3.0T ~1H-MRS在脑星形细胞瘤分级中的应用
摘要
目的探讨3.0T氢质子磁共振波谱(1H-MRS)在脑星形细胞瘤分级中的临床应用价值。
方法采用3.0T超导型磁共振成像波谱一体化扫描系统(MAGNETOM Trio Tim德国西门子公司),分析20例正常脑组织及45例脑星形细胞瘤。其中I级星形细胞瘤6例;II级星形细胞瘤16例;III级星形细胞瘤12例;IV级星形细胞瘤11例;所有患者术前均行MR常规扫描,随后行二维多体素1H-MRS检查,检测肿瘤病灶区及对侧正常参照区N-乙酰门冬氨酸(NAA)、胆碱(Cho)、肌酸(Cr)、乳酸(Lac)、肌醇(mI)和脂质(Lip)峰代谢物浓度,比较四级肿瘤病灶区代谢物含量及各级内比较肿瘤病灶区与对侧正常参照区NAA/Cr、Cho/Cr及NAA/Cho比值。
结果脑星形细胞瘤波谱表现NAA下降,Cho升高,相应NAA/Cho和NAA/Cr比值降低,而Cho/Cr比值升高,23例出现Lac峰,30例出现mI峰,18例出现Lip峰。各组肿瘤病灶区、与对侧正常参照区NAA/Cr、Cho/Cr及NAA/Cho比值比较均有显著性差异( P<0.05 )。病灶区Cho/Cr比值在I、II、III、IV级分别是1.44±0.15、1.85±0.35、2.81±0.22、4.38±0.39;各级别Cho/Cr比值之间均有显著性差异( P<0.05 )。NAA/Cr ,NAA/Cho比值在II、III、IV级间均无显著性差异(P>0.05),I级与II、III、IV级间有显著性差异( P<0.05 )。
结论各级别星形细胞瘤1H-MRS N-乙酰门冬氨酸(NAA)、胆碱(Cho)、肌酸(Cr)、乳酸(Lac)、肌醇( mI)和脂质(Lip)等各种化学成份含量和NAA/Cr、Cho/Cr及NAA/Cho比值均存在着差异,通过测量和分析上述指标可以进一步提高星形细胞瘤分级诊断的准确率,有助于术前手术方案的制定及术后治疗方案的选择。
Objective: To investigate the value of 3T 1H-MRS on grading cerebral gliomas.
Methods: 3.0 T magnetic resonance spectroscopy (MRS) was obtained in a total of 20 normal cases and 45 patients with cerebral gliomas ( grade one 6, grade two16, grade three 12, grade four 11). 45 cases of astrocytomas underwent routine MRI, and 1H-MRS spectroscopy examination. N-acetylaspartate(NAA),Choline(Cho),Creatine(Cr),Lactate(Lac) and myo-Inositol(mI) were measured in the regions of tumor,and corresponding normal brain. NAA/Cr、Cho/Cr and NAA/Cho ratios were obtained from both the regions of tumor and corresponding normal brain of each group and that of four grades.
Results: We can observe the decreasing of NAA and increasing of Cho in the region of tumor. While Lac signal was detected in 23 patients and mI signal was detected in 30 patients, Lip signal was detected in 18 patients. In the regions of tumor, the NAA/Cr,NAA/Cho and Cho/Cr ratios changed significantly by comparing with that of normal control of brain tissue . Cho to Cr ratios of four grades were (1.44±0.15,1.85±0.35,2.81±0.22,4.38±0.39).A significant difference existed the Cho/Cr ratios in the region of tumor among the four group (P<0.05),but no significant different existed the NAA/Cr,NAA/Cho among II to IV groups (P >0.05).
Conclusion: Each rank of astrocytoma has difference in various chemical composition content including NAA, Cho, Cr, Lac, Lip, mI etc. NAA/Cr、Cho/Cr and NAA/Cho ratios also exited difference among each rank of astrocytoma. Surveys and analyzes each chemical composition content and the ratio difference of various ranks can improve diagnostic accuracy of astrocytoma, and provides a helpful surgery plan and the choice of treating plan after surgery.
方法采用3.0T超导型磁共振成像波谱一体化扫描系统(MAGNETOM Trio Tim德国西门子公司),分析20例正常脑组织及45例脑星形细胞瘤。其中I级星形细胞瘤6例;II级星形细胞瘤16例;III级星形细胞瘤12例;IV级星形细胞瘤11例;所有患者术前均行MR常规扫描,随后行二维多体素1H-MRS检查,检测肿瘤病灶区及对侧正常参照区N-乙酰门冬氨酸(NAA)、胆碱(Cho)、肌酸(Cr)、乳酸(Lac)、肌醇(mI)和脂质(Lip)峰代谢物浓度,比较四级肿瘤病灶区代谢物含量及各级内比较肿瘤病灶区与对侧正常参照区NAA/Cr、Cho/Cr及NAA/Cho比值。
结果脑星形细胞瘤波谱表现NAA下降,Cho升高,相应NAA/Cho和NAA/Cr比值降低,而Cho/Cr比值升高,23例出现Lac峰,30例出现mI峰,18例出现Lip峰。各组肿瘤病灶区、与对侧正常参照区NAA/Cr、Cho/Cr及NAA/Cho比值比较均有显著性差异( P<0.05 )。病灶区Cho/Cr比值在I、II、III、IV级分别是1.44±0.15、1.85±0.35、2.81±0.22、4.38±0.39;各级别Cho/Cr比值之间均有显著性差异( P<0.05 )。NAA/Cr ,NAA/Cho比值在II、III、IV级间均无显著性差异(P>0.05),I级与II、III、IV级间有显著性差异( P<0.05 )。
结论各级别星形细胞瘤1H-MRS N-乙酰门冬氨酸(NAA)、胆碱(Cho)、肌酸(Cr)、乳酸(Lac)、肌醇( mI)和脂质(Lip)等各种化学成份含量和NAA/Cr、Cho/Cr及NAA/Cho比值均存在着差异,通过测量和分析上述指标可以进一步提高星形细胞瘤分级诊断的准确率,有助于术前手术方案的制定及术后治疗方案的选择。
Objective: To investigate the value of 3T 1H-MRS on grading cerebral gliomas.
Methods: 3.0 T magnetic resonance spectroscopy (MRS) was obtained in a total of 20 normal cases and 45 patients with cerebral gliomas ( grade one 6, grade two16, grade three 12, grade four 11). 45 cases of astrocytomas underwent routine MRI, and 1H-MRS spectroscopy examination. N-acetylaspartate(NAA),Choline(Cho),Creatine(Cr),Lactate(Lac) and myo-Inositol(mI) were measured in the regions of tumor,and corresponding normal brain. NAA/Cr、Cho/Cr and NAA/Cho ratios were obtained from both the regions of tumor and corresponding normal brain of each group and that of four grades.
Results: We can observe the decreasing of NAA and increasing of Cho in the region of tumor. While Lac signal was detected in 23 patients and mI signal was detected in 30 patients, Lip signal was detected in 18 patients. In the regions of tumor, the NAA/Cr,NAA/Cho and Cho/Cr ratios changed significantly by comparing with that of normal control of brain tissue . Cho to Cr ratios of four grades were (1.44±0.15,1.85±0.35,2.81±0.22,4.38±0.39).A significant difference existed the Cho/Cr ratios in the region of tumor among the four group (P<0.05),but no significant different existed the NAA/Cr,NAA/Cho among II to IV groups (P >0.05).
Conclusion: Each rank of astrocytoma has difference in various chemical composition content including NAA, Cho, Cr, Lac, Lip, mI etc. NAA/Cr、Cho/Cr and NAA/Cho ratios also exited difference among each rank of astrocytoma. Surveys and analyzes each chemical composition content and the ratio difference of various ranks can improve diagnostic accuracy of astrocytoma, and provides a helpful surgery plan and the choice of treating plan after surgery.
引文
[1] Vion-Dury J, Meyerhoff DJ, Cozzone PJ, et al. What might be the impact on neurology of the analysis of brain metabolism by in vivo magnetic resonance spectroscopy? [J] Neurol, 1994, 241:354-371
[2] Rudkin FM,Arnold DL.Proton magnetic resonance spectroscopy for the diagnosis and management of cerebral disorders.[J] Arch Neurol,1999,56(8):919-926
[3] Castilo M.Co.elation of myo-inositol levels and gradings of cerebral astrocytomas.[J]AJNR,2000,21(10):1645-1649.
[4] Smith JK,Castillo M,Kwock L,et a1.MR spetroscopy of brain tumors.[J]Magn Reson Imaging Clin N Am,2003,11:415-429.
[5]Weybright P , Maly P . MR spectroscopy in the evaluation of recurrent contrast-enhancing lesions in the posterior fossa after tumor treatment.[J]Neuroradiology,2004,46(7):541-549.
[6]Kumar A, Kaushik S, Tripathi RP. Et al. Role of in vivo proton MR spectroscopy in the evaluation of adult brain lesions: our preliminary experience. [J] Neurol Indin.2003.51 (4):474-478
[7]Kaminogo M, Ishimaru H,Morikawa M, et al. Diagnostic potential of short echo time MR spectroscopy of gliomas with single-voxel and point-resolved spatially localised proton spectroscopy of brain. [J] Neuroradiology.2001, 43(5):353-363
[8]Meyerand ME, Pipas JM, Maamourian A, et al. Classification of biopsy-confirmed brain tumors using single-voxel MR spectroscopy.[J] AJNR,1999,20(1):117-123
[9]Jeffry RA, Sophia CS, Albert B, et al. Classification of biopsy confirmed brain tumors using Single-voxel MR spectroscopy[J]. AJNR, 1999, 20:117-123
[10]ShimIzu H, Kumabe T, Shirane R, et al. Correlation between choline levels measured by proton MR spectroscopy and KI-67 labeling index gliomas. [J] AJNR, 2000, 21(4):659-665
[11]Negendank WG, Sauter R, Brown TR, et al. Proton magnetic resonance spectroscopy in patients with glial tumors: a multicenter study. [J] J Neurosurg,1996,84(3):449-58
[12] Kim J H, Chang K H, Na D G, et al. 3T 1H-MR spectroscopy in grading of cerebral gliomas: comparison of short and intermediate echo time sequences. [J]AJNR Am J Neuroradiol,2006,27(7):1412-1418.
[13] Jeun S S, Kim M C, Kim B S, et al. Assessment of malignancy in gliomas by 3T 1H MR spectroscopy . [J]Clin Imaging , 2005, 29(1):10-15.
[14] Castilo M. Co.elation of myo-inositol levels and gradings of cerebral astrocytomas[J].AJNR, 2000,21(10):1645-1649.
[15] Freitas I , Pontiggia P ,Barni S , et al . Histochemical probes for the detection of hypoxic tumor cells. [J]Anticancer Res , 1990 , 10(3) :613 – 622
[16] Kuesel AC , Briere KM , Halliday WC , et al . Mobile lipid accumulation in necrotic tissue of high grade astrocytomas. [J]Anti-cancer Res, 1996, 16(3):1485 - 1490
[17] Tien RD , Lai PH , SmIt h J S , et al . Single-voxel proton brain spectroscopy exam( PROBE/ SV) in patient s wit h primary brain tumors. [J]AJ R, 1996, 167(7):201 - 209
[18] Bendszus M , Warmut h-Metz M , Klein R , et al . MR spectroscopy in glomatosis cerebri. [J]AJNR, 2000, 21(2):375-380
[19]Lazareff JA , Bockhorst KHJ , Curran J , et al . Pediatric low-grade gliomas: prognosis wit h proton magnetic resonance spectroscopic imaging. [J]Neurosurgery, 1998, 43(10):809-818
[20] Girard N, Wang ZJ, Erbet ta A, et al. Prognostic value of proton MR spectroscopy of cerebral hemIsphere tumors in children. [J]Neuroradiology ,1998 ,40(2) :121-125
[21] Wu WC , Chen CY , Chung HW , et al . Discrepand MR spectroscopic and perfusion imaging result s in a case of malignant t ranformation of cerebral glioma . [J]AJNR, 2002 , 23(11) : 1775-1778
[22] Wald LL , Nelson SJ , Day MR , et al . Serial proton magnetic resonance spectroscopy imaging of glioblastoma muliforme after brachyt herapy. [J]Neurosurgery, 1997, 87(10):525 -534
[23] Norf ray J F , TomIta T , Byrd SE , et al . Clinical impact of MR Spectroscopy when MR imaging is indeterminate for pediatric brain tumors. [J]AJR ,1999 ,173(7) :119-125
[24] Preul MC , Caramanos Z , Villemure J G , et al . Using proton magnetic resonance spectroscopic imaging to predict in vivo the resonance of recurrent malignant gliomas to tamoxifen chemotherapy. [J] Neurosurgery, 2000, 46(2):306-318
[25]Alger JR, Frank JA, Bizzi A , et al. Metabolism of human gliomas : assessment with 1H M R spectroscopy and F-18 fluorodeoxyglucose PET. [J]R adiology,1990,177(2):633-641
[26]Sijens PE,van den Bent M J,Nowak PJ, et al. 1H chemical shift Imaging reveals loss of brain tumor choline signal after administration of Gd-contrast. [J]Magn Reson Med,1997,3 7(2):222-225
[27]Smith JK,K wock L ,Castillo M .Effects of contrast material on single-volume proton M R spectrosocpy. [J]AJNR,2000,21(6):1084-1089
[28]Costa MOR, Lacerda MTC, Otaduy MCG, et al. 1HMR spectroscopy in cerebellar hemIshpere in childhood Presented at the 39th annual meeting of the American. [J]Society of Neuroradiology, Boston, April 2001(2):33-41.
[1]. Stefano ND,Balestr P,Dotti MT.Severe metabolite abnormalities in the white matter of patients with vacuolating mega1encepha1ic leukoencephalopathy with subcortical cyst:a proton spectroscopic imaging study.[J] Neurel,2001,248(5):403-409.
[2] Rock JP,Hearshen D.Scarpaee L.et a1.Correlations between magnetic resonmIce spectrescopy and image—guided histopathologic.with special attention to radiation neemsis.[J] NeumsurgeD.2002,51(4):912-919.
[3] Tamawski R.Sokol M.Pieniazek P.et a1.1H- MRS in vivo predicts the early treatnxent on contrast of postoperative radiotherapy for nignmxt gliomas.[J] J Radiat On BioPllys,2002.52(5):1271-1276.
[4]. Burtscher IM,Holtas S.Proton MR spectroscopy in clinical routine.[J] Magn Reson Imaging.2001,13:560-567.
[5].Smith JK,Castillo M,Kwock L,et a1.MR spetroscopy of brain tumors.Magn Reson Imaging Clin N Am,2003,11:415-429.
[6]. Majos C,Alonso J,Agilera C,et a1.Utility of proton MR spectroscopy in the diagnosis of radiologically atypical intracranial meningiolmas[J].Neuroradiol,2003,45:129-136.
[7]. Opstad KS,Murphy MM,Wilkins PR,et a1.Dfferentiation of metastases from high-grade gliomas using short echo time 1H spectroscopy[J]. Magn Reson Imaging,2OO4,20:187-192.
[8]Smith JK,Castillo M,Kwock L,et a1.MR spetroscopy of brain tumors.[J]Magn Reson Imaging Clin N Am,2003,11:415-429.
[9]Bendszus M,Warmuth-Metz M,Klein R,et a1.MR spectroscopy in gliomatosis cerebri.[J]AJNR,2000,21:375-380.
[10] Peptone H,Gupta RK,Roy R,et a1.Characterization of intracranial mass lesions with in vivo Proton MR spectroscopy.[J]AJNR,1995,16:1593-1603.
[11]TamIya T,Kinoshita K,Ono Y,et a1.Proton magnetic resonance spectroscopy reflects cellular proliferative activity in astrocytomas.[J]Neuroradiology,2000,42:333-338.
[12].Kaminogo M,Ishimaru H,Morikawa M,et a1.Diagnostic potential of short echo time MR spectroscopy of gliomas with single-voxel and point-resolved spatially localised proton spectroscopy of brain.[J] Neuroradiology,2001,43:353-363.
[13]. Castilo M. Co.elevation of myo-inositol levels and gradings of cerebral astrocytomas[J].AJNR, 2000,21(10):1645-1649.
[14]. Magalhaes A,Godfrey W,Shen Y,et a1.Proton magnetic resonance spectroscopy of brain tumors correlated with pathology[J].Acad Radiol,2005,12:51-57.
[15]. Sabstier J,Robert O,Delisle MB,et a1.Usefulness of in vitro 1H magnetic resonance spectroscopy for the characterization of primary brain tumors:report of two case[J].Stereotact Funct Neurosurg,2005,83:122-126.
[16]Lazareff JA , Bockhorst KHJ , Curran J , et al . Pediatric low-grade gliomas: prognosis with proton magnetic resonance spectroscopic imaging. [J]Neurosurgery, 1998, 43(10):809-818
[17] Girard N, Wang ZJ, Erbet ta A, et al. Prognostic value of proton MR spectroscopy of cerebral hemisphere tumors in children. [J]Neuroradiology ,1998 ,40(2) :121 – 125
[18] Wu WC , Chen CY , Chung HW , et al . Discrepand MR spectroscopic and perfusion imaging result s in a case of malignant tranformation of cerebral glioma . [J]AJNR , 2002 , 23(11) :1775 -1778
[19] Wald LL , Nelson SJ , Day MR , et al . Serial proton magnetic resonance spectroscopy imaging of glioblastoma muliforme after brachy therapy. Neurosurgery, 1997, 87(10):525-534
[20] Norf ray J F , TomIta T , Byrd SE , et al . Clinical impact of MR Spectroscopy when MR imaging is indeterminate for pediatric brain tumors. [J]AJ R ,1999 ,173(7) :119 -125
[21] Preul MC , Caramanos Z , Villemure J G , et al . Using proton magnetic resonance spectroscopic imaging to predict in vivo the resonance of recurrent malignant gliomas to tamoxifen chemotherapy. [J]Neurosurgery, 2000, 46(2):306 - 318
[2] Rudkin FM,Arnold DL.Proton magnetic resonance spectroscopy for the diagnosis and management of cerebral disorders.[J] Arch Neurol,1999,56(8):919-926
[3] Castilo M.Co.elation of myo-inositol levels and gradings of cerebral astrocytomas.[J]AJNR,2000,21(10):1645-1649.
[4] Smith JK,Castillo M,Kwock L,et a1.MR spetroscopy of brain tumors.[J]Magn Reson Imaging Clin N Am,2003,11:415-429.
[5]Weybright P , Maly P . MR spectroscopy in the evaluation of recurrent contrast-enhancing lesions in the posterior fossa after tumor treatment.[J]Neuroradiology,2004,46(7):541-549.
[6]Kumar A, Kaushik S, Tripathi RP. Et al. Role of in vivo proton MR spectroscopy in the evaluation of adult brain lesions: our preliminary experience. [J] Neurol Indin.2003.51 (4):474-478
[7]Kaminogo M, Ishimaru H,Morikawa M, et al. Diagnostic potential of short echo time MR spectroscopy of gliomas with single-voxel and point-resolved spatially localised proton spectroscopy of brain. [J] Neuroradiology.2001, 43(5):353-363
[8]Meyerand ME, Pipas JM, Maamourian A, et al. Classification of biopsy-confirmed brain tumors using single-voxel MR spectroscopy.[J] AJNR,1999,20(1):117-123
[9]Jeffry RA, Sophia CS, Albert B, et al. Classification of biopsy confirmed brain tumors using Single-voxel MR spectroscopy[J]. AJNR, 1999, 20:117-123
[10]ShimIzu H, Kumabe T, Shirane R, et al. Correlation between choline levels measured by proton MR spectroscopy and KI-67 labeling index gliomas. [J] AJNR, 2000, 21(4):659-665
[11]Negendank WG, Sauter R, Brown TR, et al. Proton magnetic resonance spectroscopy in patients with glial tumors: a multicenter study. [J] J Neurosurg,1996,84(3):449-58
[12] Kim J H, Chang K H, Na D G, et al. 3T 1H-MR spectroscopy in grading of cerebral gliomas: comparison of short and intermediate echo time sequences. [J]AJNR Am J Neuroradiol,2006,27(7):1412-1418.
[13] Jeun S S, Kim M C, Kim B S, et al. Assessment of malignancy in gliomas by 3T 1H MR spectroscopy . [J]Clin Imaging , 2005, 29(1):10-15.
[14] Castilo M. Co.elation of myo-inositol levels and gradings of cerebral astrocytomas[J].AJNR, 2000,21(10):1645-1649.
[15] Freitas I , Pontiggia P ,Barni S , et al . Histochemical probes for the detection of hypoxic tumor cells. [J]Anticancer Res , 1990 , 10(3) :613 – 622
[16] Kuesel AC , Briere KM , Halliday WC , et al . Mobile lipid accumulation in necrotic tissue of high grade astrocytomas. [J]Anti-cancer Res, 1996, 16(3):1485 - 1490
[17] Tien RD , Lai PH , SmIt h J S , et al . Single-voxel proton brain spectroscopy exam( PROBE/ SV) in patient s wit h primary brain tumors. [J]AJ R, 1996, 167(7):201 - 209
[18] Bendszus M , Warmut h-Metz M , Klein R , et al . MR spectroscopy in glomatosis cerebri. [J]AJNR, 2000, 21(2):375-380
[19]Lazareff JA , Bockhorst KHJ , Curran J , et al . Pediatric low-grade gliomas: prognosis wit h proton magnetic resonance spectroscopic imaging. [J]Neurosurgery, 1998, 43(10):809-818
[20] Girard N, Wang ZJ, Erbet ta A, et al. Prognostic value of proton MR spectroscopy of cerebral hemIsphere tumors in children. [J]Neuroradiology ,1998 ,40(2) :121-125
[21] Wu WC , Chen CY , Chung HW , et al . Discrepand MR spectroscopic and perfusion imaging result s in a case of malignant t ranformation of cerebral glioma . [J]AJNR, 2002 , 23(11) : 1775-1778
[22] Wald LL , Nelson SJ , Day MR , et al . Serial proton magnetic resonance spectroscopy imaging of glioblastoma muliforme after brachyt herapy. [J]Neurosurgery, 1997, 87(10):525 -534
[23] Norf ray J F , TomIta T , Byrd SE , et al . Clinical impact of MR Spectroscopy when MR imaging is indeterminate for pediatric brain tumors. [J]AJR ,1999 ,173(7) :119-125
[24] Preul MC , Caramanos Z , Villemure J G , et al . Using proton magnetic resonance spectroscopic imaging to predict in vivo the resonance of recurrent malignant gliomas to tamoxifen chemotherapy. [J] Neurosurgery, 2000, 46(2):306-318
[25]Alger JR, Frank JA, Bizzi A , et al. Metabolism of human gliomas : assessment with 1H M R spectroscopy and F-18 fluorodeoxyglucose PET. [J]R adiology,1990,177(2):633-641
[26]Sijens PE,van den Bent M J,Nowak PJ, et al. 1H chemical shift Imaging reveals loss of brain tumor choline signal after administration of Gd-contrast. [J]Magn Reson Med,1997,3 7(2):222-225
[27]Smith JK,K wock L ,Castillo M .Effects of contrast material on single-volume proton M R spectrosocpy. [J]AJNR,2000,21(6):1084-1089
[28]Costa MOR, Lacerda MTC, Otaduy MCG, et al. 1HMR spectroscopy in cerebellar hemIshpere in childhood Presented at the 39th annual meeting of the American. [J]Society of Neuroradiology, Boston, April 2001(2):33-41.
[1]. Stefano ND,Balestr P,Dotti MT.Severe metabolite abnormalities in the white matter of patients with vacuolating mega1encepha1ic leukoencephalopathy with subcortical cyst:a proton spectroscopic imaging study.[J] Neurel,2001,248(5):403-409.
[2] Rock JP,Hearshen D.Scarpaee L.et a1.Correlations between magnetic resonmIce spectrescopy and image—guided histopathologic.with special attention to radiation neemsis.[J] NeumsurgeD.2002,51(4):912-919.
[3] Tamawski R.Sokol M.Pieniazek P.et a1.1H- MRS in vivo predicts the early treatnxent on contrast of postoperative radiotherapy for nignmxt gliomas.[J] J Radiat On BioPllys,2002.52(5):1271-1276.
[4]. Burtscher IM,Holtas S.Proton MR spectroscopy in clinical routine.[J] Magn Reson Imaging.2001,13:560-567.
[5].Smith JK,Castillo M,Kwock L,et a1.MR spetroscopy of brain tumors.Magn Reson Imaging Clin N Am,2003,11:415-429.
[6]. Majos C,Alonso J,Agilera C,et a1.Utility of proton MR spectroscopy in the diagnosis of radiologically atypical intracranial meningiolmas[J].Neuroradiol,2003,45:129-136.
[7]. Opstad KS,Murphy MM,Wilkins PR,et a1.Dfferentiation of metastases from high-grade gliomas using short echo time 1H spectroscopy[J]. Magn Reson Imaging,2OO4,20:187-192.
[8]Smith JK,Castillo M,Kwock L,et a1.MR spetroscopy of brain tumors.[J]Magn Reson Imaging Clin N Am,2003,11:415-429.
[9]Bendszus M,Warmuth-Metz M,Klein R,et a1.MR spectroscopy in gliomatosis cerebri.[J]AJNR,2000,21:375-380.
[10] Peptone H,Gupta RK,Roy R,et a1.Characterization of intracranial mass lesions with in vivo Proton MR spectroscopy.[J]AJNR,1995,16:1593-1603.
[11]TamIya T,Kinoshita K,Ono Y,et a1.Proton magnetic resonance spectroscopy reflects cellular proliferative activity in astrocytomas.[J]Neuroradiology,2000,42:333-338.
[12].Kaminogo M,Ishimaru H,Morikawa M,et a1.Diagnostic potential of short echo time MR spectroscopy of gliomas with single-voxel and point-resolved spatially localised proton spectroscopy of brain.[J] Neuroradiology,2001,43:353-363.
[13]. Castilo M. Co.elevation of myo-inositol levels and gradings of cerebral astrocytomas[J].AJNR, 2000,21(10):1645-1649.
[14]. Magalhaes A,Godfrey W,Shen Y,et a1.Proton magnetic resonance spectroscopy of brain tumors correlated with pathology[J].Acad Radiol,2005,12:51-57.
[15]. Sabstier J,Robert O,Delisle MB,et a1.Usefulness of in vitro 1H magnetic resonance spectroscopy for the characterization of primary brain tumors:report of two case[J].Stereotact Funct Neurosurg,2005,83:122-126.
[16]Lazareff JA , Bockhorst KHJ , Curran J , et al . Pediatric low-grade gliomas: prognosis with proton magnetic resonance spectroscopic imaging. [J]Neurosurgery, 1998, 43(10):809-818
[17] Girard N, Wang ZJ, Erbet ta A, et al. Prognostic value of proton MR spectroscopy of cerebral hemisphere tumors in children. [J]Neuroradiology ,1998 ,40(2) :121 – 125
[18] Wu WC , Chen CY , Chung HW , et al . Discrepand MR spectroscopic and perfusion imaging result s in a case of malignant tranformation of cerebral glioma . [J]AJNR , 2002 , 23(11) :1775 -1778
[19] Wald LL , Nelson SJ , Day MR , et al . Serial proton magnetic resonance spectroscopy imaging of glioblastoma muliforme after brachy therapy. Neurosurgery, 1997, 87(10):525-534
[20] Norf ray J F , TomIta T , Byrd SE , et al . Clinical impact of MR Spectroscopy when MR imaging is indeterminate for pediatric brain tumors. [J]AJ R ,1999 ,173(7) :119 -125
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