脑肿瘤磁共振波谱分析研究
摘要
目的探讨氢质子磁共振波谱~1HMRS在脑肿瘤中的不同表现及临床应用价值。方法使用GE signa ExciteⅡ1.5T超导MR扫描仪对36例经手术活检病理确诊或临床密切随访诊断为脑肿瘤的患者(包括胶质瘤22例,转移瘤11例,淋巴瘤3例)进行常规MRI平扫和增强扫描,并在肿瘤最大层面(包括肿瘤强化区、瘤周水肿区、对侧相应正常脑实质区)设置感兴趣区进行多体素氢质子波谱成像,利用FunctionTool软件对波谱数据进行分析,测量肿瘤组织强化区、瘤周T2WI上高信号区及对侧相应部位正常区主要代谢产物N-乙酰天门冬氨酸(N-acetylaspartate,NAA)、胆碱(Choline-containing compounds,Cho)、肌酸(Creatine and phosphocreatine)浓度,计算Cho/Cr、NAA/Cho、NAA/Cr值。结果胶质瘤的异常强化区、瘤周水肿区的Cho/Cr、NAA/Cho、NAA/Cr值分别为3.1811±2.3135,0.4144±0.2818,1.0485±0.7123;2.0879±1.5921,0.727±0.5272,1.2169±0.7079。转移瘤的异常强化区、瘤周水肿区的Cho/Cr、NAA/Cho、NAA/Cr值分别为3.2104±1.3423,0.6352±0.2086,1.3111±0.4946;1.3313±0.4254,1.1463±0.3303,1.7677±0.7002。以对侧相应部位正常脑实质为参照组,胶质瘤异常强化区及瘤周水肿区与对侧相应部位正常脑实质区的Cho/Cr、NAA/Cho、NAA/Cr值均有统计学差异(P＜0.05);转移瘤异常强化区与对侧相应部位正常脑实质区的Cho/Cr、NAA/Cho、NAA/Cr值均有统计学差异(P＜0.05),转移瘤瘤周水肿区与对侧相应部位正常脑实质区的Cho/Cr、NAA/Cho、NAA/Cr值无统计学差异。胶质瘤异常强化区与瘤周水肿区比较,Cho/Cr、NAA/Cho、NAA/Cr值均无统计学差异。转移瘤异常强化区与瘤周水肿区比较,Cho/Cr、NAA/Cho值有统计学差异(P＜0.05),而NAA/Cr值无统计学差异。胶质瘤与转移瘤异常强化区的Cho/Cr、NAA/Cho、NAA/Cr值无统计学差异;二者的瘤周水肿区的Cho/Cr值无统计学差异,而NAA/Cho、NAA/Cr值差异有统计学意义(P＜0.05)。结论多体素~1HMRS检查对脑肿瘤的诊断、鉴别诊断有重要的临床价值。
Objective To investigate the different manifestations and clinical value of hydrogen proton magnetic resonance spectroscopy in brain tumor.Methods 36 patients with surgical biopsy and clinical follow-up diagnosis of brain tumor were examed by GE signa 1.5T ExciteⅡMR superconducting scanner(22 patients with glioma,metastatic tumors in 11 cases,3 cases of lymphoma).Examing sequences contained conventional MRI scans including Axial TlWI,T2WI,T2FLAIR,DWI and sagittal T2WI and after intravenous injection of Gd-DTPA(Gd-DTPA,0.2mmol/kg),axial,sagittal and coronal T1WI examed. After setting up the largest level in the tumor(including enhanced part,peritumoral edema. corresponding contralateral normal brain parenchyma) to be areas of interest in hydrogen proton spectroscopy scanning,then analyze the collected spectral data using Function Tool software in the areas of enhanced tumor tissue,high signal area on T2WI and corresponding contralateral normal area.The data contains major metabolites peaks.The major metabolites are N-acetylaspartate(NAA),Choline-containing compounds(Cho ), Creatine and phosphocreatine(Cr).Then Cho/Cr,NAA/Cho,NAA/Cr were calculated.Result The Cho/Cr,NAA/Cho,NAA/Cr values of strengthened and edema area of glioma were 3.1811±2.3135,0.4144±0.2818,1.0485±0.7123;2.0879±1.5921,0.727±0.5272,1.2169±0.7079.The Cho / Cr,NAA / Cho,NAA / Cr values of the strengthened and edema of metastases were 3.2104±1.3423,0.6352±0.2086,1.3111±0.4946;1.3313±0.4254,1.1463±0.3303,1.7677±0.7002.Corresponding contralateral normal brain tissue as a reference group,Cho / Cr,NAA / Cho,NAA / Cr values were significant differences(P＜0.05) between abnormal strengthened and edema area of glioma and corresponding contralateral normal area;Cho/Cr,NAA/Cho,NAA/Cr values were significant differences(P＜0.05) between strengthened area of Metastases and the corresponding contralateral normal area.Cho / Cr,NAA / Cho,NAA / Cr was no significant difference between peritumoral edema district of metastases and the corresponding contralateral normal area.Comparing abnormal strengthened area with edema area,Cho/Cr,NAA/Cho,NAA/Cr values were not statistically different in glioma. Cho/Cr,NAA/Cho values have significant difference(P＜0.05)between strengthened and peritumoral edema Regions of metastases;The NAA/Cr was no significant difference. Comparing the abnormal strengthened of glioma with metastatic tumors,the Cho/Cr, NAA/Cho,NAA/Cr were no significant difference;The edema region of both,Cho / Cr was no significant difference,and NAA / Cho,NAA / Cr values are statistically significant differences(P＜0.05).Conclusion Multi-voxel ~1HMRS examination has important clinical value in brain tumor diagnosis and differential diagnosises.
Objective To investigate the different manifestations and clinical value of hydrogen proton magnetic resonance spectroscopy in brain tumor.Methods 36 patients with surgical biopsy and clinical follow-up diagnosis of brain tumor were examed by GE signa 1.5T ExciteⅡMR superconducting scanner(22 patients with glioma,metastatic tumors in 11 cases,3 cases of lymphoma).Examing sequences contained conventional MRI scans including Axial TlWI,T2WI,T2FLAIR,DWI and sagittal T2WI and after intravenous injection of Gd-DTPA(Gd-DTPA,0.2mmol/kg),axial,sagittal and coronal T1WI examed. After setting up the largest level in the tumor(including enhanced part,peritumoral edema. corresponding contralateral normal brain parenchyma) to be areas of interest in hydrogen proton spectroscopy scanning,then analyze the collected spectral data using Function Tool software in the areas of enhanced tumor tissue,high signal area on T2WI and corresponding contralateral normal area.The data contains major metabolites peaks.The major metabolites are N-acetylaspartate(NAA),Choline-containing compounds(Cho ), Creatine and phosphocreatine(Cr).Then Cho/Cr,NAA/Cho,NAA/Cr were calculated.Result The Cho/Cr,NAA/Cho,NAA/Cr values of strengthened and edema area of glioma were 3.1811±2.3135,0.4144±0.2818,1.0485±0.7123;2.0879±1.5921,0.727±0.5272,1.2169±0.7079.The Cho / Cr,NAA / Cho,NAA / Cr values of the strengthened and edema of metastases were 3.2104±1.3423,0.6352±0.2086,1.3111±0.4946;1.3313±0.4254,1.1463±0.3303,1.7677±0.7002.Corresponding contralateral normal brain tissue as a reference group,Cho / Cr,NAA / Cho,NAA / Cr values were significant differences(P＜0.05) between abnormal strengthened and edema area of glioma and corresponding contralateral normal area;Cho/Cr,NAA/Cho,NAA/Cr values were significant differences(P＜0.05) between strengthened area of Metastases and the corresponding contralateral normal area.Cho / Cr,NAA / Cho,NAA / Cr was no significant difference between peritumoral edema district of metastases and the corresponding contralateral normal area.Comparing abnormal strengthened area with edema area,Cho/Cr,NAA/Cho,NAA/Cr values were not statistically different in glioma. Cho/Cr,NAA/Cho values have significant difference(P＜0.05)between strengthened and peritumoral edema Regions of metastases;The NAA/Cr was no significant difference. Comparing the abnormal strengthened of glioma with metastatic tumors,the Cho/Cr, NAA/Cho,NAA/Cr were no significant difference;The edema region of both,Cho / Cr was no significant difference,and NAA / Cho,NAA / Cr values are statistically significant differences(P＜0.05).Conclusion Multi-voxel ~1HMRS examination has important clinical value in brain tumor diagnosis and differential diagnosises.
引文
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