论文部分内容阅读
背景:以往磁共振波谱研究多用点解析波谱或单体素波谱,其兴趣区主要集中在MRI可见的病灶区,不能显示病灶边缘区的改变状况,而化学位移成像磁共振氢波谱(1H-MRS)检测方法可将检测范围扩大至整个脑部区域。目的:观察海洛因海绵状白质脑病患者的1H-MRS表现,分析其脑内N-乙酰天门冬氨酸、肌酸和胆碱的代谢规律。设计:病例-对照观察。单位:南方医院神经内科。对象:病例组为2005-08/2006-08南方医院神经内科收治的,经临床和影像诊断的海洛因海绵状白质脑病3例(男2例,女1例),对照组为10例同龄健康志愿者。方法:使用Siemens Megnetom Vision Plus1.5T超导MR系统和标准头部线圈,应用化学位移成像法对所有受试者行1H-MRS检查。主要观察指标:观察额、顶和枕叶白质中N-乙酰天门冬氨酸、肌酸和胆碱的水平、代谢图以及它们之间的比例关系。结果:13例受试者均进入结果分析。①N-乙酰天门冬氨酸:病例1的额、顶和枕叶白质低于对照组(79.50±21.65,96.75±16.14,77.05±22.47;146.07±15.49,117.77±14.56,120.83±16.02;P<0.05,0.01),病例2、病例3的顶叶白质低于对照组(87.50±7.89,80.65±11.73,P<0.01)。②肌酸:病例组和对照组无显著性差异(P>0.05)。③胆碱:除病例1额叶白质以外,病例组中均低于对照(P<0.01)。④病例组N-乙酰天门冬氨酸/肌酸比值在各部位均较对照降低,而胆碱/肌酸降低更明显。⑤病灶处N-乙酰天门冬氨酸和肌酸在代谢图中均为低信号。⑥在病灶边缘区,胆碱/肌酸比值有明显反转现象。未见乳酸波。结论:1H-MRS发现海洛因海绵状白质脑病患者脑的物质代谢变化明显大于MRI病灶范围,病灶周围影像正常部位已经有代谢改变。
BACKGROUND: In the past, multi-point analytical spectroscopy or single-element spectroscopy was used in magnetic resonance spectroscopy (MRS). The ROIs mainly focused on the lesion areas visible in MRI and could not show the change of lesion margins. The chemical shift imaging 1H-MRS The detection method can extend the detection range to the entire brain area. OBJECTIVE: To observe the 1H-MRS manifestations in patients with heroin causal leukoencephalopathy and analyze the metabolism of N-acetyl-aspartate, creatine and choline in the brain. Design: Case-control observation. Unit: Nanfang Hospital, Department of Neurology. PARTICIPANTS: The case group was treated by Department of Neurology, Southern Hospital from August 2005 to August 2006. There were 3 cases (2 males and 1 females) of heroin cavernous disease diagnosed by clinical and imaging diagnosis. The control group consisted of 10 healthy volunteers of same age By. METHODS: 1H-MRS examinations were performed on all subjects using the Siemens Megnetom Vision Plus 1.5T superconducting MR system and a standard head coil using chemical shift imaging. MAIN OUTCOME MEASURES: To observe the levels of N-acetyl-aspartate, creatine and choline in the amount, white matter of the top and occipital lobe, metabolic map and the proportion between them. Results: All 13 subjects entered the result analysis. ① N-acetyl-aspartate: The amount, white matter of top and occipital lobe of case 1 were lower than that of the control group (79.50 ± 21.65,96.75 ± 16.14,77.05 ± 22.47; 146.07 ± 15.49,117.77 ± 14.56,120.83 ± 16.02; P <0.05 , 0.01). Case 2, the parietal white matter in case 3 was lower than the control group (87.50 ± 7.89,80.65 ± 11.73, P <0.01). ② creatine: no significant difference between the case group and the control group (P> 0.05). ③ Choline: In addition to case 1 frontal white matter, the case group were lower than the control (P <0.01). ④ Case group N-acetyl aspartate / creatine ratio decreased in all parts of the control, while the choline / creatine decreased more significantly. Â ’¤ focal N-acetyl aspartate and creatine in the metabolism are low signal. ⑥ marginal zone in the lesion, choline / creatine ratio significantly reversed phenomenon. No lactic acid wave. Conclusion: 1H-MRS found that the changes of brain metabolism in patients with heroin causative leukoencephalopathy were significantly greater than those of MRI lesions. Metabolic changes had been found in the normal parts of the lesions around the lesion.