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目的探讨3D多体素质子波谱成像(1H-MRS)对脑低、高级星形细胞瘤鉴别诊断的价值和限度。资料与方法前瞻分析60例星形细胞瘤患者的传统平扫加增强及3D多体素1H-MRS资料,病理分为高级别组(WHOⅢ、Ⅳ级)和低级别组(WHOⅠ、Ⅱ级)。结果(1)传统MR平扫加增强诊断高级别星形细胞瘤的敏感性为70.5%、特异性为68.8%。(2)瘤体实质区胆碱(Cho)/N-乙酰天门冬氨酸(NAA)的敏感性82.0%,特异性81.0%;瘤周区Cho/NAA的敏感性77.0%,特异性81.0%;瘤体实质区乳酸(Lac)/肌酸(Cr)的敏感性82.0%,特异性88.0%;瘤周区乳酸盐(Lac)/肌酸(Cr)的敏感性91.0%,特异性69.1%。结论同传统MR相比,1H-MRS 3D多体素检查能增加星形细胞瘤分级诊断的敏感性,是传统MR检查的一种重要补充。
Objective To investigate the value and limitations of 3D multi-voxel proton spectroscopy (1H-MRS) in the differential diagnosis of low and advanced astrocytomas. Materials and Methods Prospective analysis of 60 cases of astrocytoma patients with conventional plain scan and enhanced 3D multi-voxel 1H-MRS data, the pathology is divided into high-grade group (WHO Ⅲ, Ⅳ grade) and low-grade group (WHO Ⅰ, Ⅱ grade) . Results (1) The sensitivity and specificity of traditional MR scan and enhanced diagnosis of high-grade astrocytoma were 70.5% and 68.8% respectively. (2) The sensitivity and specificity of Cho / NAA in tumor area were 82.0% and 81.0%, respectively. The sensitivity and specificity of Cho / NAA in peritumor area were 77.0% and 81.0% ; The sensitivity of lactate (Lac) / creatine (Cr) in the tumor area was 82.0% and the specificity was 88.0%; the sensitivity of lactate / creatine in the peritumoral area was 91.0% and the specificity was 69.1 %. Conclusion Compared with conventional MR, 1H-MRS 3D multi-voxel examination can increase the sensitivity of staging diagnosis of astrocytoma and is an important complement to traditional MR examination.