大脑胶质瘤病的核磁共振成像及核磁波谱成像

目的：评价磁共振成像（MRI）、磁波谱成像（MRS）对大脑胶质瘤病诊断及病理分级的临床价值。方法：对11例经病理证实的大脑胶质瘤病MRI平扫、增强及病灶MRS综合影像学资料的回顾性分析。结果：所有病例均侵犯两个或两个以上脑叶，以颞叶、额叶、胼胝体常见，分别为91％、64％、64％。MRI表现：T1WI呈低或等低信号，T2WI呈高或混杂高信号，FLAIR像敏感，呈高信号，受累区脑组织轻度肿胀，邻近脑裂、脑沟变浅或消失，占位效应轻；注射Gd-DTPA增强扫描示，4例不规则、结节状强化，1例肿块样强化，2例线状轻度强化，4例无强化；DWI3例弥散受限，8例弥散不受限。MRS：5例强化患者行MRS分析，肌酸（Cr）升高明显，胆碱复合物（Cho）中等程度的升高，N-乙酰天门冬氨酸（NAA）和乳酸、脂质（LL）降低，Cho／Cr、Cho／NAA比值升高，肿块样强化患者MRS数值变化明显。病理检查结果：肿瘤分级6例为星形细胞瘤Ⅰ-Ⅱ级，4例（强化）Ⅱ-Ⅲ级，1例（肿块样强化）Ⅳ级。结论：MRI，MRS对大脑胶质瘤病的诊断及病理分级有重要的临床价值。

Diagnosis of Cerebri Gliomatosis with Magnetic Resonance Image and Magnetic Resonance Spectroscopy

Objective: To evaluate the clinical significance of diagnosis and pathologic grade of cerebri gliomatosis(CG) with magnetic resonance image(MRI) and magnetic resonance spectroscopy(MRS).Methods: MRI and MRS results of 11 cases of(CG) which have been confirmed by pathological examination were studied retrospectively.Results: The tumor involved at least 2 cerebral lobes in all the cases,especially temporal lobe(91%),frontal lobe(64%) and corpus callosum(64%).It demonstrated low or iso-low signal intensity on T1WI,hyperintensity on T2WI,and high sensitivity on FLAIR image,with slightly surrounding swelling,sulci disappearing and poor space occupying.After Gd-DTPA injection,nodular or irrigular enhancement occurred in 4 cases,mass enhancement in 1 case,poor thread enhancement in 2 cases,no contrast enhancement was found in the other 4 cases.In regard of DWI,the diffusion was limited in 3 cases,but not in the rest cases.It was showed in the results of enhanced MRS of 5 cases that Cho,Cr,Cho/Cr,and Cho/NAA levels were elevated,and NAA,LL levels were decreased.The pathological diagnosis of these cases were all astrocytoma.Among them,6 cases were grade I-II,4 cases(enhanced) grade II-III,and 1 case(mass enhancement) grade IV,Conclusion: MRI and MRS have significantly clinical value in the diagnosis of cerebri glimatosis and its pathologic grading.