| 摘要: |
| 目的:探讨二维化学位移成像氢质子磁共振波谱(2D CSI1H-MRS)对脑内环形强化病变的诊断价值.方法:回顾性分析经临床诊断和(或)手术病理证实的62例脑内环形强化病变的MRS及MRI表现,包括胶质瘤20例、转移瘤18例、脑部炎性病变16例、放射性损伤8例.比较4组乳酸(Lac)峰出现率,计算增强区及增强区内部的胆碱(Cho)、N-乙酰天门冬氨酸(NAA)、肌酐(Cr)的浓度及NAA/Cho、Cho/Cr、NAA/Cr比值.结果:(1)4组病变的Lac峰出现率无明显差异.(2)胶质瘤、转移瘤、炎性病变、放射性损伤的NAA/Cho分别为0.43±0.32、0.69±0.29、1.26±0.53、0.63±0.34,胶质瘤显著低于其他3组病变(P＜0.05);当取NAA/Cho＜0.4时,MRS区分胶质瘤的灵敏度、特异度、阳性预测值(PPV)、阴性预测值(NPV)分别为80.2﹪、77.4﹪、71.5﹪、89.4﹪,均高于MRI,两种方法联合使用时各项指标均提高.(3)4组病变的Cr浓度分别为0.17±0.05、0.10±0.05、0.21±0.08、0.21±0.09,转移瘤显著低于其他3组病变(P＜0.05);当取Cr＜0.06时,MRS区分转移瘤的灵敏度、特异度、PPV、NPV分别为81.3﹪、81.9﹪、74.1﹪、90.1﹪,均高于MRI,两种方法联合使用时各项指标均提高.结论:2DCSI1H-MRS在脑内环形病变的鉴别诊断上有重要价值,两种方法联合使用诊断价值更高. |
| 关键词: 磁共振波谱学、代谢产物、脑疾病、诊断、鉴别诊断 |
| DOI：10.3724/SP.J.1008.2006.00981 |
| 投稿时间：2006-06-29修订日期：2006-08-21 |
| 基金项目: |
|
| Magnetic resonance spectroscopy of ring-enhancing intracerebral lesions |
| KUANG Fei,WANG Fei,LU Jian-ping,LIU Qi,WANG Li |
| (第二军医大学长海医院放射科,上海,200433) |
| Abstract: |
| Objective：To assess the value of two-dimensional chemical shift imaging magnetic resonance spectroscopy （2 D CSI ^1 H-MRS） in diagnosis of ring-enhancing intracerebral lesions. Methods： Magnetic resonance spectroscopy and magnetic resonance imaging manifestations were analyzed retrospectively in 62 patients with ring-enhancing intracerebral lesions （confirmed by clinical or histopathologic findings）, including 20 gliomas, 18 metastatic tumors, 16 brain inflammations, and 8 radiation damages. The appearance rate of lactate （Lac） was analyzed and the concentrations of choline （Cho）, N-acetyl aspartate （NAA）, creatine （Cr） and NAA/Cho, Cho/Cr and NAA/Cr ratios in the enhancing regions were calculated （including the inside of enhancing regions ） . Results： （1）There was no difference in appearance rate of Lac among the 4 groups. （2）NAA/Cho ratios in the glioma, metastatic tumor, inflammation and radiation damage group were 0.43±0.32, 0.69±0.29, 1.26±0.53 and 0. 63±0. 34, respectively, with that of the glioma group being significantly lower than those of the other 3 groups（P〈 0.05）. When NAA/Cho ratio is less than 0.4, the sensitivity, specificity, positive predictive value （PPV） and negative predictive value （NPV） of MRS for high-grade glioma were 80.2%, 77.4%, 71.5% and 89.4%, respectively, all higher than those of MRI, but lower than those of MRI combined with MRS. （3）The concentrations of Cr in glioma, inflammation and radiation damage groups were 0.17±0.05, 0.10±0.05, 0.21±0.08 and 0.21±0. 09, respectively, with that of metastatic tumor being significantly lower than those of the other 3 groups（P〈0.05）. When Cr〈0.06, the sensitivity, specificity, PPV and NPV of MRS for metastatic tumor were 81.3~, 81.9~, 74. 1% and 90. 1%, respectively, all higher than those of MRI, but lower than those of MRI combined with MRS. Conclusion, 2D CSI 1 H-MRS is very useful in the differential diagnosis of ring-enhancing intracerebral lesions and the combined application of MRI and MRS has a higher diagnostic value |
| Key words: magnetic resonance spectroscopy metabolites brain diseases diagnosis differential diagnosis |
