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目的探讨多体素二维氢质子MR波谱(2D protonmagnetic resonance spectroscopy,2D1H-MRS)对脑结核瘤、高级别胶质瘤和脑转移瘤的鉴别诊断价值。方法对16例脑结核瘤、15例高级别胶质瘤和21例脑转移瘤患者术前或接受治疗前行常规MRI和2D1H-MRS检查,1H-MRS采用点分辨表面线圈法(PRESS)序列(TR1000ms,TE144ms)。统计分析3种疾病瘤体实质部分胆碱/肌酸(Cho/Cr)、胆碱/N-乙酰天门冬氨酸(Cho/NAA)、胆碱/对侧相应正常脑实质区肌酸(Cho/Cr-n)比值,记录3种疾病是否有脂质(Lip)或乳酸(Lac)峰出现。结果脑结核瘤、高级别胶质瘤和脑转移瘤瘤体Cho/Cr比值分别为(1.90±0.85)、(3.84±2.23)和(3.78±2.38);Cho/NAA值分别为(1.80±0.95)、(3.94±2.52)和(3.18±2.40);Cho/Cr-n值分别为(0.97±0.11)、(2.71±0.56)和(2.42±0.54)。Cho/Cr、Cho/NAA、Cho/Cr-n比值在3种疾病间两两比较有统计学差异(P<0.05,P<0.01)。3种疾病瘤体Lip和Lac阳性率比较差异无统计学意义(P>0.05)。结论多体素2D1H-MRS结合临床资料对脑结核瘤、高级别胶质瘤和脑转移瘤的鉴别诊断有一定的临床应用价值。
Objective To investigate the differential diagnosis value of 2D proton magnetic resonance spectroscopy (2D1H-MRS) on brain tuberculoma, high-grade glioma and brain metastases. Methods 16 cases of brain tuberculoma, 15 cases of high grade glioma and 21 cases of brain metastases were examined by conventional MRI and 2D1H-MRS before operation or before treatment. 1H-MRS was performed using point-resolved surface coil method (PRESS) (TR1000ms, TE144ms). Statistical analysis of the three tumor tissues showed that Cho / Cr, Cho / NAA and Cho / Cr-n ratio, recording whether there are Lip or lactic acid (Lac) peaks in the three diseases. Results The Cho / Cr ratios of brain tumors, high grade gliomas and brain metastases were (1.90 ± 0.85), (3.84 ± 2.23) and (3.78 ± 2.38), respectively. The values of Cho / NAA were (1.80 ± 0.95 (3.94 ± 2.52) and (3.18 ± 2.40), respectively. The Cho / Cr-n values were (0.97 ± 0.11), (2.71 ± 0.56) and (2.42 ± 0.54), respectively. The ratios of Cho / Cr, Cho / NAA and Cho / Cr-n were statistically different between the three diseases (P <0.05, P <0.01). The positive rate of Lip and Lac in the three kinds of diseases had no significant difference (P> 0.05). Conclusion The multi-voxel 2D1H-MRS combined with clinical data has certain clinical value in differential diagnosis of brain tuberculoma, high-grade glioma and brain metastases.