氢质子磁共振波谱成像在脑胶质瘤诊断中的研究进展

正脑胶质瘤是最常见的原发性脑肿瘤[1],常弥漫性侵及周围正常的脑组织,对放、化疗不敏感[2]。氢质子磁共振波谱成像(proton magnetic resonancespectroscopy,1H-MRS)是目前能无创性地检测人体组织代谢、生化改变及化合物定量分析的医学影像技术,可检测多种微量代谢物。1H-MRS应用探测到的化学位移现象分析组织分子结构,直观显示正常     

二维氢质子磁共振波谱分析在胶质瘤诊治中的应用价值

目的 探讨颅内胶质瘤2D1H-MRS代谢物值和病理学分级的相关性.方法 46例幕上脑胶质瘤患者行MR平扫.2D1H-MRS及MR增强扫描.量化分析NAA、Cho、Cr及Lip-Lac,与术后病理结果 对比分析研究,得出1H-MRS几种代谢物值与肿瘤恶性程度的相关性.结果 随着胶质瘤恶性程度的增加,Cho呈上升趋势,NAA及NAA/cho呈下降趋势;Cr含量有所降低,Cho/Cr随胶质瘤恶性度的增加而增高,Cho/Cr比Cho更敏感;Lip-Lac呈升高趋势.Cho/Cr与NAA/Cho各组之间两两比较,差异均有统计学意义(P＜0.05).结论 NAA/Cho、Cho/Cr和Lip-Lac可做为脑胶质瘤恶性程度评判的综合指标.     

磁共振波谱分析在脑胶质瘤分级中的应用价值

目的分析氢质子磁共振波谱(~1H-MRS)分析在脑胶质瘤分级中的应用价值。方法回顾性分析我院2013-01—2016-06收治的经术后病理或活组织病理检查确诊的36例脑胶质瘤患者的临床资料,均行常规磁共振(MRI)及~1H-MRS检查,依据世界卫生组织(WHO)2007年分级方法分为低级别胶质瘤组(n=15)和高级别胶质瘤组(n=21),对比分析2组肿瘤占位核心实质区、瘤周区域及对侧镜像区胆碱复合物(Cho)、N-乙酰-L-天门冬氨酸复(NAA)、肌酐(Cr)脂质(Lip)、乳酸(Lac)。结果所有患者肿瘤占位核心实质的Cho/Cr比值均较对侧镜像区升高,NAA/Cr、NAA/Cho比值较对侧镜像区降低(P0.05)。高级别胶质瘤NAA/Cho比值低于低级别胶质瘤,而Cho/Cr高于低级别胶质瘤(P0.05)。高级别胶质瘤瘤周区域Cho/Cr比值较对侧镜像区升高,NAA/Cho比值较对侧镜像区降低(P0.05);低级别胶质瘤瘤周区域Cho/Cr比值较对侧镜像区升高,NAA/Cr、NAA/Cho比值较对侧镜像区降低(P0.05)。高级别胶质瘤组20例出现Lac峰,14例出现Lip;低级别胶质瘤组6例出现Lac峰,1例出现Lip峰。Cho/Cr比值与病理级别呈正相关(r=0.812,P0.05),而NAA/Cho比值与病理级别呈负相关(r=-0.634,P0.001),NAA/Cr与病理级别无明显相关性(r=-0.060,t=0.241)。结论氢质子磁共振波普能够有效显示脑胶质瘤患者肿瘤周围水肿区及肿瘤实质区的代谢变化情况,可为胶质瘤临床术前分级提供客观依据,提高诊断的准确性。     

磁共振波谱在颅脑胶质瘤分级中的应用价值

目的：探讨磁共振波谱在颅脑胶质瘤分级中的应用价值。方法回顾性分析36例颅脑胶质瘤患者的磁共振波谱检查资料,所有患者均行M RI平扫、增强扫描及磁共振波谱检查。结果本组36例脑胶质瘤患者经磁共振及磁共振波谱检查确诊34例,诊断正确率为94.4％。按照W H O脑胶质瘤病理分级标准：低级（1～2级）胶质瘤21例,高级（3～4级）胶质瘤15例。低级胶质瘤瘤体实质部分DWI表现为低信号13例,表现为等信号8例,ADC图均为明显高信号,高级胶质瘤肿瘤实质部分DWI表现为高信号11例,等信号4例,ADC图均为明显低信号。低、高级胶质瘤MRS的共同表现为NAA降低,Cr轻度下降,Cho升高,Cho／NAA倒置,Cho／Cr、Cho／NAA在低级别和到高级别胶质瘤间有增高趋势。结论磁共振波谱在颅脑胶质瘤的分级诊断中具有重要的价值,对于指导临床治疗,提高临床疗效,改善患者预后具有重要意义。     

氢质子磁共振波谱在脑胶质瘤中的应用

目的探讨1H-MRS在预测各级别胶质瘤浸润范围及判断肿瘤级别的临床应用价值。方法回顾分析经术前活检或术后病理证实为脑胶质瘤的33例患者,按WHO(2007)脑胶质瘤诊断分级标准分为Ⅰ、Ⅱ、Ⅲ、Ⅳ级,其术前均行MRI及1H-MRS检查,对肿瘤瘤体区、瘤周区及正常区通过1H-MRS分析,比较4个级别胶质瘤不同区域代谢产物NAA、Cho、Cr及NAA/Cho、NAA/Cr、Cho/Cr比值差异。结果通过1H-MRS代谢物在各级别胶质瘤不同区域比较发现:判断Ⅰ级胶质肿瘤实体区域大小时,Cho、Cho/Cr、NAA/Cho在瘤体区和瘤周区之间变化有统计学意义(t值分别为4.14、4.01、5.18,P0.025),判断肿瘤浸润范围时Cho、Cr、NAA/Cho、Cho/Cr在瘤周区和正常区之间变化有统计学意义(t值分别为5.81、10.68、5.75、6.60,P0.025);判断Ⅱ级胶质肿瘤实体区域大小时,NAA、NAA/Cho、NAA/Cr的差异有统计学意义(t值分别为5.99、6.89、5.87,P0.025),其判断肿瘤浸润范围时,Cho、NAA、Cr、NAA/Cho、NAA/Cr、Cho/Cr比值的差异有统计学意义(t值分别为16.94、8.66、30.30、21.57、6.13、17.94,P0.025);判断Ⅲ、Ⅳ级胶质肿瘤实体区域大小时,Cho、NAA、NAA/Cho、NAA/Cr、Cho/Cr均有统计学意义(Ⅲ级t值分别为6.24、8.93、13.09、8.95、6.21,Ⅳ级t值分别为8.94、12.53、2.43、14.41、12.28、9.19,P0.025),其判断肿瘤浸润范围时,Cho、NAA、Cr、NAA/Cho、NAA/Cr、Cho/Cr比值差异均有统计学意义(Ⅲ级t值分别为31.38、20.19、15.59、34.97、18.49、32.16,Ⅳ级t值分别为37.11、40.69、9.58、59.85、38.85、39.90,P0.025)。随着肿瘤级别增加瘤体区NAA/Cho、NAA/Cr比值逐渐降低(F分别为403.9、159.46,P0.05),Cho/Cr比值逐渐升高(F=119.91,P0.05)。结论1H-MRS的分析,具有预测各级别胶质瘤浸润范围及术前初步判断肿瘤级别的潜能,为术前初步确定手术方案、切除范围、降低术后复发及预后判断,指导后续治疗具有一定意义。     

磁共振波谱在脑胶质瘤放疗中的应用价值

目的：分析磁共振波谱（M RS ）在脑胶质瘤放疗的应用价值。方法选取2012‐01—2013‐12我院脑胶质瘤部分切除术后放疗患者30例,在放疗前后7 d予以M RS及M RI检查,观察患者肿瘤及周围区域放疗前后代谢物浓度变化。结果放疗后肿瘤强化区的NAA、Cho值均高于放疗前,NAA放疗前后变化差异有统计学意义（P＝0.022）;放疗后的NAA／Cr 、Cho／NAA 、Cho／Cr均降低,其中Cho／Cr变化差异有统计学意义（P＝0.004）。放疗后肿瘤强化区的NAA值均高于放疗前、Cho值低于放疗前,两个指标放疗前后变化差异均无统计学意义（P＞0.05）;放疗后的NAA／Cr 、Cho／NAA 、Cho／Cr均降低,其中Cho／Cr变化差异有统计学意义（P＝0.011）。结论脑胶质瘤放疗中应用MRS可清晰显示肿瘤及周围水肿区域放疗前后代谢变化情况,可作为了解放疗综合效果的主要手段。     

磁共振波谱在脑胶质瘤放疗中的应用价值分析

目的探讨和分析磁共振波谱在脑胶质瘤放疗中的应用价值。方法选择我院2011-02—2012-12收治的42例脑胶质瘤患者进行研究。在进行放疗前后1周分别对患者进行MRI平扫和增强剂磁共振波普检查。同时对患者肿瘤周围水肿及肿瘤强化区域设置兴趣区,并计算化疗前、后相关代谢产物的浓度和比值改变情况。结果患者肿瘤增强区域NAA值升高,而肿瘤周围水肿区域的Cho值下降且NAA值升高,但差异无统计学意义（P〉0.05）。在患者肿瘤增强区域和水肿区域,其Cho/Cr比值比治疗前出现明显下降,差异具有统计学意义（P〈0.05）。在经放疗后,患者肿瘤增强区域和肿瘤周围水肿区域的Cho/NAA和NAA/Cr比较与治疗前均出现明显下降（P〈0.05）。放疗前,脑胶质瘤患者肿瘤强化区域Cho/Cr值为（3.37±1.94）,放疗后为（2.27±0.99）,两者比较（P〈0.05）。肿瘤周围水肿区域在放疗前Cho/Cr值为（1.91±0.64）与放疗后（1.47±0.57）比较（P〈0.05）。结论应用磁共振波普检测能够有效显示脑胶质瘤患者肿瘤周围水肿区及肿瘤强化区在放疗后所发生的早期代谢变化,能有效反映患者的放疗效果。     

氢质子磁共振波谱在胶质瘤活检术中的应用

目的探讨氢质子磁共振波谱(proton magnetic resonance spectroscopy,1H—MRS)指导无框架立体定向穿刺活检的最优化代谢指标。方法选择2011年7月至2015年1月行1H—MRS影像自动融合的无框架立体定向穿刺活检术的胶质瘤患者。共57例,其中男32例,女25例,年龄13~77岁,平均46岁。统计分析各级别胶质瘤术前波谱代谢指标水平,并将其与术后病理级别进行相关性分析。结果胶质瘤Ⅱ级、Ⅲ级、Ⅳ级组间NAA值、Cho/NAA、Cho/Cr存在显著性差异,而Cho、Cr、NAA/Cr不存在差异。与病理级别具有相关性的代谢指标有Cho/Cr:r=0.381(P=0.002)、Cho/NAA:r=0.468(P0.01)、NAA:r=-0.437(P0.01)、Cr:r=-0.266(P=0.032)。结论 1H—MRS自动融合的无框架立体定向活检技术具有明显优势,均质瘤体内Cho/NAA最大值代谢热区可作为穿刺活检首选靶点。     

情感障碍脑磁共振质子波谱研究现状

磁共振氢质子波谱(H1-MRS)能够检测活体组织生化物的相对含量,是研究脑内神经生化的一种新技术。本文就近年来H1-MRS在情感障碍(抑郁症)各个脑区的研究发现作一综述。     

脑干胶质瘤磁共振波谱分析

目的探讨磁共振波谱(Magnetic resonance spectroscopy,MRS)在脑干胶质瘤诊断中的意义。方法回顾性分析10例脑干胶质瘤的临床资料,肿瘤位于中脑1例,中脑脑桥1例,脑桥7例,延髓1例。均行MRS检查,对肿瘤区、肿瘤边缘区和正常对照区进行对照研究。结果MRS均显示肿瘤区N-乙酰天门冬氨酸(N-acetylaspartate,NAA)峰值下降,胆碱(Choline,Cho)峰上升。与肿瘤边缘区和正常对照区比较,肿瘤区NAA/Cr明显减低,Cho/Cr和Cho/NAA明显升高。星形细胞瘤4例,间变性星形细胞瘤1例,胶质母细胞瘤2例;另3例根据临床特点和影像学表现诊断为脑干胶质瘤。结论MRS可检测到脑干胶质瘤的代谢改变,具有无创、敏感、诊断准确的特点。     

1H MRS对星形细胞瘤的诊断价值

目的探讨质子磁共振波谱(1H Magnetic Resonance Spectroscopy,1H MRS)在星形细胞肿瘤诊断及分级中的价值.方法对MRI诊断为脑星形细胞肿瘤并经病理证实的40例患者术前行1H MRS检查,每例患者均行肿瘤区和与之相对应的健侧部位的1HMRS,以作对照研究.结果40例星形细胞瘤均表现为异常的1HMRS,主要表现为氮乙酰门氡氨酸(N-acetylaspartate,NAA)的含量下降;胆碱(choline,Cho)的含量增高,但有3例呈轻微减少改变;肌酸(creatine,Cr)总量变化不大,且无规律性;肌醇(Ins)含量表现为轻度下降,有1例升高;特别是NAA/Cho比值明显下降.结论1HMRS可提高对星形细胞瘤诊断和分级的准确性.     

Hippocampal glutamate-glutamine (Glx) in adults with Down syndrome: a preliminary study using in vivo proton magnetic resonance spectroscopy (1H MRS)

Background

Down syndrome (DS), or trisomy 21, is one of the most common autosomal mutations. People with DS have intellectual disability (ID) and are at significantly increased risk of developing Alzheimer’s disease (AD). The biological associates of both ID and AD in DS are poorly understood, but glutamate has been proposed to play a key role. In non-DS populations, glutamate is essential to learning and memory and glutamate-mediated excitotoxicity has been implicated in AD. However, the concentration of hippocampal glutamate in DS individuals with and without dementia has not previously been directly investigated. Proton magnetic resonance spectroscopy (¹H MRS) can be used to measure in vivo the concentrations of glutamate-glutamine (Glx). The objective of the current study was to examine the hippocampal Glx concentration in non-demented DS (DS-) and demented DS (DS+) individuals.

Methods

We examined 46 adults with DS (35 without dementia and 11 with dementia) and 39 healthy controls (HC) using ¹H MRS and measured their hippocampal Glx concentrations.

Results

There was no significant difference in the hippocampal Glx concentration between DS+ and DS-, or between either of the DS groups and the healthy controls. Also, within DS, there was no significant correlation between hippocampal Glx concentration and measures of overall cognitive ability. Last, a sample size calculation based on the effect sizes from this study showed that it would have required 6,257 participants to provide 80% power to detect a significant difference between the groups which would indicate that there is a very low likelihood of a type 2 error accounting for the findings in this study.

Conclusions

Individuals with DS do not have clinically detectable differences in hippocampal Glx concentration. Other pathophysiological processes likely account for ID and AD in people with DS.     

质子磁共振波谱对帕金森病的诊断价值

目的　探讨质子磁共振波谱 (1 H MRS)对帕金森病 (PD)的诊断价值。方法　通过对 1 5例PD患者和 5名年龄匹配健康对照者双侧基底节区1 H MRS观测 ,分析其基底节区N 乙酰天冬氨酸 /肌酸 (NAA/Cr)和胆碱 (Cho) /Cr比值的变化。结果　PD患者基底节区NAA/Cr含量显著低于对照组 (P <0 0 5)。结论　1 H MRS是研究PD患者基底节区神经元是否遭受破坏的一种无创技术     

磁共振波谱成像在神经外科的应用

磁共振波谱成像是一种可以提供脑的代谢和生化信息的无创性检查方法，能客观地反映脑内代谢物的变化。文章从影像学角度分析证实了颅脑损伤、脑肿瘤等在磁共振波谱成像上各有不同的表现，提示磁共振波谱成像能从影像学角度对颅脑损伤、脑肿瘤、脑脓肿和颞叶癫痫等进行辅助诊断和预后判断。     

Proton magnetic resonance spectroscopy (1H MRS) in patients with sporadic cerebellar degeneration.

The authors studied 23 patients with cerebellar degeneration including multiple systemic atrophy (MSA) and cerebellar cortical atrophy (CCA) by proton magnetic resonance spectroscopy (1H-MRS). 1H-MRS allowed noninvasive measurement of the signal intensities derived from N-acetylaspartate (NAA), creatine + phosphocreatine (CRE), and choline-containing compounds (CHO). There was significant reduction of the NAA/CRE level in the frontal cortex, putamen, cerebellar hemisphere and cerebellar vermis of patients with MSA, and in the frontal cortex, cerebellar hemisphere and cerebellar vermis of patients with CCA as compared with those of normal controls. There was significant reduction of the NAA/CRE level also in the putamen of patients with MSA as compared with that of patients with CCA. These results indicated the presence of a degenerative process and/or functional impairment in the frontal cortex and putamen of patients with MSA and in the frontal cortex of patients with CCA, in addition to a degenerative process in the cerebellum. There was a significant correlation between the NAA/CRE level and the severity of clinical signs. 1H-MRS is valuable in providing information regarding the pathophysiology and the progress of cerebellar degenerative diseases.     

Brain 1H magnetic resonance spectroscopic differences in myotonic dystrophy type 2 and type 1

To evaluate cerebral metabolism and intergroup differences in closely matched patients with myotonic dystrophy type 2 (DM2, n = 15) and type 1 (DM1, n = 14), we performed (1)H magnetic resonance spectroscopic (MRS) analyses of the occipital and temporoparietal cortical regions as well as of subcortical frontal white matter. Relative to healthy subjects, the concentration of N-acetylaspartate was significantly reduced in all tested brain regions in both disease groups. In the DM1 patients we also observed a concomitant depletion of creatine and choline levels, particularly in the frontal white matter. A discriminant analysis based on the (1)H-MRS data distinguished between the DM2, DM1, and control groups with an overall accuracy of 88%. (1)H-MRS indicates that neurochemical alterations involving gray and white matter occur in patients with DM2 and DM1. Although structural abnormalities (cerebral atrophy, white matter lesions) are similar in DM2 and DM1, changes in cerebral metabolites can differentiate these disease groups, suggesting that the diseases differ in their neurocellular pathology.     

Assessment of GABA concentration in human brain using two-dimensional proton magnetic resonance spectroscopy

A quantitative method to assess in vivo brain gamma-aminobutyric acid (GABA) levels is proposed using a J-resolved, two-dimensional (2D) magnetic resonance spectroscopy (MRS) technique. Localized, J-resolved 2D MR spectra were obtained from a 12-cm³ voxel in the occipital lobe of 36 healthy volunteers (18 male and 18 female, age: 25.1±4.8 years). Based on phantom measurements, a GABA resonance peak located at 2.94 ppm, 7.45 Hz, in J-resolved 2D MRS overlaps the least with other resonance peaks which arise from N-acetylaspartate, choline, creatine, glutamate and glutamine. Measurements of this resonance peak yield in vivo GABA concentrations of 1.01±0.36 μmol/cm³ for male and 1.16±0.43 μmol/cm³ for female volunteers, without correction for T1 and T2 relaxation effects. These results are in good agreement with previously reported data and suggest that, with further development, 2D MRS may provide a practical means to estimate the concentration of this important neurotransmitter.     

(1)H magnetic resonance spectroscopy of autosomal ataxias

Multiple forms of autosomal ataxia exist which can be identified by genetic testing. Due to their wide variety, the identification of the appropriate genetic test is difficult but could be aided by magnetic resonance data. In this study, magnetic resonance spectroscopy (MRS) and imaging (MRI) data were recorded for 20 ataxia patients of six different types and compared to 20 normal subjects. Spectra were acquired in the pons, left frontal lobe, left basal ganglia, left cerebellar hemisphere and vermis. Both metabolite spectra and absolute metabolite concentrations were determined. Differences in metabolite levels were observed between ataxia patients and control subjects and between ataxia patients of different types. A number of correlations were found between metabolite ratios, atrophy levels, number of repeats on the small and large allele, age at examination, symptoms duration and age at symptoms onset for ataxia patients. These MR characteristics are expected to be useful for the identification of the ataxia type.     

Differential diagnosis of intracranial meningiomas based on magnetic resonance spectroscopy

Background and purposeTo determine in vivo magnetic resonance spectroscopy (MRS) characteristics of intracranial meningiomas and to assess MRS reliability in meningioma grading and discrimination from tumours of similar radiological appearance, such as lymphomas, schwannomas and haemangiopericytomas.Material and methodsAnalysis of spectra of 14 patients with meningiomas, 6 with schwannomas, 2 with lymphomas, 2 with haemangiopericytomas and 17 control spectra taken from healthy hemispheres.ResultsAll the patients with meningiomas had a high Cho signal (long TE). There were very low signals of Naa and Cr in the spectra of 10 patients. A reversed Ala doublet was seen only in 2 cases. Four patients had a negative Lac signal, whereas 3 had high Lac-Lip spectra. Twelve spectra showed high Cho signals (short TE). In one case the Cho signal was extremely low. All spectra displayed a very low Cr signal, but high Glx and Lac-Lip signals. Ala presence was found only in 3 patients. The mean Cho/Cr ratio (PRESS) was 5.97 (1.12 in normal brain, p < 0.05). Lac-Lip was present in all the meningiomas (STEAM). The Ala signal was seen only in 2 spectra with long TE and in 3 sequences of the short TE sequences. There were both β/γ-Glx and α-Glx/glutathione signals in all 14 meningiomas.ConclusionsMRS is unable to discriminate low and high grade meningiomas. The method seems to be helpful in discriminating lymphomas (absent Glx signal), schwannomas (mI signal in the short TE sequences) and haemangiopericytomas (presence of mI band) from meningiomas.