大脑胶质瘤病磁共振成像结合磁共振波谱成像的诊断价值

摘要

Objective To evaluate MR imaging(MRI) and MR spectroscopy(MRS) in diagnosis and differential diagnosis of gliomatosis cerebri. Methods Clinical representation,MRI and MRS imaging results of 135 patients with gliomatosis cerebri confirmed by biopsy or operation were reviewed retrospectively. Routine MRI with T 1WI, T2WI, FLAIR and MRA with TOF (time of fly) together with contrast enhancement MRI were performed. Single voxel (SV) was chosen for the 1H-MRS acquisition at lesion and normal areas with STEAM sequence. The peak amplitude of the NAA, Cr, Cho was analysed. Results At least two lobes of the brain were involved in tumors with all patients. The temporal lobe, occipital lobe, corpus callosum, basal ganglia and thalamus et al were most involved. Iso-intensity or hypo-intensity on T1WI, hyper-intensity or mixed hyper-intensity on T2WI and FLAIR with the lesion were seen,while no prominent necrosis and calcification were founded. The area invaded by tumor showed slight swelling and no obvi-ous space occupying effect. There was no contrast enhancement in 10 cases, irregular pathy enhancement in 3 cases, nodular enhancement in 1 case and line-like enhancement in 1 case after Gd-DTPA injection. NAA and NAA/Cr ra-tios decreased in some degree, while Cho, Cho/Cr and Cho/NAA levels increased in the lesion with the MRS exami-nation. Conclusion MRI combined with MRS have significant clinical value for diagnosis and differential diagnosis of gliomatosis cerebri.%目的：探讨磁共振成像（MRI）结合磁共振波谱成像（MRS）对大脑胶质瘤病的诊断价值。方法对15例经活体组织检查或手术病理证实的大脑胶质瘤病患者的临床表现及MRI平扫、增强，MRS影像学资料进行回顾性分析。MRI常规行T1WI、T2WI及FLAIR序列，采用时间飞跃法（TOF）的磁共振血管成像（MRA），T1WI增强扫描。氢质子MRS采用单体素STEAM序列，并分析N-乙酰天门冬氨酸（NAA）、肌酸（Cr）、胆碱复合物（Cho）等物质峰值改变。结果所有病例均侵犯2个或2个以上脑叶，以颞叶、枕叶、胼胝体、基底节和丘脑等部位侵犯受累常见。病变区T1WI呈低或等低信号、T2WI呈高或混杂高信号、FLAIR上为高信号,未见明显坏死、钙化，受累区域脑组织肿胀，占位效应轻。注射钆喷酸葡胺增强扫描示10例无明显强化、3例斑片状强化、1例结节状强化、1例线状轻度强化。病变区域MRS表现为不同程度NAA降低，NAA/Cr比值降低；Cho上升，Cho/Cr和Cho/NAA的比值上升。结论 MRI结合MRS对大脑胶质瘤病的诊断及鉴别诊断具有临床价值，是目前诊断大脑胶质瘤病的首选影像学方法。