摘要
目的探讨氢质子磁共振波谱成像(~1H-MRS)技术在脑结核瘤、弓形虫脑病和脑转移瘤鉴别诊断的作用。方法搜集2015年9月至2018年8月就诊于本院且符合纳入标准的弓形虫脑病和脑结核瘤患者各15例,脑转移瘤患者20例;分别进行脑MRI常规扫描、增强扫描和~1H-MRS扫描。观察脑结核瘤、弓形虫脑病和脑转移瘤病灶实质区、病灶水肿区及对侧相应正常部位脑实质,分别观察N-乙酰天门冬氨酸(NAA)(2.02 ppm)、胆碱(Cho)(3.22 ppm)、肌酸(Cr)(3.02 ppm)、脂质(Lip)(0.8~1.5 ppm)、乳酸(Lac)(0.33~1.35 ppm)、肌醇(MI)(3.56 ppm),Lip与Lac之和(LL);计算Cho/Cr、Cho/NAA、Cr/NAA、MI/Cr、(Cho+MI)/Cr、LL/Cr值。结果弓形虫脑病病灶实质区Cho、MI峰明显低于脑转移瘤,弓形虫脑病病灶实质区Cho/Cr、Cho/NAA、(Cho+MI)/Cr值低于脑转移瘤,差异有统计学意义。脑结核瘤病灶实质区Cho/Cr、Cho/NAA、(Cho+MI)/Cr值低于脑转移瘤,差异有统计学意义。弓形虫脑病病灶实质区Cr、NAA、MI、LL峰明显低于脑结核瘤,弓形虫脑病病灶实质区Cr/NAA值低于脑结核瘤,差异有统计学意义。弓形虫脑病、脑结核瘤和脑转移瘤病灶水肿区Cho/Cr、Cho/NAA、Cr/NAA、MI/Cr、(Cho+MI)/Cr、LL/Cr比值均无统计学差异。结论~1H-MRS技术可以提供脑结核瘤、弓形虫脑病和脑转移瘤病灶及病灶周围水肿区组织代谢的特点,为鉴别诊断提供客观依据。
Objective To explore the role of 1H-MRS technology in the differential diagnosis of cerebral tuberculosis,toxoplasmosis encephalopathy and brain metastases.Methods We collected 15 patients with toxoplasma encephalopathy and cerebral tuberculosis who were treated in our hospital from September 2015 to August 2018 and met the inclusion criteria,and 20 patients with brain metastases.Conventional brain MRI scans,enhanced scans and hydrogen proton spectroscopy scans were performed.Observation of cerebral tuberculomas,toxoplasmosis encephalopathy and brain metastases lesions parenchymal area,perilesional edema area and the corresponding normal part of the brain parenchyma was done.N-acetyl-aspartate(NAA)(2.02 ppm),choline(Cho)(3.22 ppm),creatine(Cr)(3.02 ppm),lipid(1 ipids,Lip)(0.8-1.5 ppm),lactate(Lactate,Lac)(0.33-1.22 ppm,inositol(MI)(3.56 ppm peaks were observed.Cho/Cr,Cho/NAA,Cr/NAA,MI/Cr,(Cho+MI)/Cr,LL/Cr values were calculated.Results(1)The Cho and MI peaks in the parenchymal areas of Toxoplasma encephalopathy were significantly lower than those of brain metastases,and the Cho/Cr,Cho/NAA and(Cho+MI)/Cr values in the parenchymal areas of Toxoplasma encephalopathy were lower than those of brain metastases,with statistical significance.(2)Cho/Cr,Cho/NAA and(Cho+MI)/Cr values in the parenchymal areas of brain tuberculoma lesions were lower than those of brain metastases,with statistical significance.(3)The peak values of Cr,NAA,MI and LL in the parenchymal area of Toxoplasma encephalopathy were significantly lower than those in brain tuberculosis,and the value of Cr/NAA in the parenchymal area of Toxoplasma encephalopathy was lower than that in brain tuberculosis.(4)There was no significant difference in the ratio of Cho/Cr,Cho/NAA,Cr/NAA,MI/Cr,(Cho+MI)/Cr,LL/Cr in the perilesional edema areas of Toxoplasma encephalopathy,brain tuberculosis and brain metastasis.Conclusion^1H-MRS can provide the characteristics of tissue metabolism in brain tuberculosis,Toxoplasma encephalopathy,brain metastasis and edema area around the lesion,and provide objective basis for differential diagnosis.
作者
高欣
张丹
艾尼瓦尔·吾拉木
杨豫新
王艳
戴国朝
吕新胜
陈宏
王俭
GAO Xin;ZHANG Dan;AiNiWaEr·WuLaMu(Department of Imaging Center,First Affiliated Hospital of Xinjiang Medical University,Urumqi,Xinjiang 830054,P.R.China)
出处
《临床放射学杂志》
CSCD
北大核心
2020年第3期440-445,共6页
Journal of Clinical Radiology
基金
新疆维吾尔自治区重点研发计划项目(编号:2016B03052)
