【作者】 方维东；

【导师】 罗天友；

【作者基本信息】 重庆医科大学 ， 影像医学与核医学， 2004， 硕士

【摘要】 目的：探讨DWI、PWI以及¹H-MRS在鉴别脑脓肿与坏死囊变性胶质瘤和脑转移瘤中的价值。 方法：经手术病理或临床随访证实的12例脑脓肿与16例坏死囊变性胶质瘤和15例坏死囊变性脑转移瘤病例，在手术切除或临床治疗前接受了常规MRI和DWI、PWI以及多体素2D ¹H-MRS检查。DWI检查采用SE-EPI序列，弥散敏感系数（b值）为0s／mm²和1000s／mm²。PWI采用GR-EPI序列。多体素2D ¹H-MRS检查采用PRESS法。将DWI、PWI以及多体素2D ¹H-MRS检查的有关分析指标的测量和（或）计算值，输入SPSS10.0版统计软件行统计学处理。 结果：（1）DWI：脓腔（脓液）在DWI上呈明显的高信号，而胶质瘤和脑转移瘤的坏死囊变区呈明显的低信号。脓腔的平均最小ADC值(0.52±0.12×10^-3mm²／s)与两类肿瘤坏死囊变区的平均最小ADC值(2.90±0.38×10^-3mm²／s和2.53+0.43×10^-3mm²／s)之间的差别有高度显著性（P＜0.01）。脑脓肿灶周水肿带的平均最小ADC值(1.75±0.16×10^-3mm²／s)与坏死囊变性胶质瘤瘤周水肿带的平均最小ADC值(1.28±0.24×10^-3mm²／s)之间的差别有高度显著性（P＜0.01），但与脑转移瘤瘤周水肿带的平均最小ADC值(1.80±0.17×10^-3mm²／s)之间的差别无显著性（P＞0.05）。ADC伪彩图能直观地显示上述有关差别。（2）PWI：脓肿壁的平均最大rrCBV（2.55+0.92）与两类肿瘤瘤体的平均最大rrCBV（4.12±0.96和5.17±1.75）之间的差别有高度显著性（P＜0.01）。脑脓肿灶周水肿带的平均最大rrCBV值（0.45±0.20）与坏死囊变性胶质瘤瘤周水肿带的平均最大rrCBV 重庆医科大学硕士毕业论文值（l .71士0.56）之间的差别有高度显著性（P<0.01），而与坏死囊变性脑转移瘤瘤周水肿带的平均最大rrCBV值（0 .23士0.09）之间的差别无显著性（P>0.05）。脓肿壁的平均最大甘MTT值（l .43士0.14）与两类肿瘤瘤体的平均最大rrMTT值（l .41士0.15和1.65士0.25）之间的差别无显著性（P>0.05）。脑脓肿灶周水肿带的平均最大仃MTT值 （l .37土0.13）与两类肿瘤瘤周水肿带的平均最大仃MTT值（l .41士0.14和1.20士0.18）之间的差别无显著性（P>0.05）。脓肿壁的平均最大rrCBF值（2.00士0.49）与两类肿瘤瘤体的平均最大rrCBF值 （5.17士1.75和4.16士1.31）之间的差别有高度显著性（P<0.01）。脑脓肿灶周水肿带的平均最大rrCBF值（0.41士0.23）与坏死囊变性胶质瘤瘤周水肿带的平均最大仃CBF值（2.08士0.97）之间的差别有高度显著性（P<0.01），而与坏死囊变性脑转移瘤瘤周水肿带的平均最大rrCBF值（0 .28士0.08）之间的差别无显著性（P>0.05）。脓肿壁的平均最大P’值（0.47士0.21）与两类肿瘤瘤体的平均最大P‘值（l .55士0.40和1.69士0.57）之间的差别有高度显著性（P<0.01）。脑脓肿灶周水肿带的平均最大P‘值（0.03士0.03）与坏死囊变性胶质瘤瘤周水肿带的平均最大P’值（0.51士0.17）之间的差别有高度显著性（P<0.01），而与坏死囊变性脑转移瘤瘤周水肿带的平均最大P’值（0 .09士0.14）之间的差别无显著性（P>0.05）。rCBV和rMTT伪彩图可直观地显示上述有关差别。（3）多体素ZD‘H一MRs:脑脓肿均可探测到AA（0.gppm）峰及其他多种氨基酸峰，部分病例并可见无氧代谢产物Ac峰和Suc峰;而坏死囊变性胶质瘤和脑转移瘤除少数可见Glu（2.09一2.36ppm）峰外，未探测到脑脓肿所具有的上述代谢产物峰。脑脓肿的Cho‘值（0.52士0.19）与两类肿瘤的Cho’值（1.69:I= 0.69和1.59士0.46）之间的差别有高度显著性（P<0.01）。脑脓肿的NAA’值（0.45士0.21）与两类肿瘤 重庆医科大学硕士毕业论文的NAA’值（0.45士0.19和0.47士0.13）之间的差别无显著性（P>0.05）。脑脓肿的e:‘值（0.20士0.18）与两类肿瘤的Cr‘值（0.60:I= 0.20和0.40士0.13）之间的差别有高度显著性（p<0 .01）。脑脓肿的NA刀Cr值（2.49士0.90）与两类肿瘤的NAA/Cr值（1 .03士0.36和1 .70士0.47）之间的差别有高度显著性（P<0.01）。脑脓肿的Cho/Cr值（3 .08士1 .47）与两类肿瘤的Cho/Cr值（3 .92士1 .48和3 .90士0.82）之间的差别无显著性 （P>0.05）。脑脓肿的Cho/Cr一n值（0.72士0.27）与两类肿瘤的Cho/Cr-n值（2.76士0.73和2.46士0.87）之间的差别具有高度显著性（P<0.01）。脑脓肿的NAA/Cho值（0.93士0.41）与两类肿瘤的NAA/Cho值（0.25士0.11和0.45士0.n）之间的差别有高度显著性（P<0.01）。 结论:Dwl、Pwi以及’H一MRS检查在脑脓肿与坏死囊变性胶质瘤和脑转移的鉴别诊断中具有重要价值。更多还原

【Abstract】 Objective To explore the value of DWI, PWI and [H-MRS in differentiation between brain abscess and necrotic or cystic glioma and metastasis.Methods The conventional MR imaging, and MR imaging with DWI, PWI and multivoxel 2D ’H-MRS were performed in 43 patients (12 patients with abscess and 26 patients with necrotic or cystic glioma and 15 patients with metastasis) before operations or treatments. DWI was performed using single shot SE-EPI sequence with two different b values (0s/mm and 1000s/mm ). PWI was performed using single shot GR-EPI sequence. Multivoxel !H-MRS was performed using PRESS sequence. The values of which measuring or calculating from DWI, PWI and 1H-MRS data were processed and then statistical analyses were performed with one way anova by using the software of SPSS 10.0.Results (1) DWI The cavities (pus) of brain abscesses showed marked hyperintensity in all 12 patients, whereas necrotic or cystic regions of gliomas and metastases demonstrated hypointensity in all 31 patients. The mean minimum ADC value of the cavities of the abscesses (0.52 ±0.12 x10-3 mm2/s) was lower than that of the necrotic or cystic regions of gliomas and metastases(2.90 ± 0.38 X 10-3 mm2/s and 2.53± 0.43X10-3 mm2/s) (P<0.01) . The mean minimum ADC value of the edema regions of the abscesses (1.75 ± 0.16 X 103 mm2/s) was lowerthan that of the peritumoral edema regions of the gliomas (1.28 ± 0.24 X 10-3mm /s) (P<0.01), but was similar with that of the peritumoral edema regions of the metastases (1.80 ± 0.16X 103 mm2/s) (P>0.05).The ADC artificial colour maps could directly reflect all the differences. (2)PWI The maximum rrCBV in the walls of the abscesses (2.55 ± 0.92) was lower than in the bodies of the gliomas and metastases (4.12 ± 0.96 and 4.32 ±1.09) (P<0.01). The maximum rrCBV in the edema regions of the abscesses (0.45 ± 0.20) was lower than in the peritumoral edema regions of gliomas (1.71±0.56) (P<0.01), but was similar with that of the peritumoral edema regions of the metastases (0.23 ± 0.09) (P>0.05). The mean maximum rrMTT was no significant difference between the walls of the abscesses (1.43 ± 0.14) and the bodies of the gliomas and metastases (1.41±0.15 and 1.65 ± 0.25 ) (P>0.05), also was it between the edema regions of the abscesses (1.37 ± 0.13) and peritumoral edema regions of the gliomas and metastases (1.41±0.14 and 1.20 ± 0.18) (P>0.05). The mean maximum rrCBF was lower in the walls of the abscesses (1.78 ± 0.49) than in the bodies of the gliomas and metastases (2.92±1.75 and 2.62±1.31 ) (P<0.01), also was it in the edema regions of the abscesses (0.33 ± 0.23) than the peritumoral edema regions of the gliomas (1.21 ± 0.37) (P<0.01), but no significant difference was found between the edema regions of the abscesses and the peritumoral edema regions of the metastases (0.19 ± 0.08) (P>0.05). The mean maximum P’ was lower in the walls of the abscesses (0.47 ± 0.21) than in the bodies of the gliomas and metastases (1.55 ± 0.40 and 1.69 ± 0.57) (P<0.01), also was it in the edema regions of the abscesses (0.03 ± 0.03) than in the peritumoral edema regions of gliomas (0.51±0.17) (P<0.01), but nosignificant difference was found between the edema regions of the abscesses and the peritumoral edema regions of the metastases (0.09 ± 0.14) (P>0.05). The rCBV and rMTT artificial colour maps could directly reflect all the differences. (3)Multivoxel 2D 1H-MRS The amino acide (AA) resonances at 0.9ppm and other amino acides resonances were detected in all brain abscesses, and the succinate and or acetate resonances were also detected in some of brain abscesses, while all necrotic or cystic gliomas and metastases showed no AA resonances at 0.9ppm and other amino acides resonances and the succinate and acetate resonances except Glu resonances in fewer cases. The NAA/Cr ratio in the abscesses (2.49 ± 0.90) was higher than in the necrotic or cystic gliomas and metastases (1.03 ±0.36 and 1.70 ± 0.47) (P<0.01). No significant difference was found on the Cho/Cr ratio between the absc更多还原