_1HMRS对高级别脑胶质瘤与孤立脑转移瘤的鉴别诊断价值

CHINESE JOURNAL OF CT AND MRI, FEB 2010,V ol.8,No.1 total No.30

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The value of 1HMRS spectroscopy for the differential diagnosis of brain high-grade gliomas and solitary metastase

LU Yong-ming, DING Qing-guo,CHEN Zhen-hu,　et al. Department of Radiology,Changshu No 2 Hospital, Changshu 215542,China

[Abstract] Objective To investigate the value of 1HMRS in differential diagnosis on high-grade gliomas and solitary metastases. Methods 18 patients with high-grade gliomas and 12 patients with solitary metastases were confirmed by pathology. All cases were performed routine MRI,contrast enhanced MRI and 1HMRS preoperatively. Three regions,the solid component,necro-sis and peritumoral edema of the two types of tumor, were measured,then the value of NAA,Cho, Cr and their ratio were obtained.The independent-samples t test was used to determine if there were significant statistical differenes in metabolic levels of the three regions between the high-grade gliomas and the metastase. Results The two types of tumor showed isointense or hypointense on T 1-weighted image,heterogeneous hyperintense on T 2-weighted image,with multiple enhancement and peritumoral edema.The solid components of high-grade gliomas and solitary metastases both showed the ratio of NAA/Cho and NAA/Cr decreased,Cho/Cr increased.But there were no significant statistical differences among the ratios.NAA/Cho and NAA/Cr in central necrosis regions have significant statistical difference,whereas Cho/Cr no.NAA/Cho and Cho/Cr in peritumoral edema regions have significant statistical difference,whereas NAA/Cr no.Conclusion 1HMRS can be used to analysize the metabolism of cerebral tumor by non-invasive way ，it may be helpful to differentiate high-grade gliomas from solitary metastase.[Key words]metastasis; magnetic resonance spectrum; magnetic resonance imaging

通讯作者：（２１５５４２）常熟市第二人民 医院核磁共振室 陆永明

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ＨＭＲＳ对高级别脑胶质瘤与孤立脑转移瘤的鉴别诊断价值

常熟市第二人民医院

核磁共振室 陆永明 丁庆国陈振湖 贾传海 周建春 陈珏

【摘要】　目的　初步探讨氢质子磁共振波谱（１ＨＭＲＳ）在高级别脑胶质瘤、孤立脑转移瘤鉴别诊断中的应用价值。　方法　搜集经手术病理证实的高级别脑胶质瘤１８例及孤立脑转移瘤１２例，术前分别行常规ＭＲＩ、增强扫描及１ＨＭＲＳ检查，测量两种肿瘤的实质强化区、中央坏死区、瘤周水肿区的代谢物浓度（包括ＮＡＡ、Ｃｈｏ、Ｃｒ）及其比值的变化，并进行分析比较。结果　两种肿瘤的Ｔ１ＷＩ多表现为等、低信号，Ｔ２ＷＩ呈不均匀高信号，伴有不同程度强化和瘤周水肿。高级别脑胶质瘤与孤立脑转移瘤实质区的１

ＨＭＲＳ均表现为ＮＡＡ／Ｃｈｏ、ＮＡＡ／Ｃｒ下降，Ｃｈｏ／Ｃｒ升高，　但其差异无统计学意义；中央坏死区的ＮＡＡ／Ｃｈｏ、ＮＡＡ／Ｃｒ差异有统计学意义，但Ｃｈｏ／Ｃｒ差异无统计学意义；瘤周水肿区ＮＡＡ／Ｃｈｏ、Ｃｈｏ／Ｃｒ差异有统计学意义，但ＮＡＡ／Ｃｒ差异无统计学意义。结论　１ＨＭＲＳ可无创地分析脑肿瘤的代谢情况，有助于对高级别脑胶质瘤与孤立脑转移瘤的诊断和鉴别诊断。

【关键词】胶质瘤；转移瘤；磁共振 波谱；磁共振成像【中图分类号】　Ｒ７３０．２６４；Ｒ４４５．２【文献标识码】Ａ

论 著

子磁共振波谱（ｍａｇｎｅｔｉｃ　ｒｅｓｏｎａｎｃｅ　ｓｐｅｃｔｒｏｓｃｏｐｙ，１ＨＭＲＳ）是目前唯一无

创性的观察活体组织代谢与生化指标的磁共振技术，近年来发展迅速，临床上已逐渐应用于脑肿瘤的诊断、鉴别诊断、肿瘤分级等方面的研究［１－２］，对于胶质瘤与转移瘤的比较分析亦见报道，但关于此两种肿瘤坏死区的ＭＲＳ比较尚未有报道。本文回顾性分析１８例高级别脑胶质瘤与１２例孤立脑转移瘤的实质区、坏死区、水肿区的１ＨＭＲＳ特征，并结合肿瘤病理特征初步探讨１ＨＭＲＳ对两者的鉴别诊断价值，以更好地指导临床治疗方案的选择。

材料和方法

１．一般资料 搜集２００４年８月至２００９年６月在我院经手术病理证实的１８

例高级别脑胶质瘤与１２例孤立脑转移瘤，所有病例术前均行常规ＭＲＩ检查和１

ＨＭＲＳ扫描。高级别脑胶质瘤中，男性１１例，女性７例，年龄２１～６８岁，平均３６．５岁，孤立脑转移瘤中，男性７例，女性５例，年龄４２～７９岁，平均５８．５岁。 ２．检查方法 采用１．５Ｔ　ＧＥ　ｓｉｇｎａ　Ｅｘｃｉｔｅ　ＩＩ　超导型磁共振扫描仪，头颈联合线圈，仰卧位，行ＭＲＩ平扫：ＳＥ序列，轴位Ｔ１ＷＩ，Ｔ２ＷＩ，轴位扩散加权成像（ＤＷＩ）；冠状位Ｔ２ＦＬＡＩＲ；增强扫描：静脉团注Ｇｄ－ＤＴＰＡ，剂量０．１ｍｍｏｌ／Ｋｇ，分别行横断面、矢状面、冠状面Ｔ１ＷＩ扫描，参数与平扫相同。１ＨＭＲＳ：增强扫描前，所有病例均行多体素化学位移成像，在轴位Ｔ２ＷＩ上定位，点分辨波谱分析法（ＰＲＥＳＳ），ＴＥ１４４ｍｓ，兴趣区包括肿瘤实质区、肿瘤坏死区、周围水肿区及对侧正常脑组织。扫描完成后，利用主机软件包Ｆｕｎｃｔｏｏｌ　２处理，得到波谱与解剖的叠加图，分别选择位于肿瘤实质区、肿瘤坏死区、周围水肿区、