氢质子磁共振波谱在颅内环形强化病变的应用价值
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摘要
目的探讨氢质子磁共振波谱在高级别脑星形细胞瘤、单发脑转移瘤及脑脓肿的应用价值。
方法选择43例术前行磁共振平扫、增强扫描、二维1H-MRS检查并经外科手术病理证实的脑内环形强化病变患者,其中高级别星形细胞瘤28例,单发脑转移瘤6例,脑脓肿9例。使用Sienens Sonata 1.5T超导型磁共振扫描仪,常规横断位T1WI SE(TR/TE=500/7.7ms)、T2WI TSE序列(TR/TE=4000/95ms),辅以T1WI矢状位,扫描层厚5mm,间隔1mm,层数20,采集次数2,矩阵256×256,翻转角90°。全部病例均做增强扫描,马根维显剂量0.1 mmol/kg,经肘静脉快速注射后,立即行横断位、矢状位及冠状位T1WI扫描。1H-MRS检查采用二维多体素检查方法,点分辨波谱序列(PRESS),TR/TE=1500/135ms,体素大小1cm×1cm×1cm,匀场、水抑制和信号采集均为自动完成,测定病变强化区、病灶周围区N-乙酰天冬氨酸(NAA)、胆碱(Cho)、肌酐(Cr)以及对侧正常脑白质参照区NAA、Cho、肌酐(Cr-n)的代谢物浓度。
结果高级别星形细胞瘤强化区和周围区NAA/Cr、Cho/Cr及NAA/Cho分别与对侧正常脑白质各代谢物比值比较有显著性差异(P<0.05),单发脑转移瘤和脑脓肿强化区各代谢物比值与对侧正常脑白质比较有显著性差异(P<0.05),周围区各代谢物比值与对侧正常脑白质比较无显著性差异(P>0.05)。强化区Cho/Cr-n比值在高级别脑星形细胞瘤、单发脑转移瘤和脑脓肿分别为2.85±0.23、2.79±0.78、1.13±0.08,前两者与脑脓肿均有显著性差异(P<0.05)。病灶周围区Cho/Cr比值在高级别脑星形细胞瘤、单发脑转移瘤和脑脓肿分别为2.25±0.21、1.47±0.16、1.57±0.15;病灶周围区NAA/Cho比值在高级别脑星形细胞瘤、单发脑转移瘤和脑脓肿分别为0.80±0.27、1.24±0.17、1.22±0.16,病灶周围区Cho/Cr和NAA/Cho分别在高级别脑星形细胞瘤和单发脑转移瘤组以及高级别脑星形细胞瘤和脑脓肿组存在显著性差异(P<0.05)。
结论对于单发颅脑环形强化病灶,测定病变强化区Cho/Cr-n、病灶周围区Cho/Cr和NAA/Cho有助于鉴别高级别星形细胞瘤、单发脑转移瘤和脑脓肿,是对常规MRI的重要补充。
Purpose To evaluate the value of 1H-MRS in differential diagnosis on high-grade cerebral astrocytomas , solitary metastases and cerebral abscesses.
Materials and Methods 43 patients with histological verified(28 cases of high-grade cerebral astrocytomas,6 cases of solitary metastases and 9 cases of cerebral abscesses) were examined with conventional MRI and 1H-MRS before operation by Sienens Sonata 1.5T. Multivoxel 1H–MRS was performed and spectra of three voxels were taken from enhanced-solid part of the lesion, perienhancement region and normal white matter.Fitted areas in the spectrum for NAA, Cho, Cr.
Results In multivoxel 1H-MRS from the enhanced-solid part and perienhancement region of high-grade cerebral astrocytomas, the ratios of NAA/Cr, Cho/Cr and NAA/Cho changed significantly by comparing with that of normal control brain tissues. In voxel from enhanced-solid part of the solitary metastases and abscesses, All ratios changed significantly by comparing with that of normal control brain tissues. In voxel from perienhancement region of the solitary metastases and abscesses, All ratios no significant by comparing with that of normal control brain tissues. In voxel from enhanced-solid part of high-grade cerebral astrocytomas、solitary metastases and abscesses, the ratio of Cho/Cr-n was 2.85±0.23、2.79±0.78and1.13±0.08,it was changed significantly by comparing between high-grade cerebral astrocytomas and abscesses, solitary metastases and abscesses. In the perienhancement region the ratios of Cho/Cr changed significantly by comparing between high-grade cerebral astrocytomas(2.25±0.21) and solitary metastases(1.47±0.16), high-grade cerebral astrocytomas(2.25±0.21)and abscesses(1.57±0.15). In the perienhancement region the ratios of NAA/Cho changed significantly by comparing between high-grade cerebral astrocytomas(0.80±0.27) and solitary metastases(1.24±0.17), high-grade cerebral astrocytomas(2.25±0.21)and abscesses(1.22±0.16).
Conclusion Combining with routine MRI scan, the ratio of Cho/Cr-n in the enhanced-solid part and the ratios of Cho/Cr and NAA/Cho in the perienhancement region were important to diagnosis intracranial lesions with ring-like enhancement(high-grade cerebral astrocytomas、solitary metastases and abscesses).
方法选择43例术前行磁共振平扫、增强扫描、二维1H-MRS检查并经外科手术病理证实的脑内环形强化病变患者,其中高级别星形细胞瘤28例,单发脑转移瘤6例,脑脓肿9例。使用Sienens Sonata 1.5T超导型磁共振扫描仪,常规横断位T1WI SE(TR/TE=500/7.7ms)、T2WI TSE序列(TR/TE=4000/95ms),辅以T1WI矢状位,扫描层厚5mm,间隔1mm,层数20,采集次数2,矩阵256×256,翻转角90°。全部病例均做增强扫描,马根维显剂量0.1 mmol/kg,经肘静脉快速注射后,立即行横断位、矢状位及冠状位T1WI扫描。1H-MRS检查采用二维多体素检查方法,点分辨波谱序列(PRESS),TR/TE=1500/135ms,体素大小1cm×1cm×1cm,匀场、水抑制和信号采集均为自动完成,测定病变强化区、病灶周围区N-乙酰天冬氨酸(NAA)、胆碱(Cho)、肌酐(Cr)以及对侧正常脑白质参照区NAA、Cho、肌酐(Cr-n)的代谢物浓度。
结果高级别星形细胞瘤强化区和周围区NAA/Cr、Cho/Cr及NAA/Cho分别与对侧正常脑白质各代谢物比值比较有显著性差异(P<0.05),单发脑转移瘤和脑脓肿强化区各代谢物比值与对侧正常脑白质比较有显著性差异(P<0.05),周围区各代谢物比值与对侧正常脑白质比较无显著性差异(P>0.05)。强化区Cho/Cr-n比值在高级别脑星形细胞瘤、单发脑转移瘤和脑脓肿分别为2.85±0.23、2.79±0.78、1.13±0.08,前两者与脑脓肿均有显著性差异(P<0.05)。病灶周围区Cho/Cr比值在高级别脑星形细胞瘤、单发脑转移瘤和脑脓肿分别为2.25±0.21、1.47±0.16、1.57±0.15;病灶周围区NAA/Cho比值在高级别脑星形细胞瘤、单发脑转移瘤和脑脓肿分别为0.80±0.27、1.24±0.17、1.22±0.16,病灶周围区Cho/Cr和NAA/Cho分别在高级别脑星形细胞瘤和单发脑转移瘤组以及高级别脑星形细胞瘤和脑脓肿组存在显著性差异(P<0.05)。
结论对于单发颅脑环形强化病灶,测定病变强化区Cho/Cr-n、病灶周围区Cho/Cr和NAA/Cho有助于鉴别高级别星形细胞瘤、单发脑转移瘤和脑脓肿,是对常规MRI的重要补充。
Purpose To evaluate the value of 1H-MRS in differential diagnosis on high-grade cerebral astrocytomas , solitary metastases and cerebral abscesses.
Materials and Methods 43 patients with histological verified(28 cases of high-grade cerebral astrocytomas,6 cases of solitary metastases and 9 cases of cerebral abscesses) were examined with conventional MRI and 1H-MRS before operation by Sienens Sonata 1.5T. Multivoxel 1H–MRS was performed and spectra of three voxels were taken from enhanced-solid part of the lesion, perienhancement region and normal white matter.Fitted areas in the spectrum for NAA, Cho, Cr.
Results In multivoxel 1H-MRS from the enhanced-solid part and perienhancement region of high-grade cerebral astrocytomas, the ratios of NAA/Cr, Cho/Cr and NAA/Cho changed significantly by comparing with that of normal control brain tissues. In voxel from enhanced-solid part of the solitary metastases and abscesses, All ratios changed significantly by comparing with that of normal control brain tissues. In voxel from perienhancement region of the solitary metastases and abscesses, All ratios no significant by comparing with that of normal control brain tissues. In voxel from enhanced-solid part of high-grade cerebral astrocytomas、solitary metastases and abscesses, the ratio of Cho/Cr-n was 2.85±0.23、2.79±0.78and1.13±0.08,it was changed significantly by comparing between high-grade cerebral astrocytomas and abscesses, solitary metastases and abscesses. In the perienhancement region the ratios of Cho/Cr changed significantly by comparing between high-grade cerebral astrocytomas(2.25±0.21) and solitary metastases(1.47±0.16), high-grade cerebral astrocytomas(2.25±0.21)and abscesses(1.57±0.15). In the perienhancement region the ratios of NAA/Cho changed significantly by comparing between high-grade cerebral astrocytomas(0.80±0.27) and solitary metastases(1.24±0.17), high-grade cerebral astrocytomas(2.25±0.21)and abscesses(1.22±0.16).
Conclusion Combining with routine MRI scan, the ratio of Cho/Cr-n in the enhanced-solid part and the ratios of Cho/Cr and NAA/Cho in the perienhancement region were important to diagnosis intracranial lesions with ring-like enhancement(high-grade cerebral astrocytomas、solitary metastases and abscesses).
引文
[1] Kleihuse P, Cavenee WK. Pathology and genetics of tumors of the nervous system. Lyon IARC Press, 2000:6-7.
[2] Ross B, Michaelis T. Clinical applications of magnetic resonance spectroscopy [J]. Mag Reson Q, 1999,10:191-247.
[3]赵喜平.磁共振成像系统的原理及其应用[M].北京:科学出版社,2000.12.
[4] Dowling C, Bollen AW, Noworolski SM,et al. Preoperative proton MR spectroscopic imaging of brain tumors: correlation with histopathologic analysis of resection specimens. AJNR,2001,22:604-609..
[5] Law M, Cha S, Knopp EA, et al. High-grade gliomas and solitary metastases: differentiation by using perfusion and proton spectroscopic MR imaging[J].Radiology, 2002;222(3):715-721.
[6] Hanstock CC,Rothman DJ,Prichard JW et al.Spatially localized 1H NMR spectra of metaolites in the human brain[J].Proc Natl Acad Sci USA,1998,85:1821-1825.
[7] MS van der Knaap,J van der Grond,PC van Rijen.Age-dependent changes in localized proton and phosphorus MR spectroscopy of the brain.Radiology 1995;176:509-515.
[8]陈星荣,沈天真,段承祥,等主编。全身CT和MRI[J].上海:上海医科大学出版社,1993:32-47.
[9] Duyn JH,Gillen J,Sobering G.Multisection proton MR spectr oscopic imaging of the brain.Radiology 1997;188:277-282.
[10] Roland K,Thomas E,Brain D.Devlopment of the human brain:in vivo quantification of metabolite and water content with proton magnetic resonance spectroscopy.MRM 1993;30:424-437.
[11] Leclerc X, Huisman TA, Sorensen AG. The potential of proton magnetic resonance spectroscopy ((1)H-MRS) in the diagnosis and management of patients with brain tumors. Curr Opin Oncol, 2002,14(3):292-298.
[12] Burtscher IM, Skagerberg G, Geijer B, et al. Proton MR spectroscopy and reoperative diagnostic accuracy :an evaluation of intracranial mass lesions characterized by stereo tactic biopsy findings. AJNR, 2000,21(1):84-93.
[13] Poptani H, Gupta RK, Jain VK,et al. Cystic intracranial mass lesions: possible role of in vivo MR spectroscopy in its differential diagnosis. Magn Reson Imaging,1995,13:1019-1023.
[14] Nguyen JB, Black BR, Leimkuehler MM,et al. Intracranial pyogenic abscess: imaging diagnosis utilizing recent advances in computed tomography and magnetic resonance imaging. Crit Rev Comput Tomogr,2004, 45:18-22.
[15] Lai PH, Hsu SS, Ding SW, et al. Proton magnetic resonance spectroscopy and diffusion-weighted imaging in intracranial cystic mass lesions. Surg Neurol.2007, 8(11):25-31.
[16] Hwang YF, Huang TY, Hwang SL, et al. Differentiation among metastatic brain tumors, radiation necroses, and brain abscesses using proton magnetic resonance spectroscopy. Kaohsiung J Med Sci.2004,20(9);437-442.
[17] Grand S, Ternier J,Rousseau N, et al. Cerebral abscess: MRI, DWI and MRS features. J Neuroradiol,2004,31(2),145-149.
[18] Croteau D, Scarpace L, Hearshen D,et al. Correlation between magnetic resonance spectroscopy imaging and image-guided biopsies: semiquantitative and qualitative histopathological analyses of patients with untreated glioma. Neurosurgery, 2001,49(4):823-830.
[19] Grand S, Passaro G, Ziegler A, et al.Necrotic tumor versus brain abscesses: importance of amino acids detected at 1H-MR spectroscopy-initial results. Radiology, 1999;213:785-793.
[20] Law M, Cha S, Knopp EA, et al. High-grade gliomas and solitary metastases: differentiation by using perfusion and proton spectroscopic MR imaging[J]. Radiology, 2002,222(3):715-721.
[21] Hartmann WM, Herminghaus S, Krings T, et al. Clinical application of proton resonance spectroscopy in the diagnosis of intracranial mass lesions. Neuroradiology, 2002, 44:371-378.
[22] Himmelreich U,Dzendrowskyj T,Allen C,et al. Cryptococcomas distinguished from gliomas with MR spectroscopy: an experimental rat and cell culture study. Radiology, 2001,220:122-128.
[23]方维东,罗天友,吕发金,等。Cho/Cr-n相对值测定在脑脓肿与坏死囊性变胶质瘤和脑转移瘤鉴别诊断中的价值。临床放射学杂志,2005,24(9):769-772.
[1] Ross B ,Michaelis T. Clinical applications of magnetic spectroscopy. Magn Reson Q , 1994 ; 10 : 191～247.
[2] Chan J HM. Physical principles of single– volume proton spectroscopy. J Hong Kong Coll Radio , 1999 ;2 :271～- 277.
[3] Ramin SL, Tognola WA, Spotti AR. Proton magnetic resonance spectroscopy: clinical applications in patients with brain lesions. Sao Paulo Med J. 2003 ,121(6):254-9
[4] Tedeschi G,Lundborn N,Raman R,et al. Increased choline signal coinciding with malignant degeneration of cerebral gliomas:a serial proton magnetic resonance spectroscopy imaging study[J].J Neurosurg, 1997, 87(4):516～524.
[5] Simone IL, Tortorella C, Federico F. The contribution of 1H-magnetic resonance spectroscopy in defining the pathophysiology of multiple sclerosis[J]. Ital J Neurol Sci ,1999,20:241～245.
[6] Castillo M. Smith J K, Kwock L et al. Correlation of myo-inositol levels and grading of cerebral astromas[J]. Am J Neuroradiol, 2000.21(9):1645-1649.
[7] Harish P, Rakesh K,Vijendera K, et al. Cystic intracranial mass lesions: possible role of in vivo MR spectroscopy in its differential diagnosis. Magnetic resonance imaging, 1995, Vol.13,1019-1029.
[8] Andréia VF, Fabiano R, Ver?nica AZ, et al. The pattern of proton magnetic resonance spectroscopy in non-neoplastic encephalic lesions. Arq Neuropsiquiatr. 2004,62 (2-B) :429-436
[9] Chang KH, Song IC, Kim SH, et al. In Vivo Single-Voxel Proton MR Spectroscopy in Intracranial Cystic Masses. AJNR Am J Neuroradiol 1998,19:401–405.
[10]董海波,戴嘉中,蔡佩武,等. 1H磁共振波谱在星形细胞瘤放疗后复发和放射性脑坏死鉴别中的初步应用.中华放射学杂志, 2001, 35: 439-441.
[11] Majos C, Alonso J,Aguilera C,et al.Proton magnetic resonance spectroscopy(1H MRS) of human brain tumours:assessment of differences between tumour types and its applicability in brain tumour categorization.Eur Radiol,2003;13:582-591.
[12] Hartmann MV,Herminghaus S,Krings T,et al. Clinical application of proton magnetic resonance spectroscopy in the diagnosis of intracranial mass lesions. Neuroradiology, 2002;44:371-381.
[13] Bulakbasi N, Kocaoglu M, Ors F, et al. Combination of single-voxel proton MR spectroscopy and apparent diffusion coefficient calculation in the evaluation of common brain tumors. AJNR, 2003;24(2):225-233.
[14] Isimaru H,Morikawa M, Iwanaga S,et al.Differentiation between high-grade glioma andmetastatic brain tumor using single-voxel proton MR spectroscopy.Eur Radiol, 2001; 11:1784-1791.
[15]吴光耀,雷皓,孙骏谟等。颅内囊性病变1HMR波谱分析。中华放射学杂志,2006,40(4):389-392
[16] Kimura T, Sako K, Gotch T et al. In vivo single-voxel proton MR spectroscopy in brain lesions with ring-like enhancement [J]. NMR Biomed, 2001;14(6):339-349.
[17] Law M, Cha S, Edmond A, et al. High-grade gliomas and solitary metastases: differentiation by using perfusion and proton spectroscopic MR imaging, Radiology, 2002; 222: 751-721.
[18]孙庚喜,罗柏宁,张波。1H-MRS对脑转移瘤和恶性胶质瘤的鉴别诊断作用。临床放射学杂志,2005,24(11):955-959。
[19] Shukla-Dave A, Gupta RK, Roy R, et al. Prospective evaluation of in vivo proton MR Spectroscopy in differentiation of similar appearing intracranial cystic lesions. Magn Reson Imaging, 2001;19:103-110.
[20] Kim SH, Chang KH, Song IC, et al. Brain abscess and brain tumor: discrimination with in vivo H-1 MR spectroscopy. Radiology,1997;204,239-245.
[21] Grand S, Passaro G, Ziegler A, et al. Necrotic tumor versus brain abscess: importance of amino acids detected at 1H MR spectroscopy initial results. Radiology, 1999;213:785-793.
[22] Osamu K,Kanehisa K,Shiro O, et al. Discrimination of brain abscess and cystic tumor by in vivo proton magnetic resonance spectroscopy. Neuro Med Chir(Tokyo) 2001,41,121-126,.
[23] Asht M, Rakesh K, Ramandeep S, et al. Role of diffusion-weighted imaging and in vivo proton magnetic resonance spectroscopy in the differential diagnosis of ring-enhancing intracranial cystic mass lesion. Neuroimaging,2004,28,540-547.
[2] Ross B, Michaelis T. Clinical applications of magnetic resonance spectroscopy [J]. Mag Reson Q, 1999,10:191-247.
[3]赵喜平.磁共振成像系统的原理及其应用[M].北京:科学出版社,2000.12.
[4] Dowling C, Bollen AW, Noworolski SM,et al. Preoperative proton MR spectroscopic imaging of brain tumors: correlation with histopathologic analysis of resection specimens. AJNR,2001,22:604-609..
[5] Law M, Cha S, Knopp EA, et al. High-grade gliomas and solitary metastases: differentiation by using perfusion and proton spectroscopic MR imaging[J].Radiology, 2002;222(3):715-721.
[6] Hanstock CC,Rothman DJ,Prichard JW et al.Spatially localized 1H NMR spectra of metaolites in the human brain[J].Proc Natl Acad Sci USA,1998,85:1821-1825.
[7] MS van der Knaap,J van der Grond,PC van Rijen.Age-dependent changes in localized proton and phosphorus MR spectroscopy of the brain.Radiology 1995;176:509-515.
[8]陈星荣,沈天真,段承祥,等主编。全身CT和MRI[J].上海:上海医科大学出版社,1993:32-47.
[9] Duyn JH,Gillen J,Sobering G.Multisection proton MR spectr oscopic imaging of the brain.Radiology 1997;188:277-282.
[10] Roland K,Thomas E,Brain D.Devlopment of the human brain:in vivo quantification of metabolite and water content with proton magnetic resonance spectroscopy.MRM 1993;30:424-437.
[11] Leclerc X, Huisman TA, Sorensen AG. The potential of proton magnetic resonance spectroscopy ((1)H-MRS) in the diagnosis and management of patients with brain tumors. Curr Opin Oncol, 2002,14(3):292-298.
[12] Burtscher IM, Skagerberg G, Geijer B, et al. Proton MR spectroscopy and reoperative diagnostic accuracy :an evaluation of intracranial mass lesions characterized by stereo tactic biopsy findings. AJNR, 2000,21(1):84-93.
[13] Poptani H, Gupta RK, Jain VK,et al. Cystic intracranial mass lesions: possible role of in vivo MR spectroscopy in its differential diagnosis. Magn Reson Imaging,1995,13:1019-1023.
[14] Nguyen JB, Black BR, Leimkuehler MM,et al. Intracranial pyogenic abscess: imaging diagnosis utilizing recent advances in computed tomography and magnetic resonance imaging. Crit Rev Comput Tomogr,2004, 45:18-22.
[15] Lai PH, Hsu SS, Ding SW, et al. Proton magnetic resonance spectroscopy and diffusion-weighted imaging in intracranial cystic mass lesions. Surg Neurol.2007, 8(11):25-31.
[16] Hwang YF, Huang TY, Hwang SL, et al. Differentiation among metastatic brain tumors, radiation necroses, and brain abscesses using proton magnetic resonance spectroscopy. Kaohsiung J Med Sci.2004,20(9);437-442.
[17] Grand S, Ternier J,Rousseau N, et al. Cerebral abscess: MRI, DWI and MRS features. J Neuroradiol,2004,31(2),145-149.
[18] Croteau D, Scarpace L, Hearshen D,et al. Correlation between magnetic resonance spectroscopy imaging and image-guided biopsies: semiquantitative and qualitative histopathological analyses of patients with untreated glioma. Neurosurgery, 2001,49(4):823-830.
[19] Grand S, Passaro G, Ziegler A, et al.Necrotic tumor versus brain abscesses: importance of amino acids detected at 1H-MR spectroscopy-initial results. Radiology, 1999;213:785-793.
[20] Law M, Cha S, Knopp EA, et al. High-grade gliomas and solitary metastases: differentiation by using perfusion and proton spectroscopic MR imaging[J]. Radiology, 2002,222(3):715-721.
[21] Hartmann WM, Herminghaus S, Krings T, et al. Clinical application of proton resonance spectroscopy in the diagnosis of intracranial mass lesions. Neuroradiology, 2002, 44:371-378.
[22] Himmelreich U,Dzendrowskyj T,Allen C,et al. Cryptococcomas distinguished from gliomas with MR spectroscopy: an experimental rat and cell culture study. Radiology, 2001,220:122-128.
[23]方维东,罗天友,吕发金,等。Cho/Cr-n相对值测定在脑脓肿与坏死囊性变胶质瘤和脑转移瘤鉴别诊断中的价值。临床放射学杂志,2005,24(9):769-772.
[1] Ross B ,Michaelis T. Clinical applications of magnetic spectroscopy. Magn Reson Q , 1994 ; 10 : 191～247.
[2] Chan J HM. Physical principles of single– volume proton spectroscopy. J Hong Kong Coll Radio , 1999 ;2 :271～- 277.
[3] Ramin SL, Tognola WA, Spotti AR. Proton magnetic resonance spectroscopy: clinical applications in patients with brain lesions. Sao Paulo Med J. 2003 ,121(6):254-9
[4] Tedeschi G,Lundborn N,Raman R,et al. Increased choline signal coinciding with malignant degeneration of cerebral gliomas:a serial proton magnetic resonance spectroscopy imaging study[J].J Neurosurg, 1997, 87(4):516～524.
[5] Simone IL, Tortorella C, Federico F. The contribution of 1H-magnetic resonance spectroscopy in defining the pathophysiology of multiple sclerosis[J]. Ital J Neurol Sci ,1999,20:241～245.
[6] Castillo M. Smith J K, Kwock L et al. Correlation of myo-inositol levels and grading of cerebral astromas[J]. Am J Neuroradiol, 2000.21(9):1645-1649.
[7] Harish P, Rakesh K,Vijendera K, et al. Cystic intracranial mass lesions: possible role of in vivo MR spectroscopy in its differential diagnosis. Magnetic resonance imaging, 1995, Vol.13,1019-1029.
[8] Andréia VF, Fabiano R, Ver?nica AZ, et al. The pattern of proton magnetic resonance spectroscopy in non-neoplastic encephalic lesions. Arq Neuropsiquiatr. 2004,62 (2-B) :429-436
[9] Chang KH, Song IC, Kim SH, et al. In Vivo Single-Voxel Proton MR Spectroscopy in Intracranial Cystic Masses. AJNR Am J Neuroradiol 1998,19:401–405.
[10]董海波,戴嘉中,蔡佩武,等. 1H磁共振波谱在星形细胞瘤放疗后复发和放射性脑坏死鉴别中的初步应用.中华放射学杂志, 2001, 35: 439-441.
[11] Majos C, Alonso J,Aguilera C,et al.Proton magnetic resonance spectroscopy(1H MRS) of human brain tumours:assessment of differences between tumour types and its applicability in brain tumour categorization.Eur Radiol,2003;13:582-591.
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