In vivo single-voxel proton MR spectroscopy in the differentiation of high-grade gliomas and solitary metastases
In vivo single-voxel proton MR spectroscopy in the differentiation of high-grade gliomas and solitary metastases
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DOI：
10.1016/j.crad.2003.08.006
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发表时间：
2004-01-01
影响因子：
2.6
通讯作者：
Guo,Y
中科院分区：
文献类型：
--
作者：
Fan, G;Sun, B;Guo,Y
目的：确定单体素质子磁共振波谱（1HMRS）是否可以根据不同受累区域代谢物水平的差异来区分胶质瘤和转移瘤。 材料和方法：22 例孤立性脑肿瘤（14 例胶质瘤，8 例转移瘤）患者（年龄范围 32 至 62 岁，中位年龄 46.7 岁）接受常规、钆-DTPA 增强 T1 加权图像，以及手术切除前的 1HMRS。从 1HMRS 获得增强肿瘤、肿瘤周围区域和正常脑的光谱。 1HMRS 需要点分辨光谱序列。光谱中的代谢物包括：N-乙酰天冬氨酸 (NAA)、胆碱 (CHO)、肌酸化合物 (CR)、肌醇 (MI)、乳酸 (LAC)、谷氨酸和谷氨酰胺 (Glu-n)。代谢物的相对浓度与峰面积相关，并以CR表示。学生 t 检验用于确定高级别胶质瘤和转移瘤之间的相对代谢比是否存在统计学显着差异。同时，所有 22 名患者中的 16 名在手术切除后 6 个月内接受了磁共振成像 (MRI) 重新检查。 3例患者出现复发（2例为胶质瘤，1例为转移）。结果：14例胶质瘤患者中，3例NAA峰值降低，3例NAA峰值降低。 9例LAC峰升高，瘤周呈典型双峰； Glu-n 的峰也升高，在 7 例中呈锯齿状。 8 例肿瘤区域的 MI 峰值升高，所有 14 例肿瘤区域的 CHO 水平均升高。 8例转移瘤患者中，增强肿瘤区内3例肿瘤区GLu-n峰升高，4例肿瘤区CHO峰升高，3例CR峰降低，4例NAA峰明显降低。神经胶质瘤的肿瘤和瘤周区域中的 CHO 水平升高（CHO 与 CR 的比率为 4.98:1.46、2.65:0.32），但转移灶中没有升高（CHO 与 CR 的比率为 1.37:0.92、1.22:0.38），并且存在 MI 水平升高（MI 与 CR 的比率为 1.67:0.35）在神经胶质瘤的增强灶内，但不在转移灶内（MI 与 CR 的比率为 0.89:0.31）。差异具有统计学意义（p < 0.01）。所有三名复发患者均出现谷氨酰胺和血脂水平升高。结论：1HMRS 是区分这两种肿瘤的有效方法。它还可能提供有用的预后信息。 (C) 2004 年皇家放射科医生学院。由爱思唯尔有限公司出版。保留所有权利。
AIM: To determine whether single-voxel proton magnetic resonance spectroscopy (1HMRS) could be used to differentiate gliomas from metastases on the basis of differences in metabolite levels in the different involved regions.MATERIALS AND METHODS: Twenty-two patients (age range from 32 to 62 years, with a median age of 46.7years) with a solitary brain tumour (14 gliomas, eight metastases) underwent conventional, gadolinium-DTPA enhanced T1-weighted images, and 1HMRS before surgical resection. Spectra from the enhancing tumour, the peritumoural region, and normal brain were obtained from 1HMRS. A point resolved spectroscopy sequence was required for 1HMRS. The metabolites in the spectra include: N-acetylaspartate (NAA), choline (CHO), creatine compounds (CR), myo-inositol (MI), Lactate (LAC), glutamate and glutamine (Glu-n). Relative concentrations of metabolites were related to the peak area, and expressed with reference to CR. Student's t-test was used to determine whether there was a statistically significant difference in relative metabolic ratios between high-grade gliomas and metastases. Meanwhile, 16 of all 22 patients were re-examined using magnetic resonance imaging (MRI) within 6 months of surgical resection. Recurrence was present in three patients (two gliomas, one metastasis).RESULTS: Of the 14 patients with gliomas, the peaks of NAA were reduced in three cases; the peaks of LAC, which were elevated, appeared as typical double-peaks in the peritumoural region in nine cases; the peaks of Glu-n, which were also elevated, had a zigzag appearance in seven cases. The peaks of MI were increased in the tumoural region in eight cases, and CHO levels were elevated in all 14 cases. Of the eight patients with metastases, GLu-n peaks in the tumoural region in three cases and CHO peaks in the tumoural region in four cases were elevated, respectively, white the peaks of CR were reduced in three cases, and the peaks of NAA were markedly reduced in four cases within the enhancing tumoural region. Elevated CHO levels (CHO-to-CR ratio was 4.98:1.46, 2.65:0.32) in both the tumoural and peritumoural regions of gliomas but not in the metastases (CHO-to-CR ratio was 1.37:0.92, 1.22:0.38), and elevated MI Levels were present (MI-to-CR ratio was 1.67:0.35) within the enhancing foci of gliomas but not in the metastases (MI-to-CR ratio was 0.89:0.31). The difference was statistically significant (p < 0.01). Elevated Glu-n and lipid Levels were present in all three patients with recurrences.CONCLUSION: 1HMRS is a useful method in the distinction of these two kinds of tumours. It may also may provide useful prognostic information. (C) 2004 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.