【作者】 李国文； 吴沛宏； 吕衍春； 谢传淼；

【Author】 Li Guo-wen Wu Pei-hong Lv Yuan-chun Xie Chuan-miao Dept.of Medical Imaging and Interventional Radiology,Cancer Hospital,Sun Yat-sen University,Guangzhou China,510060

【机构】 中山大学肿瘤医院医学影像与介入中心；

【摘要】 目的:探讨质子磁共振波谱(3D~1H—MRS)在胶质瘤治疗随访中的价值。材料与方法:18例经病理证实的胶质瘤患者经手术或手术加放疗或手术加放、化疗后,均行 MRI 及3D~1H—MRS 检查。结果:3例复发、1例放射性坏死经手术病理证实,2例残留和12例治疗后改变经 MRI 临床随访证实。(1)肿瘤残留或复发:4例均表现为 Cho 明显增高,NAA、 Cr 下降或消失,Cho/Cr、Cho/NAA 比值升高,NAA/Cr 比值下降;另1例 Cho 稍下降, NAA、Cr 消失,Cho/Cr、Cho/NAA 明显高于对侧正常脑组织;1例出现高耸 Lip 峰,2 例出现 Lac 峰;(2)放射性坏死:该病灶大部分表现为 Cho 明显增高,NAA、Cr 下降,Cho/Cr、 Cho/NAA 比值升高,NAA/Cr 比值下降,出现明显 Lip 峰;少部分病灶表现 Cho、NAA、 Cr 下降或消失,可见一高耸 Lip 峰,无 Lac 峰;(3)治疗后反应性强化:7例 Cho 明显降低, 5例 Cho 明显增高,12例均表现 NAA、Cr 下降或消失,Cho/Cr、Cho/NAA 比值升高,NAA/Cr 比值下降,部分出现 Lip 峰或 Lac 峰。结论:3D~1H—MRS 在胶质瘤治疗后随访中有重要的价值,但必须结合临床和其它影像学资料才能正确判断。更多还原

【Abstract】 Objective:To evaluate 3D ~1H magnetic resonance spectroscopy (3D~1H- MRS)imaging in the application of brain gliomas after therapy.Material and Methods:Eighteen patients with gliomas proved by pathology underwent magnetic resonance imaging and 3D ~1H magnetic resonance spectroscopy after surgery,or/and irradiation,or/and chemotherapy.Results: Two cases with recurrent tumor and one case with delayed cerebral necrosis were proved by surgical pathology.Two cases with residue disease and twelve cases with reflecting intensity were proved by following up with magnetic resonance imaging.(1)~1H-MRS in 3 cases with gliomas exhibited specific spectral peaks including prominent choline-containing compounds(Cho), decreased or absent acetylaspartate(NAA) and total creatine(Cr),and the metabolic ratios showed significantly increased Cho/Cr,Cho/NAA,decreased NAA/Cr.The other case with glioma showed low choline,absent NAA,Cr,but increased Cho/Cr and Cho/NAA compared with the contralateral side.One case showed steep Lip(lipid).Two cases showed abnormal Lac(lactate).(2) The majority lesion of the case who was delayed cerebral necrosis exhibited significantly increased Cho,Cho/Cr and Cho/NAA,decreased NAA,Cr and NAA/Cr,obvious Lip.The fraction lesion of the case showed decreased or absent Cho,NAA and Cr,steep Lip.The case showed no Lac.(3) Twelve cases were reflecting intensity.Among 12 cases who showed decreased or absent NAA,Cr,increased Cho/Cr,Cho/NAA,decreased NAA/Cr,7 cases showed obvious decreased Cho,and 5 cases showed obvious increased Cho.Some cases exhibited Lac or Lip.Conclusion:3D~1H-MRS is an useful tool in following up of the patients with gliomas who were operated by surgery,or and irradiation,or and chemotherapy.But it could not make correct diagnosis without clinical evaluation and other imaging data.更多还原