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目的利用多体素氢质子磁共振波谱(~1H-MRS)分析脑炎与脑炎样胶质瘤的差别,探讨~1H-MRS的鉴别诊断价值。方法搜集经手术或活检病理证实的脑炎样胶质瘤患者11例,经手术或病理活检证实、或多次随访确诊的脑炎患者14例。两组患者均行MRI平扫和增强扫描及多体素~1H-MRS(PRESS序列,TR/TE=2000 ms/135ms)。选择位于病灶强化区或T_2WI高信号区的体素,分析N-乙酰天门冬氨酸(NAA)、胆碱(Cho)、肌酸(Cr)、肌醇(MI)峰下面积值及比值,并以对侧正常脑实质的波谱为参照作进一步分析。结果与脑炎相比,胶质瘤的1HMRS具有以下特点:(1)NAA峰下面积显著降低(P=0.004)而MI峰下面积显著增高(P=0.002),Cho与Cr峰下面积无显著差异(P>0.05);(2)峰下面积比值NAA/Cr(P=0.033)与NAA/Cho(P=0.001)显著降低,而MI/Cr(P=0.003)与Cho/NAA(P=0.022)显著升高,Cho/Cr无显著差异(P=0.097);(3)病灶区代谢物与健侧肌酸峰下面积(Cr-n)比值中,胶质瘤NAA/Cr-n显著降低(P=0.018)而MI/Cr-n(P<0.001)和Cho/Cr-n(P=0.003)显著升高。结论 ~1H-MRS作为一种无创伤性检查手段,可为脑炎与脑炎样胶质瘤的鉴别诊断提供重要依据。
Objective To analyze the difference of encephalitis and encephalitis-like glioma by multi-voxel proton magnetic resonance spectroscopy (~ 1H-MRS), and to explore the value of ~ 1H-MRS in differential diagnosis. Methods Eleven patients with encephalitogenic gliomas confirmed by surgery or biopsy were enrolled and 14 patients with encephalitis confirmed by surgery or pathological biopsy or multiple follow-up were selected. Both groups underwent MRI plain scan and multi-voxel 1H-MRS (PRESS sequence, TR / TE = 2000 ms / 135 ms). The voxels in lesion-enhanced area or T-2WI high signal area were selected to analyze the area values and ratios of NAA, Cho, Cr and MI, And the contralateral normal brain parenchyma spectrum as a reference for further analysis. Results Compared with encephalitis, 1HMRS of glioma had the following characteristics: (1) The area under the NAA peak was significantly lower (P = 0.004) and the area under the MI peak was significantly higher (P = 0.002) (P = 0.033) and NAA / Cho (P = 0.001), while MI / Cr (P = 0.003) and Cho / NAA = 0.022) (P = 0.097). (3) The ratio of NAA / Cr-n (P = 0.018) and MI / Cr-n (P <0.001) and Cho / Cr-n (P = 0.003) increased significantly. Conclusion ~ 1H-MRS as a noninvasive means of examination may provide an important basis for the differential diagnosis of encephalitis and encephalitis-like glioma.