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目的探讨多体素磁共振氢质子波谱(1HMRS)对高级别脑胶质瘤瘤周水肿区代谢物的特点及其诊断意义。方法对经手术病理确诊为Ⅲ～Ⅳ级脑胶质瘤的35例患者术前行1HMRS检查,观察肿瘤实质区、瘤周水肿区及对侧相应部位正常脑实质区N-乙酰天门冬氨酸(NAA)、胆碱(Cho)和肌酸(Cr)等代谢物的变化,计算代谢物NAA/Cr、Cho/Cr、NAA/Cho值,并对结果进行统计学分析。结果高级别脑胶质瘤肿瘤实质区的Cho/Cr、NAA/Cho、NAA/Cr值分别为3.181 1±2.313 5、0.414 4±0.281 8、1.048 5±0.712 3;瘤周水肿区的Cho/Cr、NAA/Cho、NAA/Cr值分别为2.087 9±1.592 1、0.727 0±0.527 2、1.216 9±0.707 9;对侧相应部位正常脑实质区的Cho/Cr、NAA/Cho、NAA/Cr值分别为0.633 2±0.077 9,0.833 4±0.102 6,0.771 2±0.094 9。Ⅲ～Ⅳ级脑胶质瘤瘤周水肿区与肿瘤实质区的Cho/Cr、NAA/Cho、NAA/Cr值相比差异无统计学意义(P>0.05);瘤周水肿区与对侧相应部位正常脑实质区的Cho/Cr、NAA/Cho、NAA/Cr值相比差异均有统计学意义(P<0.05)。结论高级别(Ⅲ～Ⅳ级)脑胶质瘤瘤周水肿区存在病理性波谱,多体素1HMRS检查对高级别脑胶质瘤瘤周水肿区的评价以及对肿瘤边界的判定具有较大的临床价值。
Objective To investigate the characteristics and diagnostic significance of multi-voxel magnetic resonance hydrogen proton spectroscopy (1HMRS) on metabolites of peri-edema in high-grade gliomas. Methods Totally 35 patients with histologically confirmed grade III-IV glioma underwent preoperative 1HMRS examinations to observe the changes of N-acetyl-aspartate in normal parenchyma of the tumor parenchyma, peritumoral edema and contralateral side (NAA), cholines (Cho) and creatine (Cr) were calculated. The metabolites NAA / Cr, Cho / Cr and NAA / Cho were calculated and the results were statistically analyzed. Results The Cho / Cr, NAA / Cho, NAA / Cr values of the high grade gliomas were 3.181 1 ± 2.313 5,0.414 4 ± 0.281 8 and 1.048 5 ± 0.712 3, respectively. Cho / Cr, NAA / Cho and NAA / Cr values were 2.087 9 ± 1.592, 0.727 ± 0.527 2 and 1.216 9 ± 0.707 9, respectively. Cho / Cr, NAA / Cho and NAA / Cr in normal parenchyma The values were 0.633 2 ± 0.077 9, 0.833 4 ± 0.102 6 and 0.771 2 ± 0.094 9, respectively. There was no significant difference in Cho / Cr, NAA / Cho and NAA / Cr between the stage Ⅲ ~ Ⅳ glioma peritumoral edema and the tumor parenchyma (P> 0.05) The differences of Cho / Cr, NAA / Cho and NAA / Cr in normal brain parenchyma were statistically significant (P <0.05). Conclusions There are pathological spectra of perihematomal edema in high grade gliomas (Ⅲ ~ Ⅳ grade). The evaluation of multi - voxel 1H MRS in the evaluation of perihematomal edema of high grade gliomas and the determination of tumor border Clinical Value.