多体素1H - MRS在脑肿瘤强化周围区域中的临床应用

目的探讨多体素1H磁共振波谱(1H-MRS)在颅脑肿瘤强化周围区的代谢物改变特点及其鉴别诊断意义。方法脑肿瘤患者35例,多体素1H-MRS采集NAA、Cho、Cr、Lac、L ip、m I和A la峰,分别计算星形细胞瘤、转移瘤、脑膜瘤的肿瘤强化区、强化周围区和正常参照区域的代谢物浓度,计算不同脑肿瘤、同种脑肿瘤不同区域及高、低级胶质瘤各代谢物比值平均值,比较统计学差异,记录Lac、L ip、m I和A la是否出现。结果肿瘤强化区NAA/Cho、NAA/Cr和Cho/Cr平均值与正常参照区比较均有显著性差异(P<0.05);共出现17例Lac峰、7例L ip峰、6例A la峰和6例m I峰;强化周围区,三者的NAA/Cho、NAA/Cr、NAA/nCr、Cho/NAA值具显著性差异;良、恶性胶质瘤间,NAA/Cho、NAA/nCr、Cho/Cr和Cho/nCho值具有统计学差异(P<0.05)。结论多体素1H-MRS对肿瘤强化周围区域的评价,有助于星形细胞瘤与脑转移瘤、脑膜瘤的鉴别诊断及浸润范围的划定。

Clinical Study on Perienhancement Area of Brain Tumors with Multivoxel 1 H - MRS

Objective To investigate the predictive value of multivoxel proton magnetic resonance spectroscopy(~1H-MRS) in discussing the metabolic changes in perienhancement area of brain tumors and to evaluate the role of~1H-MRS in differentiation of brain tumors.Methods 35 patients with intracranial tumors were recruited in this study.Multivoxel~1H-MRS was performed and spectra of three voxels were taken from enhanced-solid part of the tumors,perienhancement region(with T_2 hyperintensement areas) and normal white matter.Fitted areas in the spectrum for NAA,Cho,Cr,Lip,Lac,mI and Ala metabolite peaks were measured and NAA/Cho,NAA/Cr,Cho/Cho(normal),Cho/nCr ratios were calculated for each voxel.One way,ANOVA was used for statistical analysis in metabolic ratio's difference among the brain tumors.Results In multivoxel~1H-MRS from the parenchyma of the lesion,the ratios of NAA/Cho,NAA/Cr and Cho/Cr changed significantly by comparing with that of normal control brain tissues(P<0.05).Lac occurred in 17 cases,lip presented to 7 cases.Six showed Ala peak while 6 had high mI peak.On the other hand,in voxel from perienhancement region,NAA/Cho,NAA/Cr,NAA/nCr and Cho/NAA ratios revealed strong correlations between metabolite concentrations and tumor types(P<0.05).The metabolic ratio betweenmalignant and benign gliomas was significantly difference .Conclusion Evaluation of perienhancement region of brain tumors withmultivoxel~1H-MRS may be useful in the diagnosis,differentiation and deciding the border of brain tumors.