆固醇及总胆汁酸的甲基峰、1.3 ppm的脂质亚甲基峰、3.2 ppm的磷脂酰胆碱的三甲基胺峰及位于4.7 ppm的水峰;(2)恶性组(肝癌)的A_甲、A_甲/A_水低于良性组及对照组,A_(甲胺)/A_甲高于良性组及对照组,且差异均具有统计学意义(P值均<0.05);所有变量在良性组与正常对照组之间差异均无统计学意义(P值均>0.05)。(3)采用A_甲、A_甲/A_水、A_(甲胺)/A_甲对肝脏恶性肿瘤均具有一定的诊断效能,其中以A_(甲胺)/A_甲的诊断效能最高,以0.77为最佳临界值,敏感度(87.5﹪)及特异性(93.3﹪)均较高。结论利用1.5 T 1H-MRS检测人在体胆囊胆汁代谢物是可行的;恶性组的胆汁中胆固醇、总胆汁酸(TBAs)及磷脂酰胆碱(Pt C)的相对浓度下降,以胆固醇、TBAs下降较明显;A_甲、A_甲/A_水、A_(甲胺)/A_甲三个指标可作为肝癌的诊断及鉴别诊断参考指标,其中以A_(甲胺)/A_甲的诊断效能最高。Objective To study the application of in vivo IH-MRS of human gallbladder bile in hepatobiliary diseases especially in liver cancers. Methods Conventional MRI scan of liver and IH-MRS of gallbladder bile were performed on 11 healthy volunteers using 1.5 T MR scanner, 8 patients with benign hepatobiliary diseases and 6 patients with liver cancers. The conventional images of liver were read and analyzed blinded by two experienced radiology doctors and got consistent opinion finally. The spectrum data was processed with the LCModel software, and then the characteristics of every metabolite peak and to analysis were performed with all the metabolite peak areas and metabolite peak area ratios compared. Results ① Human gallbladder bile metabolites could be detected by using in vivo 1.5 T 1H-MRS, the quality of the spectrums were satisfactory. We could observe the methyl peak of cholesterol and total bile acids （TBAs） at 0.9 ppm, the methylene peak of lipids at 1.3 ppm, the trimethylamine peak of phosphatidylcholine （PtC） at 3.2 ppm and the water peak at 4.7 ppm in all of the spectrums. ② A （ -CH3 ） and A （ -CH3 ）/A （Water） were statistically significantly lower but A （ -N （CH3） 3 ）/A （-CH3 ） was statistically significantly higher in the malignant group than that in the benign group and the control group （P 〈 0.05 ）, but there were no statistical differences between the benign group and the control group inall of the variables （P 〉 0.05 ）. ③ The A （ -CH3 ）, A （ -CH3 ）/A （Water） and A （-N （ CH3 ） 3 ） / A（ -CH3）had certain diagnostic capability of liver cancers, and the diagnostic capability ofA（-N（ CH3 ）3 ）/A（ -CH3 ） was highest, 0.77 was the best critical point, its sensitivity （87.5 % ） and specificity （93.3 % ） were the highest. Conclusion It was feasible to detect human gallbladder bile metabolites by using in vivo 1.5 T 1H-MRS. The relative concentration of cholesterol, TBAs and PtC were descending in the malignant group, a

关 键 词：磁共振频谱 在体 胆囊胆汁 肝癌 

分 类 号：R445.2[医药卫生—影像医学与核医学] R575.5[医药卫生—诊断学]