多体素~1H-MRS在分析颅内肿瘤周围区域中的临床应用研究
摘要
目的
应用多体素氢质子磁共振波谱(~1H-MRS)技术探讨颅内肿瘤周围区域的脑代谢改变特点,评价多体素~1H-MRS在颅内肿瘤周围区域中的临床应用价值。
材料与方法
一、临床资料
搜集自2008年1月至2008年9月在本院行常规MRI及多体素~1H-MRS检查的颅内肿瘤病变忠者38例,男19例,女19例,年龄8～77岁,平均50.21岁,其中包括胶质瘤15例、转移瘤9例(原发肿瘤为:肺癌6例,肾癌1例,乳腺癌2例)、脑膜瘤14例(均为良性)。所有患者检查前均没接受过化疗或放疗,没有脑外伤或/和脑手术史。
二、试验设备及方法
采用Philips 1.5T超导磁共振仪,头部正交线圈,仰卧位,先行常规SE序列轴位、冠状位、矢状位扫描(扫描参数:T1加权图像TR=128ms,TE=2.3ms;T2加权图像TR=3000ms,TE=80ms)。然后行多体素质子磁共振波谱扫描,在常规扫描后增强前采用定点分辨磁共振波谱序列(PRESS)扫描,TR 1500ms,TE 136ms,层厚10mm,相位编码20cm×20cm,视野(FOV)22～32cm,激励次数(NEX)1次。自动预扫描完成匀场及水抑制,根据病灶的特征选定感兴趣区(ROI),ROI的大小既要包括肿瘤实质区、肿瘤周围区,也要尽可能的涵盖对侧大脑半球正常脑组织区,同时还要避开骨骼、脑室、血管、坏死、囊变、出血、气体及钙化等区域。成像时间约为320s。后处理应用MR机附带的波谱分析软件自动完成。
三、统计方法
利用SPSS 13.0统计学软件进行统计分析,不同肿瘤实质区及肿瘤周围区代谢物变化的比较均采用单因素方差分析(one-way analysis of variance,ANOVA),两两比较采用最小显著差异法(least-significant difference,LSD);肿瘤实质区、周围区与对侧正常脑组织区各代谢物比值的比较采用两样本t检验;P＜0.05有统计学意义。
结果
多体素~1H-MRS显示脑膜瘤、胶质瘤及转移瘤实质区NAA/Cr、Cho/Cr和NAA/Cho与对侧正常脑组织区相应代谢产物比较均有显著性差异(P值均小于0.01)。脑膜瘤实质区与胶质瘤实质区NAA/Cr、Cho/Cr和NAA/Cho比较有显著统计学差异(P＜0.01,P＜0.01,P＜0.05);脑膜瘤实质区与转移瘤实质区NAA/Cr、Cho/Cr和NAA/Cho比较有显著统计学差异(P＜0.01,P＜0.01,P＜0.05);胶质瘤实质区与转移瘤实质区NAA/Cr、Cho/Cr和NAA/Cho比较均无统计学差异(P值均大于0.05)。
胶质瘤周围区域NAA/Cr、Cho/Cr、NAA/Cho与对侧正常脑组织区相应代谢产物比较均具有统计学意义(P＜0.05,P＜0.01,P＜0.01);脑膜瘤、转移瘤周围区域上述各代谢产物与对侧正常脑组织区比较无统计学意义(P＞0.05)。胶质瘤周围区与脑膜瘤周围区代谢物NAA/Cr、Cho/Cr、NAA/Cho比较均具统计学差异(P＜0.01,P＜0.05,P＜0.01);胶质瘤周围区与转移瘤周围区NAA/Cr、Cho/Cr、NAA/Cho代谢物比值比较均具有统计学差异(P＜0.01,P＜0.05,P＜0.01),但是转移瘤与脑膜瘤周围区域上述各代谢产物之间的比较均无统计学意义(P值均大于0.05)。
结论
多体素~1H-MRS技术在颅内肿瘤周围区域中的评价,有助于进行颅内肿瘤的诊断、鉴别诊断以及预测侵袭性病变的浸润范围等。
Purpose
To study the multivoxel proton magnetic resonance spectroscopy(~1H-MRS) fingdings in peritumoral areas of intracranial tumors and to investigate the value of multivoxel ~1H-MRS in evaluating of peritumoral area of intracranial tumors.
Method and Materials
1.Research object
Thirty-eight patients of intracranial tumor were recruited in this study with 15 gliomas,9 metastases(primary tumor:6 lung cancer、1 renal cancer、2 breast cancer) and 14 meningeomas.All patients were not receiving chemotherapy or radiotherapy, and there is no injury or surgery before examination.
2.Instrument and method
All examinations were performed on Philips 1.5T MR scanner with circularly polarized head coils.All patients underwent MR conventional imaging using spin echo sequence(T1WI:TR=128ms,TE=2.3ms;T2WI:TR= 3000ms,TE=80ms). Multivoxel proton MRS was performed orderly using Point-resolved spectroscopy(PRESS) sequence with TE of 135ms,TR of 1500ms,slice thickness of 10mm、phase encode of 20cm×20cm,FOV of 22～32cm and NEX of 1.Pre-scan completed shimming and water depression automatically,then we selected ROI according to the feature of the focal.Spectra of three voxels were taken from parenchyma of the tumors,peritumoral region and corresponding contra lateral normal appearing white matter,and these regions were evaluated in every patient.The areas of skeleton,brain ventricle、blood vessel、necrosis、bleeding area、gas and calcification were excluded from the voxels.Imaging time was about 320s.Post-processing was completed automatically with spectral analysis software.
3.Statistics analysis
Metabolite change of parenchyma,peritumoral region and contra lateral normal appearing white matte in the spectrum was measured.We applied one-way analysis of variance(ANOVA) to doing inter-class comparisons,and intra-class comparisons were used two-sample t-test.
Result
In multivoxel ~1H-MRS from the parenchyma of the meningeomas、gliomas and metastases,the ratios of NAA/Cr、Cho/Cr and NAA/Cho all changed significantly by comparing with that of normal control brain tissues(P<0.01).The ratios of NAA/Cr, Cho/Cr and NAA/Cho were changed significantly in the parenchyma among gliomas and meningeomas(P<0.01,P<0.01,P<0.05);the same variation was observed among meningeomas and metastases;but there was no significant difference among gliomas and metastases(P>0.05).
The ratios of NAA/Cr,Cho/Cr and NAA/Cho were changed significantly in peritumoral region among gliomas and normal control brain tissues(P<0.05,P<0.01, P<0.01);but there was no significant difference in meningeoma and metastases(P>0.05).The ratios of NAA/Cr,Cho/Cr and NAA/Cho were changed significantly in peritumoral region among gliomas and meningeoma(P<0.01,P<0.05, P<0.01).The ratios of NAA/Cr,Cho/Cr and NAA/Cho were changed significantly in peritumoral region between gliomas and metastases(P<0.01,P<0.05,P<0.01),but there was no significant difference among meningeomas and metastases(P>0.05).
Conclusion
Evaluation of peritumoral region of intracranial tumors with multivoxel ~1H-MRS combining and routine MRI may be useful in the diagnosis,differentiation and deciding the border of intracranial tumors.
应用多体素氢质子磁共振波谱(~1H-MRS)技术探讨颅内肿瘤周围区域的脑代谢改变特点,评价多体素~1H-MRS在颅内肿瘤周围区域中的临床应用价值。
材料与方法
一、临床资料
搜集自2008年1月至2008年9月在本院行常规MRI及多体素~1H-MRS检查的颅内肿瘤病变忠者38例,男19例,女19例,年龄8～77岁,平均50.21岁,其中包括胶质瘤15例、转移瘤9例(原发肿瘤为:肺癌6例,肾癌1例,乳腺癌2例)、脑膜瘤14例(均为良性)。所有患者检查前均没接受过化疗或放疗,没有脑外伤或/和脑手术史。
二、试验设备及方法
采用Philips 1.5T超导磁共振仪,头部正交线圈,仰卧位,先行常规SE序列轴位、冠状位、矢状位扫描(扫描参数:T1加权图像TR=128ms,TE=2.3ms;T2加权图像TR=3000ms,TE=80ms)。然后行多体素质子磁共振波谱扫描,在常规扫描后增强前采用定点分辨磁共振波谱序列(PRESS)扫描,TR 1500ms,TE 136ms,层厚10mm,相位编码20cm×20cm,视野(FOV)22～32cm,激励次数(NEX)1次。自动预扫描完成匀场及水抑制,根据病灶的特征选定感兴趣区(ROI),ROI的大小既要包括肿瘤实质区、肿瘤周围区,也要尽可能的涵盖对侧大脑半球正常脑组织区,同时还要避开骨骼、脑室、血管、坏死、囊变、出血、气体及钙化等区域。成像时间约为320s。后处理应用MR机附带的波谱分析软件自动完成。
三、统计方法
利用SPSS 13.0统计学软件进行统计分析,不同肿瘤实质区及肿瘤周围区代谢物变化的比较均采用单因素方差分析(one-way analysis of variance,ANOVA),两两比较采用最小显著差异法(least-significant difference,LSD);肿瘤实质区、周围区与对侧正常脑组织区各代谢物比值的比较采用两样本t检验;P＜0.05有统计学意义。
结果
多体素~1H-MRS显示脑膜瘤、胶质瘤及转移瘤实质区NAA/Cr、Cho/Cr和NAA/Cho与对侧正常脑组织区相应代谢产物比较均有显著性差异(P值均小于0.01)。脑膜瘤实质区与胶质瘤实质区NAA/Cr、Cho/Cr和NAA/Cho比较有显著统计学差异(P＜0.01,P＜0.01,P＜0.05);脑膜瘤实质区与转移瘤实质区NAA/Cr、Cho/Cr和NAA/Cho比较有显著统计学差异(P＜0.01,P＜0.01,P＜0.05);胶质瘤实质区与转移瘤实质区NAA/Cr、Cho/Cr和NAA/Cho比较均无统计学差异(P值均大于0.05)。
胶质瘤周围区域NAA/Cr、Cho/Cr、NAA/Cho与对侧正常脑组织区相应代谢产物比较均具有统计学意义(P＜0.05,P＜0.01,P＜0.01);脑膜瘤、转移瘤周围区域上述各代谢产物与对侧正常脑组织区比较无统计学意义(P＞0.05)。胶质瘤周围区与脑膜瘤周围区代谢物NAA/Cr、Cho/Cr、NAA/Cho比较均具统计学差异(P＜0.01,P＜0.05,P＜0.01);胶质瘤周围区与转移瘤周围区NAA/Cr、Cho/Cr、NAA/Cho代谢物比值比较均具有统计学差异(P＜0.01,P＜0.05,P＜0.01),但是转移瘤与脑膜瘤周围区域上述各代谢产物之间的比较均无统计学意义(P值均大于0.05)。
结论
多体素~1H-MRS技术在颅内肿瘤周围区域中的评价,有助于进行颅内肿瘤的诊断、鉴别诊断以及预测侵袭性病变的浸润范围等。
Purpose
To study the multivoxel proton magnetic resonance spectroscopy(~1H-MRS) fingdings in peritumoral areas of intracranial tumors and to investigate the value of multivoxel ~1H-MRS in evaluating of peritumoral area of intracranial tumors.
Method and Materials
1.Research object
Thirty-eight patients of intracranial tumor were recruited in this study with 15 gliomas,9 metastases(primary tumor:6 lung cancer、1 renal cancer、2 breast cancer) and 14 meningeomas.All patients were not receiving chemotherapy or radiotherapy, and there is no injury or surgery before examination.
2.Instrument and method
All examinations were performed on Philips 1.5T MR scanner with circularly polarized head coils.All patients underwent MR conventional imaging using spin echo sequence(T1WI:TR=128ms,TE=2.3ms;T2WI:TR= 3000ms,TE=80ms). Multivoxel proton MRS was performed orderly using Point-resolved spectroscopy(PRESS) sequence with TE of 135ms,TR of 1500ms,slice thickness of 10mm、phase encode of 20cm×20cm,FOV of 22～32cm and NEX of 1.Pre-scan completed shimming and water depression automatically,then we selected ROI according to the feature of the focal.Spectra of three voxels were taken from parenchyma of the tumors,peritumoral region and corresponding contra lateral normal appearing white matter,and these regions were evaluated in every patient.The areas of skeleton,brain ventricle、blood vessel、necrosis、bleeding area、gas and calcification were excluded from the voxels.Imaging time was about 320s.Post-processing was completed automatically with spectral analysis software.
3.Statistics analysis
Metabolite change of parenchyma,peritumoral region and contra lateral normal appearing white matte in the spectrum was measured.We applied one-way analysis of variance(ANOVA) to doing inter-class comparisons,and intra-class comparisons were used two-sample t-test.
Result
In multivoxel ~1H-MRS from the parenchyma of the meningeomas、gliomas and metastases,the ratios of NAA/Cr、Cho/Cr and NAA/Cho all changed significantly by comparing with that of normal control brain tissues(P<0.01).The ratios of NAA/Cr, Cho/Cr and NAA/Cho were changed significantly in the parenchyma among gliomas and meningeomas(P<0.01,P<0.01,P<0.05);the same variation was observed among meningeomas and metastases;but there was no significant difference among gliomas and metastases(P>0.05).
The ratios of NAA/Cr,Cho/Cr and NAA/Cho were changed significantly in peritumoral region among gliomas and normal control brain tissues(P<0.05,P<0.01, P<0.01);but there was no significant difference in meningeoma and metastases(P>0.05).The ratios of NAA/Cr,Cho/Cr and NAA/Cho were changed significantly in peritumoral region among gliomas and meningeoma(P<0.01,P<0.05, P<0.01).The ratios of NAA/Cr,Cho/Cr and NAA/Cho were changed significantly in peritumoral region between gliomas and metastases(P<0.01,P<0.05,P<0.01),but there was no significant difference among meningeomas and metastases(P>0.05).
Conclusion
Evaluation of peritumoral region of intracranial tumors with multivoxel ~1H-MRS combining and routine MRI may be useful in the diagnosis,differentiation and deciding the border of intracranial tumors.
引文
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