多体素磁共振氢质子波谱在脑胶质瘤诊断及分级中的初步应用研究

摘要

Objective To determine whether metabolite ratios in multivoxel 3D proton MR spectroscopy(1H-MRS) is different between low-grade and high-grade gliomas and may be useful for diagnosis and glioma grading. Methods MR scan and 3D 1 H-MRS studies of 51 patients with histologically proven (16 low-grade ,4 Ⅱ -Ⅲ-grade and 31 hight-grade glimas) were retrospectively reviewde. Metabolite Cho,Cr,NAA and metabolite ratios Cho/NAA Cho/Cr,NAA/Cr were measured. The metabolite ratios ( Cho/NAA, Cho/Cr, NAA/Cr ) of low and high-grade gliomas were statistically analyzed. Results The Cho within voxel increased means the tumor proliferation activity. The NAA within voxel reduced means neuronal damaged. The metabolite ratios (Cho/NAA,Cho/Cr,NAA/Cr ) of low and high-grade gliomas was significant difference (P ＜ 0. 05 ). Conclusion Metabolite ratios of low-grade gliomas were significantly different from high-grade gliomas. 1H-MRS combined with morphological changes could be useful in gliomas diagnosis and differential diagnosis and grading. 1H-MRS metabolite changes were sensitive, and is closely related to contained tissue within voxel. Analysis of metabolites changes should be combined with the corresponding region of morphological changes.%目的 探讨3D多体素1H-MRS代谢物改变、并结合形态学改变在脑胶质瘤诊断及分级中的价值.方法 选取51例脑胶质瘤患者,所有患者均行开颅手术,病理证实低级16例、Ⅱ级部分区域间变呈Ⅲ级4例,高级31例;所有患者均行颅脑常规核磁共振增强扫描和3D多体素135ms序列扫描.分别测定病变实质、病变周围区域的胆碱(Cho)、肌酸(Cr)、乙酰天门冬氨酸(NAA)、Cho/NAA、Cho/Cr、NAA/Cr比值的变化;对结果进行统计学分析.结果 体素内Cho升高提示肿瘤增生活跃、NAA减低提示神经元破坏程度.低级别胶质瘤和高级别胶质瘤瘤体区Cho/Cr、Cho/NAA比值比较差异有统计学意义(P＜0.05).结论 多体素1H-MRS结合形态学改变在脑胶质瘤诊断、分级及鉴别诊断中有重要价值;1H-MRS代谢物改变较敏感,与体素内所包含组织密切相关,在分析代谢物变化时应结合相应区域形态学改变.