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目的利用多体素质子谱成像,对颅内胶质瘤患者在手术前对其浸润边界及病理学级别进行分析,并提出新的评价方法,探讨MR多体素质子谱成像在胶质瘤中的应用价值。方法经手术及病理证实的胶质瘤共30例。行常规MR检查及增强检查,随后行多体素质子谱扫描。采用胆碱(Cho)/N-乙酰天冬氨酸(NAA)残差z分数统计模型确定肿瘤的边界,最大z分数所在区域确定肿瘤的高代谢活性区,采用最大z分数、肿瘤最高乳酸指标(LLI)值及有无乳酸盐(Lac)/Cho>1的体素出现等3项指标确定肿瘤的级别。结果传统的MR扫描显示出肿瘤的瘤体及周围水肿影,15例在增强扫描中表现不同的强化影;用多体素质子谱定量分析方法所确定的肿瘤边界均超过常规MRI所确定的肿瘤边界,且可见其边界呈浸润性生长。在20例2~3级肿瘤中,其肿瘤内高的代谢活性区在常规MRI所确定的肿瘤区内;而在10例4级肿瘤中,有8例其肿瘤内高代谢活性区在常规MRI所确定的肿瘤区外。2级胶质瘤的最大z分数为6·40±2·43,3级为16·83±7·28,4级为9·16±4·38。3级的最大z分数均高于2级和4级,4级高于2级,差异具有统计学意义(t34=-2·61,P=0·01;t32=3·91,P=0·002;t42=1·90,P=0·04)。2级胶质瘤的最大LLI值为9·24±5·33,3级为22·27±14·63,4级为38·41±11·45。LLI值随肿瘤级别的升高而增大,差异具有统计学意义(t34=2·56,P=0·01;t32=2·41,P=0·02;t42=7·42,P<0·01)。4级胶质瘤有Lac/Cho>1的区域出现,即出现显著性坏死,而2、3级肿瘤均无Lac/Cho>1的区域出现。结论MR多体素质子谱成像可提供肿瘤代谢方面的功能信息,可评价胶质瘤对正常脑组织的浸润及其恶性度,结合常规MR结构成像,可为术前准确、全面评价胶质瘤、制定个性化的治疗方案提供有价值的参考信息。
Objective To analyze the infiltration boundary and pathological level of patients with intracranial glioma before operation by using multi-voxel proton spectrum imaging and to propose a new evaluation method to explore MR multi-voxel proton imaging in glioma The application value. Methods Thirty patients with gliomas confirmed by operation and pathology were included. Routine MR examination and enhanced examination, followed by multi-voxel mass spectrometry scan. The border of tumor was determined by the statistical model of residual z score of Cho / NAA. The area with the highest z score was used to determine the high metabolic activity area of the tumor. The maximum z score and the highest lactic acid index (LLI) value and the presence or absence of lactate (Lac) / Cho> 1 voxel appears three indicators such as the level of tumor. Results The traditional MR scan showed the tumor of the tumor and the surrounding edema, and 15 cases showed different intensified shadows in the enhancement scan. The tumor boundaries determined by the multi-voxel proton quantitative analysis method surpassed the tumors determined by conventional MRI Boundaries, and its borders showed infiltrative growth. In 20 cases of grade 2 to grade 3 tumors, the high metabolic activity of the tumor area within the tumor area determined by conventional MRI; and in 10 cases of grade 4 tumors, the tumor of high metabolic activity in the area of conventional MRI The tumor area was identified outside. The maximum z-score for grade 2 glioma was 6 · 40 ± 2 · 16 · 83 · 7 · 28 for grade 4 · 9 · 16 ± 4 · 38 · The maximum z-score for grade 3 was higher than 2 Grade 4 and grade 4 were higher than grade 2, the difference was statistically significant (t34 = -2.61, P = 0.01; t32 = 3.91, P = 0.002; t42 = 1.90, P = 0 · 04). The maximum LLI of grade 2 glioma was 9 · 24 ± 5 · 33, grade 3 was 22 · 27 ± 14 · 63, grade 4 was 38 · 41 ± 11 · 45. The value of LLI increased with the tumor grade, the difference was statistically significant (t34 = 2.56, P = 0.01; t32 = 2.41, P = 0.02 and t42 = 7.42, P < 0 · 01). Grade 4 gliomas had a zone of Lac / Cho> 1, with significant necrosis, whereas no zone of Lac / Cho> 1 appeared in grades 2 and 3. Conclusion MR multi-body proton imaging can provide functional information on tumor metabolism, evaluate the infiltration and malignancy of glioma in normal brain tissue. Combined with conventional MR imaging, MR imaging can be a preoperative accurate and comprehensive evaluation of glioma , Develop personalized treatment programs provide valuable reference information.