【作者】 李志红；

【导师】 张辉；

【作者基本信息】 山西医科大学 ， 影像医学与核医学， 2008， 硕士

【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。更多还原

【Abstract】 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).更多还原