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目的:利用3.0T氢质子磁共振波谱对胶质瘤和转移瘤的肿瘤组织区、瘤周水肿区进行细胞代谢物水平的检测,试图找出胶质瘤和脑转移瘤的鉴别诊断的依据,以及胶质瘤高、低级别组间的差别。方法:对经病理证实的20例高级别胶质瘤组、16例低级别胶质瘤组和19例脑转移瘤组患者,先行MRI平扫及增强扫描,波谱均在增强扫描的基础上获得,使用MR点分辨波谱序列,检测肿瘤组织区、瘤周水肿组织区NAA/Cr、Cho/Cr、NAA/Cho、NAA、Cho、Cr、Lip/Lac等值,进行比较。结果:(1)高级别胶质瘤与转移瘤在肿瘤组织区NAA/Cr代谢物浓度的比值有统计学意义。(2)高、低级别胶质瘤肿瘤组织内Cho/Cr比值有统计学意义。(3)转移瘤与高、低级别胶质瘤在瘤周水肿区NAA/Cr,以及低级别胶质瘤与转移瘤Cho/Cr代谢物浓度的比值有统计学意义;高级别胶质瘤与转移瘤瘤周区NAA代谢物浓度有明显差异。(4)胶质瘤高、低级别组间在肿瘤周围区NAA峰、Cho峰及NAA/Cho Cho/Cr代谢物浓度比值有统计学意义。(5)高级别胶质瘤和转移瘤分别与低级别胶质瘤在肿瘤组织区及瘤周水肿区Lip/Lac有显著性差异(P<0.01)。结论:利用氢质子波谱可对胶质瘤和转移瘤进行鉴别诊断;Cho/Cr及NAA/Cho比值可对胶质瘤进行分级;Lip/Lac峰的出现与肿瘤的恶性度呈正相关,但不特异。
OBJECTIVE: To detect the level of cellular metabolites in tumor tissue and peritumoral edema area of glioma and metastasis by using 3.0T hydrogen proton magnetic resonance spectroscopy in order to find out the basis of differential diagnosis of glioma and brain metastases, As well as the difference between high and low grade gliomas. Methods: Twenty cases of high grade glioma, 16 cases of low grade glioma and 19 cases of brain metastasis confirmed by pathology were scanned by MRI and enhanced scan. The spectrum was obtained on the basis of enhanced scan , MRA-resolved spectral series were used to detect NAA / Cr, Cho / Cr, NAA / Cho, NAA, Cho, Cr and Lip / Lac in the tumor tissue area and peritumoral edema area. Results: (1) The ratio of NAA / Cr metabolites in high grade gliomas and metastases was statistically significant. (2) Cho / Cr ratio in high and low grade glioma tumor tissues was statistically significant. (3) The ratio of NAA / Cr in metastatic tumor to high and low grade glioma in peritumoral edema area and the ratio of Cho / Cr metabolites in low grade glioma and metastatic tumor were statistically significant. High grade glioma Metastatic tumor neoplasms NAA metabolites concentrations were significantly different. (4) The ratio of NAA peak, Cho peak and NAA / Cho Cho / Cr metabolite concentration in the tumor surrounding area between high and low grade gliomas was statistically significant. (5) There were significant differences between high grade glioma and metastatic tumor in low grade glioma and in peritumoral edematous area (P <0.01). Conclusions: The differential diagnosis of gliomas and metastases can be made by hydrogen proton spectroscopy. The ratio of Cho / Cr and NAA / Cho can be used to grade glioma. The appearance of Lip / Lac peak is positively correlated with the malignancy of tumor, but not Specific.