MRI新技术在眼眶肿瘤诊断中基础和临床应用研究
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摘要
MRI新技术在眼眶肿瘤诊断中基础和临床应用研究
第一部分 动态增强MRI检查对眼眶病变诊断及鉴别诊断的意义
目的：运用动态增强技术的MRI检查，分析病变的强化特点，以提高对不同眼眶病变的认识，尤其是不同良性肿瘤的强化特点，以及良恶性肿瘤的强化特点的认识，进而提高MRI检查的诊断价值。
材料和方法 全部病例共41例，均为单发病灶，均行MRI检查，术后均得到病理证实。其中良性肿瘤和类肿瘤病变31例，恶性肿瘤病变10例。磁共振系统为Siemens公司Magnetom Vision Plus 1.5T。采集线圈为头颅线圈。MR平扫包括：TSE序列的T1WI、T2WI横断面以及T1WI矢状和冠状面扫描。层厚4mm。增强检查，使用高压注射器，以2.0-2.5mL／秒的速度于患者桡静脉处注射Gd-DTPA后，立即连续动态扫描7次。以观察造影剂的动态变化状况。对所测得平均及动态增强信号强度值(SI前、SI后)，计算其强化率(E％)和得到时间密度曲线(TIC)。有关的统计学分析和制图采用SPASS Ver10.0以及Powerpoint等软件分析。
结果 (1) 良恶性肿瘤第一分钟内平均强化率(E1％)比较：恶性肿瘤的第一分钟增强率＞60％，而良性肿瘤的第一分钟强化率＜60％，二者相差显著(P＜0.05)；(2) 良性肿瘤除脑膜瘤外，绝大多数强化为线型强化；(3) 恶性肿瘤和脑膜瘤为平台型强化。(4) 炎性假瘤和肉芽肿病变，主要表现为流出型。(5) 血管瘤有特殊的强化模式，表现为局部点状和小结节状强化，然后逐步向全肿瘤扩展。
结论：1) 动态增强的MRI检查，对鉴别良恶性肿瘤有明显的意义。2) 对鉴别肿瘤和炎症也可提供重要的诊断依据。3) 少数个别病种，如海绵状血管瘤有特殊的强化模式。
第二部分 眼眶病变的磁共振质子波谱的临床研究
目的：探讨眼眶肿瘤和类肿瘤病变的~1H-MRS特点．以及~1H-MRS对良、恶性肿瘤鉴别诊断的意
Page4
_二_..…~兰茎矍竺巡垫选塑竺些匕一一一一
材料与方法全部病例共40例，均为单发病灶，均行MRI和MRS检查，术后均得到病理
证实。其中良性肿瘤和类肿瘤病变，30例，包括:1)海绵状血管瘤12例:2)静脉性血
管瘤6例;3)泪腺多形性腺瘤4例;4)炎性{段瘤3例;5)神经纤维瘤2例;6)脑膜瘤
3例。恶性肿瘤病变10例，l)血管肉瘤2例;2)泪腺多形性腺癌2例;3)淋巴瘤2例;
4)粒细胞肉瘤1例;5)小细胞性恶性肿瘤1例;6)腺样囊性癌l例;7)嗅神经母细胞
瘤一例。磁共振波谱(’H一Rs)检测采用Siemens公司的Magnetom vision 1.ST超导型
磁共振检查仪，头颅线圈，用Svs一STEAM270序列测量。使用统计学软件对数据进行平均
数、标准差的计算，数据用毛土S表示，将肿瘤与同侧额部正常脑组织数据相比，比较肿
瘤与同侧额部正常脑组织有无统计学上的差异。结果进行t检验，方差分析。
结果:1)主要化合物的化学位移位置相对固定。2)恶性肿瘤Cho、Cr曲线下积分面积值
提高，而良性肿瘤Cho、Cr曲线下积分面积值变化不明显，恶性肿瘤组Ch。/Cr比值明显高
于良性肿瘤组;3)良性肿瘤Lac、Ase表现为轻度上升模式，而恶性肿瘤Lac、Ace则表现
为明显上升模式。
结论:1)肿瘤和正常脑组织的波谱有区别。表现在Lac、Aoe的不同变化特征。2)良性肿
瘤和恶性肿瘤的MRS波峰有明显差异，表现为Cho，Cr峰值增高，尤其是Cho/Cr比值的增高，
此外Lac和Ace在恶性肿瘤增高明显，可能可作为区别肿瘤与非肿瘤的标志之一。
第三三部么夕目良眶病变磁共振波锐多盛夕析的店改石出习于乡忆
目的:探讨高分辨率MRS波谱进行眼眶离体肿瘤分析的意义，并与他们的临床MRS波谱
进行了比较研究。
材料与方法全部均经手术病理证实。共积累标本12例。其中良性肿瘤7例，包括:海
绵状血管瘤5例;脑膜瘤1例。神经鞘瘤1例。恶性肿瘤3例，其中淋巴瘤2例，血管肉
瘤一例;此外，正常眼肌组织和视神经各一块。取材后，速放于一170℃液氮罐内储存。采
谓
用BRUKER AvANeE 400(SB)核磁共振谱仪，BRUKER标准腔，HR/MAS探头。测试结果，
采用SPASS软件分析，计算不同信号的波峰峰值，结果进行t检验和方差分析。-
2、结果1)临床肿瘤MRS测定值与离体MRS测定值比较结果示:在体肿瘤与离体肿瘤标
本测量具有可比性。说明临床IIJM卫S能较准确地用于眼眶肿瘤的分析，其测量结果可靠。
协良邓岭时吟的冲咚羊且吵协.件。和八咚’布和冲片，订岭帅喃均要高工自性肺喃。劝
比注衍汕侧、:一;、;‘、;一‘。、少、，一、t口一卜一卜一--··-「一…
4一3
处
Pages
第二军医大学博士研究生毕业论文
连续的单峰，而非肿瘤病灶，均无此现象。
3、结论1)临床的MRS波谱检测与离体波谱检测一致性较好。2)恶性肿瘤的波谱与良
性肿瘤有明显区别。3)肿瘤波谱具有特殊的波谱形态。
Part 1: The diagnosis of orbital tumor with dynamic contrast-enhanced MRI
Purpose: To analysis the characteristics of eye diseases with before and after dynamic contrast-enhanced MR images, improve the ability of diagnosis and different diagnosis of eye diseases, especial benign and malignant tumour. Materials and Methods: 1 -, total 41 cases had been trained by MR .examination, including 31 benign tumors and 10 malignant tumor. 2. MR examination: Using Magneton Vision Plus 1.5T MR system. MR images had been obtained from Tl WI and T2WI turbo-SE sequence include with sagittal, transverse and coronal sections, before, after and dynamic contrast-enhanced period. 3. To analysis characteristics of lesions enhancement, including: enhancement rates(E%) should be quantified by ROI-based signal intensity measurements. To accout for differences in baseline tissue Tl relaxation times, enhancement rate is calculated as signal intensity increase relative to baseline values: E%=(SIpost-SIpre)/SIprex100%. The enhancement kinetics in the intermediate and late post-contrast period had be evaluate
d by means of time/signal intensity course(TIC).Three of signal intensity
curve; Tpye 3 is a wash-out time course. Results:
1) The enhancement rate(first post-contrast minute) is higher than 60% in malignant tumor, meanwhile lower than 60% in benign ones(P<0.05).
2) Type 1 time course is indicative of most of benign tumor except meningioma, whereas type 3(wash-out) strongly supports infectious diseases and type 2 malignant tumor.
3) There are special enhanced model in Cavernous hemangiomas. Conclusions:
1) Dynamic contrast-enhanced MRI is a valuable method to distinguish malignant tumors between benign tumors, tumors between infectious diseases.
2) Typical manifestations of Cavernous hemengioma were found by Dynamic contrast-enhanced MRI.
Part 2 The clinical and fundamental application of 1HMR
Spectroscopy in orbital diseases
Purposes: 1) To investigate the clinical application of proton magnetic resonance spectroscopy (1HMRS) in orbital tumors; 2) To study character of 1HNMR spectroscopy (9.395T) of orbital tumors in vitro; 3) To study whether character of 1HNMR spectroscopy of orbital tumors in vitro and character of 1HMRS of orbital tumors in vivo are identical or not. 4) To evaluate the value of 1HMRS for
Methods: 1) 40 cases with pathology-proved tumors had been undergone HMRS
examinations. Single-voxel localized 'HMRS were performed in all patients
suspected of tumors on MR images. Depend on corresponding SVS-STEAM270
sequence, NAA, Cho, Cr, Ace and Lac were obtained from normal-forehead brain
parenchyma in each patient for comparison with the spectra from known area of
pathology at the same side. 2) 12 cases sample of tumors, including 7 benign
tumors(5 cases cavernous hemangioma 1 case meningioma 1 case Neurofibroma),
3 malignant tumors (1 case hemangiosarcoma 2 case lymphoma), and 1 normal
muscle and 1 optic nerve are measured by 400MHz BRUKER HR/MAS
(9.395T). 3) The position, wide, amp and integ of the wave peaks were calculate,
and were evaluated the changes of metabolic materials among malignant, benign
tumors.
Results :
1) The position of each metabolites are stable.
2)Curve-areas of each metabolites for all orbital tumors was significant difference,
between non-tumors.especially,a significant difference existed in curve-areas of
Cho, Cr and Cho/Cr between benign and malignant orbital tumors (P<0.05).
3) Curve-areas of Lac, Ace of benign tumors is higher than non-tumor tissues and
lower than malignant tumors.
4)The results showed that clinical 'H MRS and HR/MAS can obtained similar
results for orbital tumors.
main detectable metabolites are N-acetyl-aspartate(NAA), choline-containing compounds(Cho), creatine(Cr) ,acetate(Ace)and lactate(Lac). Conclusions:
1) The 1HMRS wave style are quite different from orbital tumor and non-tumor tissues.
2) The 1HMRS has shown a quite higher level of Cho and Cho/Cr in malignant tumour than which in benign
第一部分 动态增强MRI检查对眼眶病变诊断及鉴别诊断的意义
目的：运用动态增强技术的MRI检查，分析病变的强化特点，以提高对不同眼眶病变的认识，尤其是不同良性肿瘤的强化特点，以及良恶性肿瘤的强化特点的认识，进而提高MRI检查的诊断价值。
材料和方法 全部病例共41例，均为单发病灶，均行MRI检查，术后均得到病理证实。其中良性肿瘤和类肿瘤病变31例，恶性肿瘤病变10例。磁共振系统为Siemens公司Magnetom Vision Plus 1.5T。采集线圈为头颅线圈。MR平扫包括：TSE序列的T1WI、T2WI横断面以及T1WI矢状和冠状面扫描。层厚4mm。增强检查，使用高压注射器，以2.0-2.5mL／秒的速度于患者桡静脉处注射Gd-DTPA后，立即连续动态扫描7次。以观察造影剂的动态变化状况。对所测得平均及动态增强信号强度值(SI前、SI后)，计算其强化率(E％)和得到时间密度曲线(TIC)。有关的统计学分析和制图采用SPASS Ver10.0以及Powerpoint等软件分析。
结果 (1) 良恶性肿瘤第一分钟内平均强化率(E1％)比较：恶性肿瘤的第一分钟增强率＞60％，而良性肿瘤的第一分钟强化率＜60％，二者相差显著(P＜0.05)；(2) 良性肿瘤除脑膜瘤外，绝大多数强化为线型强化；(3) 恶性肿瘤和脑膜瘤为平台型强化。(4) 炎性假瘤和肉芽肿病变，主要表现为流出型。(5) 血管瘤有特殊的强化模式，表现为局部点状和小结节状强化，然后逐步向全肿瘤扩展。
结论：1) 动态增强的MRI检查，对鉴别良恶性肿瘤有明显的意义。2) 对鉴别肿瘤和炎症也可提供重要的诊断依据。3) 少数个别病种，如海绵状血管瘤有特殊的强化模式。
第二部分 眼眶病变的磁共振质子波谱的临床研究
目的：探讨眼眶肿瘤和类肿瘤病变的~1H-MRS特点．以及~1H-MRS对良、恶性肿瘤鉴别诊断的意
Page4
_二_..…~兰茎矍竺巡垫选塑竺些匕一一一一
材料与方法全部病例共40例，均为单发病灶，均行MRI和MRS检查，术后均得到病理
证实。其中良性肿瘤和类肿瘤病变，30例，包括:1)海绵状血管瘤12例:2)静脉性血
管瘤6例;3)泪腺多形性腺瘤4例;4)炎性{段瘤3例;5)神经纤维瘤2例;6)脑膜瘤
3例。恶性肿瘤病变10例，l)血管肉瘤2例;2)泪腺多形性腺癌2例;3)淋巴瘤2例;
4)粒细胞肉瘤1例;5)小细胞性恶性肿瘤1例;6)腺样囊性癌l例;7)嗅神经母细胞
瘤一例。磁共振波谱(’H一Rs)检测采用Siemens公司的Magnetom vision 1.ST超导型
磁共振检查仪，头颅线圈，用Svs一STEAM270序列测量。使用统计学软件对数据进行平均
数、标准差的计算，数据用毛土S表示，将肿瘤与同侧额部正常脑组织数据相比，比较肿
瘤与同侧额部正常脑组织有无统计学上的差异。结果进行t检验，方差分析。
结果:1)主要化合物的化学位移位置相对固定。2)恶性肿瘤Cho、Cr曲线下积分面积值
提高，而良性肿瘤Cho、Cr曲线下积分面积值变化不明显，恶性肿瘤组Ch。/Cr比值明显高
于良性肿瘤组;3)良性肿瘤Lac、Ase表现为轻度上升模式，而恶性肿瘤Lac、Ace则表现
为明显上升模式。
结论:1)肿瘤和正常脑组织的波谱有区别。表现在Lac、Aoe的不同变化特征。2)良性肿
瘤和恶性肿瘤的MRS波峰有明显差异，表现为Cho，Cr峰值增高，尤其是Cho/Cr比值的增高，
此外Lac和Ace在恶性肿瘤增高明显，可能可作为区别肿瘤与非肿瘤的标志之一。
第三三部么夕目良眶病变磁共振波锐多盛夕析的店改石出习于乡忆
目的:探讨高分辨率MRS波谱进行眼眶离体肿瘤分析的意义，并与他们的临床MRS波谱
进行了比较研究。
材料与方法全部均经手术病理证实。共积累标本12例。其中良性肿瘤7例，包括:海
绵状血管瘤5例;脑膜瘤1例。神经鞘瘤1例。恶性肿瘤3例，其中淋巴瘤2例，血管肉
瘤一例;此外，正常眼肌组织和视神经各一块。取材后，速放于一170℃液氮罐内储存。采
谓
用BRUKER AvANeE 400(SB)核磁共振谱仪，BRUKER标准腔，HR/MAS探头。测试结果，
采用SPASS软件分析，计算不同信号的波峰峰值，结果进行t检验和方差分析。-
2、结果1)临床肿瘤MRS测定值与离体MRS测定值比较结果示:在体肿瘤与离体肿瘤标
本测量具有可比性。说明临床IIJM卫S能较准确地用于眼眶肿瘤的分析，其测量结果可靠。
协良邓岭时吟的冲咚羊且吵协.件。和八咚’布和冲片，订岭帅喃均要高工自性肺喃。劝
比注衍汕侧、:一;、;‘、;一‘。、少、，一、t口一卜一卜一--··-「一…
4一3
处
Pages
第二军医大学博士研究生毕业论文
连续的单峰，而非肿瘤病灶，均无此现象。
3、结论1)临床的MRS波谱检测与离体波谱检测一致性较好。2)恶性肿瘤的波谱与良
性肿瘤有明显区别。3)肿瘤波谱具有特殊的波谱形态。
Part 1: The diagnosis of orbital tumor with dynamic contrast-enhanced MRI
Purpose: To analysis the characteristics of eye diseases with before and after dynamic contrast-enhanced MR images, improve the ability of diagnosis and different diagnosis of eye diseases, especial benign and malignant tumour. Materials and Methods: 1 -, total 41 cases had been trained by MR .examination, including 31 benign tumors and 10 malignant tumor. 2. MR examination: Using Magneton Vision Plus 1.5T MR system. MR images had been obtained from Tl WI and T2WI turbo-SE sequence include with sagittal, transverse and coronal sections, before, after and dynamic contrast-enhanced period. 3. To analysis characteristics of lesions enhancement, including: enhancement rates(E%) should be quantified by ROI-based signal intensity measurements. To accout for differences in baseline tissue Tl relaxation times, enhancement rate is calculated as signal intensity increase relative to baseline values: E%=(SIpost-SIpre)/SIprex100%. The enhancement kinetics in the intermediate and late post-contrast period had be evaluate
d by means of time/signal intensity course(TIC).Three of signal intensity
curve; Tpye 3 is a wash-out time course. Results:
1) The enhancement rate(first post-contrast minute) is higher than 60% in malignant tumor, meanwhile lower than 60% in benign ones(P<0.05).
2) Type 1 time course is indicative of most of benign tumor except meningioma, whereas type 3(wash-out) strongly supports infectious diseases and type 2 malignant tumor.
3) There are special enhanced model in Cavernous hemangiomas. Conclusions:
1) Dynamic contrast-enhanced MRI is a valuable method to distinguish malignant tumors between benign tumors, tumors between infectious diseases.
2) Typical manifestations of Cavernous hemengioma were found by Dynamic contrast-enhanced MRI.
Part 2 The clinical and fundamental application of 1HMR
Spectroscopy in orbital diseases
Purposes: 1) To investigate the clinical application of proton magnetic resonance spectroscopy (1HMRS) in orbital tumors; 2) To study character of 1HNMR spectroscopy (9.395T) of orbital tumors in vitro; 3) To study whether character of 1HNMR spectroscopy of orbital tumors in vitro and character of 1HMRS of orbital tumors in vivo are identical or not. 4) To evaluate the value of 1HMRS for
Methods: 1) 40 cases with pathology-proved tumors had been undergone HMRS
examinations. Single-voxel localized 'HMRS were performed in all patients
suspected of tumors on MR images. Depend on corresponding SVS-STEAM270
sequence, NAA, Cho, Cr, Ace and Lac were obtained from normal-forehead brain
parenchyma in each patient for comparison with the spectra from known area of
pathology at the same side. 2) 12 cases sample of tumors, including 7 benign
tumors(5 cases cavernous hemangioma 1 case meningioma 1 case Neurofibroma),
3 malignant tumors (1 case hemangiosarcoma 2 case lymphoma), and 1 normal
muscle and 1 optic nerve are measured by 400MHz BRUKER HR/MAS
(9.395T). 3) The position, wide, amp and integ of the wave peaks were calculate,
and were evaluated the changes of metabolic materials among malignant, benign
tumors.
Results :
1) The position of each metabolites are stable.
2)Curve-areas of each metabolites for all orbital tumors was significant difference,
between non-tumors.especially,a significant difference existed in curve-areas of
Cho, Cr and Cho/Cr between benign and malignant orbital tumors (P<0.05).
3) Curve-areas of Lac, Ace of benign tumors is higher than non-tumor tissues and
lower than malignant tumors.
4)The results showed that clinical 'H MRS and HR/MAS can obtained similar
results for orbital tumors.
main detectable metabolites are N-acetyl-aspartate(NAA), choline-containing compounds(Cho), creatine(Cr) ,acetate(Ace)and lactate(Lac). Conclusions:
1) The 1HMRS wave style are quite different from orbital tumor and non-tumor tissues.
2) The 1HMRS has shown a quite higher level of Cho and Cho/Cr in malignant tumour than which in benign
引文
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2. Kantarci M; Erdem T; Alper F,et al. Imaging characteristics of diffuse primary cutaneous B-cell lymphoma of the cranial vault with orbital and brain invasion. Am-J-Neuroradiol. 2003; 24(7): 1324-6
3、Wilms G, Raat H, Dom R, et al. Orbital cavernous hemangioma: fingings on sequential Gd-enhanced MRI. J Comput Assist Tomogr, 1995;19(4):548-551.
4、Ohtsuka K, Hashimoto M, Akiba H. Serial dynamic magnetic resonance imaging of orbital cavernous hemangioma. Am J Ophthalmol, 1997,123:396-398
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6．鲜军舫；王振常；安裕志等。眼眶海绵状血管瘤的影像学表现及其意义。中华放射学杂志 1999；33(6)：400-402。
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10. Kawashima H, Matsui O, Suzuki M, et al. Breast cancer indance breast:detection with contrast enhanced dynamic MR imaging. J Magn Reson Imaging 2000;11(3) :223-243
11. (?)
carcinoma:clinical relevance of diagnostic procedures for detection of multifocal or contralateral secondary carcinoma. J Comput Assist Tomogr 1997;21:773-779
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