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目的探讨1H-MRS对获得性免疫缺陷综合征(AIDS)局灶性脑炎的诊断及鉴别诊断价值。方法对确诊的23例AIDS局灶性脑炎患者进行MR检查,以1H-MRS分析32个病灶,测量代谢物N-乙酰天门冬氨酸(NAA)、胆碱化合物(Cho)、肌酸(Cr)、肌醇(mI)峰下面积均值,观察乳酸(Lac)、脂质(Lip)峰出现的频数,计算NAA/Cr、Cho/Cr、mI/Cr、NAA/Cho、(Cho+mI)/NAA值。比较AIDS局灶性脑炎实性区、坏死区、水肿区及与相邻正常脑组织代谢物差异。结果 AIDS局灶性脑炎病变各区均出现NAA、Cho、Cr、mI峰。与相邻正常脑组织比较,NAA峰在病变各区均降低,Cho、mI峰在实性区略升高,在坏死及水肿区降低。Lac、Lip峰在病变各区均出现,在实性及坏死区出现频数明显高于水肿区,且Lip峰出现频数较Lac峰高。病变各区之间NAA/Cr、NAA/Cho、Cho/Cr、(Cho+mI)/NAA值差异有统计学意义(P<0.05);与相邻正常脑组织比较,病变各区Cho/Cr、(Cho+mI)/NAA值差异均有统计学意义(P均<0.05)。结论 1H-MRS能够发现AIDS局灶性脑炎的特征性物质及能量代谢变化,为定性、定量诊断和鉴别诊断提供依据。
Objective To investigate the value of 1H-MRS in the diagnosis and differential diagnosis of focal encephalitis in acquired immunodeficiency syndrome (AIDS). Methods Twenty-three patients with confirmed focal encephalitis were analyzed by MR spectroscopy and 32 lesions were analyzed by 1H-MRS. The levels of metabolites such as NAA, Cho and creatine Cr, and inositol (mI) peak area, and the frequencies of lactic acid (Lac) and lipid peak were observed to calculate NAA / Cr, Cho / Cr, ) / NAA value. Comparison of real area of AIDS focal encephalitis, necrosis area, edema area and adjacent normal brain tissue metabolites. Results NAA, Cho, Cr, mI peak appeared in all regions of lesions of AIDS focal encephalitis. Compared with adjacent normal brain tissue, NAA peak decreased in all regions of lesions, Cho, mI peak in the real area slightly elevated in necrosis and edema area decreased. The peaks of Lac and Lip appeared in all regions of the lesion. The frequency of occurrence of Lac and Lip was higher in edema and necrosis area than that in edema area, and the peak frequency of Lip peak was higher than that of Lac peak. There were significant differences in NAA / Cr, NAA / Cho, Cho / Cr and (Cho + mI) / NAA between different regions of the lesion (P < Cho + mI) / NAA values were statistically significant (all P <0.05). Conclusion 1H-MRS can detect the characteristic substance and energy metabolism changes of focal encephalitis in AIDS, and provide the basis for qualitative, quantitative diagnosis and differential diagnosis.