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目的探讨氢质子磁共振波谱(1H-MRS)成像技术在颅内不典型淋巴瘤与瘤样脱髓鞘病变(TDLs)中的鉴别诊断价值。方法搜集经病理确诊的37例颅内淋巴瘤和19例临床或立体定位活检确诊TDLs的完整影像学资料。使用单体素点分辩波谱(PRESS)序列扫描1H-MRS(TE=144 ms),计算Cho/Cr比值和Cho/NAA比值,目视估测Lip-Lac峰与肌酸(Cr)峰的高度比,分成5个等级。比较颅内淋巴瘤与TDLs的1H-MRS分析结果。使用受试者工作特征曲线(ROC)对Cho/Cr、Cho/NAA及Lip-Lac在两种疾病的鉴别诊断效能进行评价。结果颅内不典型淋巴瘤和TDLs的Cho/Cr、Cho/NAA比值及Lip-Lac峰的等级存在显著性差异。Cho/Cr比值>2.39,Cho/NAA比值>1.73及Lip-Lac峰等级>3级时提示为颅内淋巴瘤。Cho/NAA比值对两种疾病鉴别诊断效能最高,曲线下面积(AUC)值为0.883。结论长TE1H-MRS对颅内不典型淋巴瘤和TDLs的鉴别有很大的临床价值,特别是增加Cho/NAA比值是常规MRI的有益补充。
Objective To investigate the value of 1H-MRS imaging in the differential diagnosis of atypical lymphomas and tumor-like demyelinating lesions (TDLs). Methods Thirty-seven cases of intracranial lymphomas confirmed by pathology and 19 cases of complete imaging data of TDLs diagnosed by clinical or stereotactic biopsy were collected. 1H-MRS (TE = 144 ms) was performed by single factor point-resolved spectroscopy (PRESS). Cho / Cr ratio and Cho / NAA ratio were calculated and the height of Lip-Lac peak and creatine Ratio, divided into five levels. 1H-MRS analysis of intracranial lymphomas and TDLs was compared. The receiver operating characteristic curve (ROC) was used to evaluate Cho / Cr, Cho / NAA and Lip-Lac in the differential diagnosis of the two diseases. Results There were significant differences in Cho / Cr, Cho / NAA ratio and Lip-Lac peak grade in atypical lymphomas and TDLs. Cho / Cr ratio> 2.39, Cho / NAA ratio> 1.73 and Lip-Lac peak level> 3 suggest intracranial lymphomas. The Cho / NAA ratio had the highest diagnostic efficacy for both diseases with an AUC of 0.883. Conclusion Long TE1H-MRS has great clinical value in differentiating intracranial atypical lymphoma from TDLs. In particular, increasing Cho / NAA ratio is a good supplement for routine MRI.