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目的探讨3.0T氢质子磁共振波谱(1H-MRS)对颅内常见肿瘤诊断、鉴别诊断、评价治疗效果及在胶质瘤分级中的价值。资料与方法选取经手术病理或临床确诊的69例颅内肿瘤患者。采用GE Signa EXCITE HD 3.0T超导型MR扫描仪对所有患者行颅脑常规MRI扫描和二维多体素序列扫描。采用Functool软件包后处理,分别测定病变实质、病变周围及健侧相应区域的胆碱(Cho)/肌酸(Cr)、Cho/N-乙酰天门冬氨酸(NAA)、NAA/Cr比值及肌醇(MI)值的变化,并对结果进行统计学分析。结果(1)实质区:低级别胶质瘤的Cho/Cr值与高级别胶质瘤、转移瘤及脑膜瘤间差异有统计学意义(P<0.01);低级别胶质瘤与高级别胶质瘤、脑膜瘤的Cho/NAA比值分别比较有统计学意义(P<0.05),转移瘤与高级别胶质瘤、脑膜瘤的Cho/NAA比值分别比较有统计学意义(P<0.05);低级别胶质瘤NAA/Cr比值与高级别胶质瘤、转移瘤分别比较有统计学意义(P<0.05),转移瘤与脑膜瘤比较有统计学意义(P<0.05);低级别胶质瘤的MI值与高级别胶质瘤、转移瘤及脑膜瘤分别比较有统计学意义(P<0.05)。(2)瘤周水肿区:高级别胶质瘤Cho/Cr比值与另外三者比较差异有统计学意义(P<0.05),低级别胶质瘤Cho/Cr比值与转移瘤、脑膜瘤分别比较差异有统计学意义(P<0.01);低级别胶质瘤Cho/NAA比值与转移瘤、脑膜瘤分别比较差异有统计学意义(P<0.05),高级别胶质瘤与转移瘤、脑膜瘤分别比较有统计学意义;低级别胶质瘤与高级别胶质瘤NAA/Cr比值差异有统计学意义(P<0.05);各肿瘤瘤周水肿区MI值比较无统计学意义(P>0.05)。结论1H-MRS在鉴别诊断颅内肿瘤中有重要价值,可较准确显示肿瘤瘤周浸润情况,结合其他影像征象对胶质瘤分级诊断亦有重要价值。
Objective To investigate the value of 3.0T hydrogen proton magnetic resonance spectroscopy (1H-MRS) in the diagnosis and differential diagnosis of common intracranial tumors and evaluate the therapeutic effect and classification of glioma. Materials and Methods 69 patients with intracranial tumors who had undergone surgical pathology or clinically diagnosed were selected. All patients underwent brain MRI and 2D multi-voxel scan using GE Signa EXCITE HD 3.0T superconducting MR scanner. After treatment with Functool software package, the ratios of Cho / Cr, Cho / N-acetylglutamic acid (NAA) and NAA / Cr were measured respectively in the parenchymatous lesions, Inositol (MI) value changes, and the results were statistically analyzed. Results (1) The real area: The difference of Cho / Cr between low grade gliomas and high grade gliomas, metastatic tumors and meningiomas was statistically significant (P <0.01); low grade gliomas and high grade glioma The ratios of Cho / NAA in tumor and meningioma were statistically significant (P <0.05). The ratios of Cho / NAA in metastatic tumor to high grade glioma and meningioma were statistically significant (P <0.05). Low-grade glioma NAA / Cr ratio and high-grade glioma, metastasis were statistically significant (P <0.05), metastasis and meningioma were statistically significant (P <0.05); low-grade glia The MI value of tumor was higher than high grade glioma, metastatic tumor and meningioma (P <0.05). (2) Peritumoral edema area: The Cho / Cr ratio of high grade glioma was significantly different from the other three groups (P <0.05). The ratio of Cho / Cr in low grade glioma was significantly lower than that in metastatic tumor and meningioma The difference was statistically significant (P <0.01). The ratio of Cho / NAA in low grade glioma was significantly different from that of metastatic tumor and meningioma (P <0.05), and the difference between high grade glioma and metastatic tumor, meningioma (P <0.05). There was no significant difference in MI between peritumoral edema and low grade glioma (P> 0.05) ). Conclusion 1H-MRS in the differential diagnosis of intracranial tumors have important value, can more accurately show the tumor around the infiltration, combined with other imaging signs of glioma grade diagnosis is also of great value.