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目的利用31P磁共振波谱(MRS)在体分析骨肉瘤与正常骨骼、肌肉组织磷脂代谢特点,探讨31PMRS结合常规MRI在骨肉瘤定性诊断中的价值。资料与方法对31名健康自愿者的33个部位、18例骨肉瘤行常规MRI与31PMRS检测。对两组各代谢物比值行独立样本t检验,分析骨肉瘤组织细胞膜磷脂代谢指标磷酸单酯(PME)/β-三磷酸腺苷(β-ATP)、磷酸二酯(PDE)/β-ATP等比值变化特点,组织能量磷酸肌酸(PCr)/总31P代谢物(T31P)、ATP/T31P、无机磷(Pi)/β-ATP及细胞内pH值变化特点。结果骨肉瘤组PME/β-ATP、Pi/β-ATP、PDE/β-ATP、PCr/T31P、低能磷酸盐(LEP)/T31P、ATP/T31P、PCr/β-ATP、(PCr+ATP)/Pi及pH值均数分别为1.08±0.19、0.85±0.40、0.98±0.38、0.28±0.09、0.30±0.07、0.42±0.09、2.75±1.25、9.45±3.84、7.35±0.24,对照组各比值均数分别为0.07±0.06、0.34±0.12、0.43±0.26、0.43±0.03、0.10±0.03、0.46±0.03、3.63±0.65、24.53±10.14、7.06±0.08,除ATP/T31P外,其余比值与对照组均存在明显差异(P值均<0.01)。对MRI征象分析结果提示:单独依靠MRI对骨肉瘤符合率为12/18例,而结合31PMRS结果,诊断符合率为16/18例。结论骨肉瘤组细胞膜磷脂代谢指标较对照组明显升高,高能磷酸盐显著降低,细胞内pH值轻度升高。结合常规MRI,这些特征性改变有利于对骨肉瘤病变的早期诊断和治疗监测。
Objective To analyze the characteristics of phospholipid metabolism in osteosarcoma, normal bone and muscle tissue using 31P magnetic resonance spectroscopy (MRS), and to explore the value of 31PMRS combined with conventional MRI in the qualitative diagnosis of osteosarcoma. Materials and Methods Conventional MRI and 31-PMRS were performed on 33 sites of 31 healthy volunteers and 18 cases of osteosarcoma. An independent sample t-test was performed on the ratios of metabolites in the two groups to analyze changes in ratios of phospholipid monophosphate (PME)/β-ATP and phosphodiester (PDE)/β-ATP in plasma membrane of osteosarcoma tissue. Characteristics, tissue energy phosphocreatine (PCr) / total 31P metabolites (T31P), ATP / T31P, inorganic phosphorus (Pi) / β-ATP and intracellular pH changes. Results Osteosarcoma group PME/β-ATP, Pi/β-ATP, PDE/β-ATP, PCr/T31P, low energy phosphate (LEP)/T31P, ATP/T31P, PCr/β-ATP, (PCr+ATP) The mean values of /Pi and pH were 1.08±0.19, 0.85±0.40, 0.98±0.38, 0.28±0.09, 0.30±0.07, 0.42±0.09, 2.75±1.25, 9.45±3.84 and 7.35±0.24, respectively. The numbers were 0.07±0.06, 0.34±0.12, 0.43±0.26, 0.43±0.03, 0.10±0.03, 0.46±0.03, 3.63±0.65, 24.53±10.14, and 7.06±0.08. Except for ATP/T31P, the ratios were compared with the control group. There are significant differences (P <0.01). The results of the MRI findings suggest that the rate of sarcoma matching with MRI alone is 12/18 cases, and that with 31PMRS results is 16/18 cases. Conclusions Compared with the control group, the plasma phospholipid metabolism index of osteosarcoma group was significantly higher, the high-energy phosphate was significantly decreased, and the intracellular pH was slightly elevated. In combination with conventional MRI, these characteristic changes facilitate the early diagnosis and treatment monitoring of osteosarcoma lesions.