【摘要】：目的分析3.0T氫質(zhì)子磁共振波譜成像(1HMRS)在鑒別腦內(nèi)單發(fā)環(huán)形強化病變中的應(yīng)用。方法應(yīng)用PHILIPS 3.0T磁共振掃描儀對65例在MRI增強掃描時表現(xiàn)為腦內(nèi)單發(fā)環(huán)形強化病變的患者治療前行1HMRS掃描,經(jīng)病理證實或臨床確診為30例高級別膠質(zhì)瘤、23例單發(fā)腦轉(zhuǎn)移瘤和12例腦膿腫。分別測量病灶中心及周圍水腫區(qū)的NAA、Cho及Cr峰的峰下面積,計算NAA/Cr、Cho/Cr、NAA/Cho比值,并記錄病灶中心Lac和Lip峰是否出現(xiàn)。對各參數(shù)值進行統(tǒng)計學(xué)分析,明確其對鑒別三種疾病的診斷價值。結(jié)果病灶中心的Cho值膠質(zhì)瘤㧐轉(zhuǎn)移瘤㧐腦膿腫;Cho/Cr值膠質(zhì)瘤㧐腦膿腫(P㩳0.05);NAA/Cho值腦膿腫㧐轉(zhuǎn)移瘤㧐高級別膠質(zhì)瘤;NAA及NAA/Cr在三組之間差異均無統(tǒng)計學(xué)意義。周圍水腫區(qū)的NAA/Cr轉(zhuǎn)移瘤組㧐腦膿腫組;Cho/Cr比值差異有顯著統(tǒng)計學(xué)意義(P㩳0.001),膠質(zhì)瘤組㧐腦膿腫組㧐轉(zhuǎn)移瘤組,高級別膠質(zhì)瘤組明顯高于單發(fā)腦轉(zhuǎn)移瘤組(P=0.000)且Cho/Cr臨界值為1.5650時診斷為高級別膠質(zhì)瘤的敏感度為73.3%,特異度為94.4%,ROC曲線下面積為0.921。周圍水腫區(qū)NAA/Cho差異有顯著統(tǒng)計學(xué)意義(P㩳0.001),轉(zhuǎn)移瘤組高于膠質(zhì)瘤組和腦膿腫組。高級別膠質(zhì)瘤Lip峰出現(xiàn)率低于轉(zhuǎn)移瘤和腦膿腫,轉(zhuǎn)移瘤和腦膿腫組間比較差異無統(tǒng)計學(xué)意義。結(jié)論1HMRS可用于鑒別腦內(nèi)單發(fā)環(huán)形強化病變,病灶中心的NAA/Cho和周圍水腫區(qū)的Cho/Cr比值對高級別膠質(zhì)瘤、單發(fā)腦轉(zhuǎn)移瘤和腦膿腫的鑒別診斷具有重要意義。
[Abstract]:Objective to analyze the application of 3.0T proton magnetic resonance spectroscopy (1HMRS) in differentiating single ring enhancement lesions in brain. Methods PHILIPS 3.0T magnetic resonance scanner was used to scan 1HMRS in 65 patients with single ring-enhanced lesions in the brain during MRI enhancement. 30 cases of high-grade gliomas were confirmed by pathology or clinical diagnosis. There were 23 cases of single brain metastasis and 12 cases of brain abscess. The subpeak area of NAA,Cho and Cr in the center of the lesion and the surrounding edema area were measured, the NAA/Cr,Cho/Cr,NAA/Cho ratio was calculated, and the Lac and Lip peaks in the center of the lesion were recorded. The diagnostic value of each parameter value in differentiating the three diseases was determined by statistical analysis. Results the Cho value of the center of the lesion was glioma. Metastatic tumor? Brain abscess; Cho/Cr value glioma? Brain abscess (P0. 05); NAA/Cho? Metastatic tumor? There was no significant difference in NAA and NAA/Cr between the three groups. NAA/Cr metastasis in peripheral edema? There was significant difference in Cho/Cr ratio between brain abscess group and glioma group (P0. 001). Brain abscess group? The sensitivity and specificity of high grade glioma were 73.3 and 94.4 when the Cho/Cr threshold value was 1.5650 and the high grade glioma group was significantly higher than that of single brain metastases group (P0. 000). The area under the ROC curve is 0.921. The difference of NAA/Cho in peripheral edema was statistically significant (P0. 001). The NAA/Cho of metastatic tumor group was higher than that of glioma group and brain abscess group. The occurrence rate of Lip peak in high grade glioma was lower than that in metastatic tumor and brain abscess, and there was no significant difference between metastatic tumor and brain abscess group. Conclusion 1HMRS can be used to differentiate the single ring-enhanced lesions in the brain. The ratio of NAA/Cho in the center of the lesion to Cho/Cr in the peripheral edema area is of great significance for the differential diagnosis of high-grade gliomas, single brain metastases and brain abscesses.
【作者單位】： 哈爾濱醫(yī)科大學(xué)附屬第四醫(yī)院醫(yī)學(xué)影像科;
【分類號】：R739.41;R445.2

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