【作者】 王弘岩；

【导师】 曹代荣； 李银官；

【作者基本信息】 福建医科大学 ， 影像医学与核医学， 2008， 硕士

【摘要】 目的:研究不同病理亚型脑膜瘤1.5T磁共振质子波谱表现,探讨各病理亚型脑膜瘤之间1.5T磁共振质子波谱的差别。方法:对42例影像学拟诊并经病理确诊为脑膜瘤的患者进行术前1.5T磁共振波谱检查,以病灶对侧或病灶周围相对正常脑实质谱线为对照,对病灶实质部分进行分析,将各病理亚型脑膜瘤谱线Glx、Ala、Lip“阳性率”及谱线尺测Cho/nCr比值进行统计学分析;同时对部分病灶周围水肿区进行波谱检查,对测得代谢物进行归纳。结果:①42例脑膜瘤谱线,除1例砂砾体型脑膜瘤谱线基线不稳之外的41例均表现为Cho峰明显升高、Cr及NAA峰明显降低、部分消失,均未见Lac峰,29例可见Ala峰,29例出现Lip峰;行35TE波谱检查的37例中30例可见增高、增宽的Glx峰;7例mI/Cr比值升高,包括2例脑膜皮细胞型脑膜瘤、1例纤维型脑膜瘤、3例过渡型脑膜瘤及1例非典型脑膜瘤。②尺测Cho/nCr比值在各病理亚型脑膜瘤之间及低高级脑膜瘤之间均无显著性差异(P值分别为0.768、0.461,LSD法多重比较得各病理亚型组间两两比较P值分别为0.788、0.468、0.334、0.788、0.691、0.505、0.468、0.691、0.734、0.334、0.505、0.734,均大于0.05)。③统计学分析提示Glx阳性率在不同亚型脑膜瘤组间可能有显著性差异(X2=10.833,P=0.013<0.05),进一步使用四格表Fisher精确概率检验提示差异表现在组别1与组别4之间(P=0.005<0.01),即Glx阳性率“脑膜皮细胞型脑膜瘤”组高于“本研究涉及的其它亚型脑膜瘤”组。④统计学分析提示Ala阳性率在不同亚型脑膜瘤组间可能有显著性差异(X2=9.107,P=0.028<0.05),进一步使用四格表Fisher精确概率检验提示差异表现在组别1与组别4及组别3与组别4之间(P值分别为0.019、0.032,均小于0.05),即Ala阳性率“脑膜皮细胞型脑膜瘤”组及“过渡型脑膜瘤”组均分别高于“本研究涉及的其它亚型脑膜瘤”组,但“脑膜皮细胞型脑膜瘤”组及“过渡型脑膜瘤”组本身之间Ala阳性率无显著性差异(P=1.000>0.05)。⑤Lip阳性率在不同亚型脑膜瘤组间没有显著性差异(X2=4.199,P=0.241>0.05)。⑥低高级脑膜瘤间Glx、Ala及Lip阳性率均无显著性差异(P值分别为0.223、0.576、0.302,均大于0.05)。⑦间变型脑膜瘤2例,肿瘤实质部分谱线均表现为单纯Lip峰明显升高、增宽合并明显升高的Cho峰。⑧脑膜瘤瘤周水肿区波谱分析6例中3例行35TE波谱检查,均可见增高或增宽的Glx峰,3例出现Ala峰,2例出现Lip峰,1例出现Lac峰,1例mI/Cr比值升高。结论:①脑膜瘤1.5T磁共振质子波谱表现为Cho明显升高、Cr及NAA峰明显降低、部分消失,多见Glx峰增高、增宽的改变及出现Ala峰,可见Lip峰,有时mI/Cr比值升高。②本组研究提示1.5T磁共振质子波谱分析时尺测Cho/nCr比值在各病理亚型脑膜瘤之间没有显著性差异。③本组研究提示1.5T磁共振质子波谱分析时Glx阳性率及Ala阳性率在部分亚型脑膜瘤组间可能有显著性差异。④本组研究提示1.5T磁共振质子波谱分析时Lip阳性率在不同亚型脑膜瘤组间没有显著性差异。更多还原

【Abstract】 Purpose:To study the proton MRS manifestation of meningiomas with different histopathologic subtypes on a 1.5T MR scanner and discuss the probable differences in it.Methods:1.5T MRS scans were given to 42 patients with meningiomas definitely diagnosed by imaging before their surgical operation. All cases were proved to be meningiomas by pathology after their operation. The MRS analyses were done in the parenchyma of the tumor,the relatively normal cerebral parenchyma of contralateral side or peritumoral area and peritumoral brain edema in part of the cases. The metabolites were analysed, such as Glx, Ala, Lac and Lip. The Cho/nCr ratio measured by a ruler was also reviewed. Statistic analyses were carried out.Results:①Except one case of psammomatous meningioma with a rough base line, all the 41 cases showed an obviously increased Cho peak and obvionsly decreased Cr and NAA, none of the 41 cases showed a Lac peak, Ala peak appeared in 29 cases, Lip appeared in 29 cases, 30 cases of the 37 cases with 35TE test showed increased Glx peaks. And among the 42 cases, mI/Cr ratio increased in 7 cases, including 2 cases of meningothelial meningioma, 1 case of fibrous meningioma, 3 cases of transitional meningioma and 1 case of atypical meningioma.②As for the Cho/nCr ratio measured by a ruler,there were no significant differences among all the histopathologic subtypes and between low grade and high grade meningiomas(all the P value higher than 0.05).③The stastistic analyses showed that there were probable significant differences among different histopathologic subtypes of meningiomas in the accurrence rate of Glx(P value lower than 0.05).The difference lay between group 1 and group4(P value lower than 0.05),giving the clue that the Glx occurrence rate of meningiothelial meningioma was higher than that of other subtypes meningioma.④The stastistic analyses showed that there were probable significant differences among different histopathologic subtypes of meningiomas in the accurrence rate of Ala(P value lower than 0.05).The differences lay between group 1 and group4,group 3 and group 4(both the P values lower than 0.05),giving the clues that the Ala occurrence rates of meningiothelial meningioma and transitional meningioma were both higher than that of other subtypes.⑤There were no significant differences among different histopathologic subtypes of meningiomas in the occurrence rate of Lip(all the P value higher than 0.05).⑥There were no significant differences in the occurrence rate of Glx,Ala and Lip between low grade and high grade meningioma(all the P values higher than 0.05).⑦An obviously increased Lip peak and an obviously increasd Cho peak appeared in 2 cases of anaplastic meningioma.⑧Among the 6 cases which analysed the peritumoral brain edema, 3 cases tested with 35TE showed increased Glx peaks, 3 cases showed Ala peaks, 2 cases showed Lip peaks, 1 case showed a Lac peak and the mI/Cr ratio increased in 1 case.Conclusions:①The 1.5T MRS of meningiomas displays obviously increased Cho, obviously discreased or even dispeared Cr and NAA and an increased Glx peak.It also displays that an Ala peak often appears, a Lip peak can be shown, sometimes an increased mI/Cr ratio can be measured.②Our 1.5T MRS study gives a clue that the Cho/nCr ratio(measured by a ruler) is no significantly different among different histopathologic subtypes of meningiomas.③Our stastistic analyses showed that there are probable significant differences among parts of the histopathologic subtypes of meningiomas in the accurrence rate of Glx and Ala.④Our 1.5T MRS study gives another clue that there are no significant differences among different histopathologic subtypes of meningiomas in the occurrence rate of Lip.更多还原