3.0T 1H-MRS对脑胶质瘤及脑转移瘤的鉴别诊断

目的：利用3.0T氢质子磁共振波谱对胶质瘤和转移瘤的肿瘤组织区、瘤周水肿区进行细胞代谢物水平的检测,试图找出胶质瘤和脑转移瘤的鉴别诊断的依据,以及胶质瘤高、低级别组间的差别。方法：对经病理证实的20例高级别胶质瘤组、16例低级别胶质瘤组和19例脑转移瘤组患者,先行MRI平扫及增强扫描,波谱均在增强扫描的基础上获得,使用MR点分辨波谱序列,检测肿瘤组织区、瘤周水肿组织区NAA/Cr、Cho/Cr、NAA/Cho、NAA、Cho、Cr、Lip/Lac等值,进行比较。结果：（1）高级别胶质瘤与转移瘤在肿瘤组织区NAA/Cr代谢物浓度的比值有统计学意义。（2）高、低级别胶质瘤肿瘤组织内Cho/Cr比值有统计学意义。（3）转移瘤与高、低级别胶质瘤在瘤周水肿区NAA/Cr,以及低级别胶质瘤与转移瘤Cho/Cr代谢物浓度的比值有统计学意义;高级别胶质瘤与转移瘤瘤周区NAA代谢物浓度有明显差异。（4）胶质瘤高、低级别组间在肿瘤周围区NAA峰、Cho峰及NAA/Cho Cho/Cr代谢物浓度比值有统计学意义。（5）高级别胶质瘤和转移瘤分别与低级别胶质瘤在肿瘤组织区及瘤周水肿区Lip/Lac有显著性差异（P〈0.01）。结论：利用氢质子波谱可对胶质瘤和转移瘤进行鉴别诊断;Cho/Cr及NAA/Cho比值可对胶质瘤进行分级;Lip/Lac峰的出现与肿瘤的恶性度呈正相关,但不特异。

The Differential Diagnosis of 3.0T 1H-MRS between Brain Metastases and Glioma

Objective： In order to evaluate the basis of the differential diagnosis between malignant gliomas and metastases, and the difference between high and low grade malignant gliomas, to use the 3.0T 1H-MRS （SV ＆ 2D-CSI）, to detect the cellular metabolism of malignant gliomas and metastases. Methrds： 20 patients with high-grade glioma, 16 patients with low-grade glioma, and 19 patients with metastases were undergone the plain and enhanced MRI; All 1H-MRS were scanned on MRI. In order to comparison of the groups, we the MR PRESS to detect the tumor tissue area, peritumoral tissue area, NAA/Cr, Cho/Cr,NAA/Cho, NAA, Cho, Cr,Lip/Lac;etc. Results： 1.Significant differences between tumor tissue area of high-grade malignant gliomas and metastases were found in metabolite concentrations of the NAA/Cr, （P〈0.0494） ratio.2.Significant differences between peritumoral tissue area of high-grade malignant gliomas, low-grade malignant gliomas and metastases were found in metabolite concentrations of the NAA/Cr and Cho/Cr ratios. 3.Significant differences between peritumoral tissue area of high-grade malignant gliomas and metastases were found in the ratio of metabolite concentration of NAA. 4.Significant differences between high-grade malignant gliomas and low-grade malignant gliomas were found in the metabolite concentrations of NAA, Cho ratio.5.Significant differences in the Lip/Lac ratio among high-grade malignant gliomas, low-grade malignant gliomas and metastases were found in the tumor tissue area and peritumoral tissue area. Conclusion： 1H-MRS on peritumoral tissue area can be used to achieve the differential diagnosis; a direct proportion was found between the ratio of Lip / Lac peaks and the stage of the tumor malignancy.