磁共振波譜在診斷顱內(nèi)腫瘤中的應(yīng)用

1、department of neurosurgerypeking university peoples hospitaldepartment of neurosurgerypeking university peoples hospitaldepartment of neurosurgerydepartment of neurosurgerypeking university peoples hospitalpeking university peoples hospitaldepartment of neurosurgerydepartment of neurosurgerypeking u

2、niversity peoples hospitalpeking university peoples hospitaldepartment of neurosurgerydepartment of neurosurgerypeking university peoples hospitalpeking university peoples hospitaldepartment of neurosurgerydepartment of neurosurgerypeking university peoples hospitalpeking university peoples hospital

3、department of neurosurgerydepartment of neurosurgerypeking university peoples hospitalpeking university peoples hospitaldepartment of neurosurgerydepartment of neurosurgerypeking university peoples hospitalpeking university peoples hospitaldepartment of neurosurgerydepartment of neurosurgerypeking u

4、niversity peoples hospitalpeking university peoples hospitaldepartment of neurosurgerypeking university peoples hospitaldepartment of neurosurgerydepartment of neurosurgerypeking university peoples hospitalpeking university peoples hospitaldepartment of neurosurgerydepartment of neurosurgerypeking u

5、niversity peoples hospitalpeking university peoples hospitaldepartment of neurosurgerydepartment of neurosurgerypeking university peoples hospitalpeking university peoples hospitaldepartment of neurosurgerydepartment of neurosurgerypeking university peoples hospitalpeking university peoples hospital

6、department of neurosurgerydepartment of neurosurgerypeking university peoples hospitalpeking university peoples hospitaldepartment of neurosurgerydepartment of neurosurgerypeking university peoples hospitalpeking university peoples hospitaldepartment of neurosurgerydepartment of neurosurgerypeking u

7、niversity peoples hospitalpeking university peoples hospitaldepartment of neurosurgerydepartment of neurosurgerypeking university peoples hospitalpeking university peoples hospitaldepartment of neurosurgerydepartment of neurosurgerypeking university peoples hospitalpeking university peoples hospital

8、department of neurosurgerydepartment of neurosurgerypeking university peoples hospitalpeking university peoples hospitaldepartment of neurosurgerydepartment of neurosurgerypeking university peoples hospitalpeking university peoples hospitaldepartment of neurosurgerydepartment of neurosurgerypeking u

9、niversity peoples hospitalpeking university peoples hospitalnaanaachocho crcrcr2cr2正常正常cho/crcho/cr、cho/naacho/naa比值范圍比值范圍約為約為0.789-0.5450.789-0.545naa/chonaa/cho比值的比值的范圍約為范圍約為1.267-1.267-1.8351.835 department of neurosurgerypeking university peoples hospitaln-n-乙酰天門冬氨酸乙酰天門冬氨酸(naa)(naa)顯著下降顯著下降膽堿膽堿(

10、cho)(cho)顯著升高顯著升高 肌酸肌酸(cr)(cr)不變或輕度下降不變或輕度下降可出現(xiàn)乳酸鹽（可出現(xiàn)乳酸鹽（lac/liplac/lip） naa/crnaa/cr下降下降 naa/chonaa/cho減少減少cho/crcho/cr升高升高 -腫瘤對(duì)神經(jīng)元的破壞腫瘤對(duì)神經(jīng)元的破壞 -腫瘤細(xì)胞增殖活躍和有絲分裂增加腫瘤細(xì)胞增殖活躍和有絲分裂增加-膠質(zhì)瘤發(fā)生壞死膠質(zhì)瘤發(fā)生壞死chochocr2cr2crcrnnannalaclac星形細(xì)胞瘤隨膠質(zhì)瘤級(jí)別增加，隨膠質(zhì)瘤級(jí)別增加，naanaa逐漸下降，逐漸下降，chocho逐漸升高逐漸升高cho/naacho/naa和和cho/crcho/c

11、r比值反映腫瘤級(jí)別比較穩(wěn)定，比值反映腫瘤級(jí)別比較穩(wěn)定， 在所有的膠質(zhì)母細(xì)胞瘤中均升高在所有的膠質(zhì)母細(xì)胞瘤中均升高 laclac峰可出現(xiàn)于各級(jí)別組腦膠質(zhì)瘤中，其峰值無(wú)峰可出現(xiàn)于各級(jí)別組腦膠質(zhì)瘤中，其峰值無(wú) 顯著差異顯著差異cho/naa高級(jí)別膠質(zhì)瘤高級(jí)別膠質(zhì)瘤低級(jí)別膠質(zhì)瘤低級(jí)別膠質(zhì)瘤瘤體實(shí)質(zhì)區(qū)瘤體實(shí)質(zhì)區(qū)2.301.3522時(shí)，患者時(shí)，患者1 1年生存率為年生存率為20%20%，而，而lac/naalac/naa值值21.31.3即可即可診斷膠質(zhì)瘤復(fù)發(fā)，診斷膠質(zhì)瘤復(fù)發(fā)，1.31.71cho/cr1.71或或/(/(和和)cho/naa1.71)cho/naa1.71作為區(qū)分復(fù)發(fā)和作為區(qū)分復(fù)發(fā)和壞死

12、的標(biāo)準(zhǔn)壞死的標(biāo)準(zhǔn)chocho明顯增高及合并明顯增高及合并laclac、naanaa、crcr的異常，提示膠質(zhì)的異常，提示膠質(zhì)細(xì)胞瘤治療后復(fù)發(fā)；治療后細(xì)胞瘤治療后復(fù)發(fā)；治療后chocho下降或保持穩(wěn)定者，下降或保持穩(wěn)定者，則腫瘤生長(zhǎng)受到抑制則腫瘤生長(zhǎng)受到抑制 mrsmrs見(jiàn)依舊明顯見(jiàn)依舊明顯增高增高chocho峰、下降峰、下降的的crcr峰峰表明腫瘤細(xì)胞仍表明腫瘤細(xì)胞仍存在存在對(duì)應(yīng)右側(cè)額葉對(duì)應(yīng)右側(cè)額葉mrsmrscrcrcrcrchochochochonnannamrsmrs見(jiàn)見(jiàn)nnanna、chocho、crcr峰均消失峰均消失無(wú)復(fù)發(fā)跡象無(wú)復(fù)發(fā)跡象對(duì)應(yīng)右側(cè)額葉對(duì)應(yīng)右側(cè)額葉mrsmrscrcrc

13、hochonnannamrimri提示原手術(shù)提示原手術(shù)病灶未見(jiàn)明顯異常病灶未見(jiàn)明顯異常mrsmrs見(jiàn)見(jiàn)chocho峰增高峰增高提示復(fù)發(fā)提示復(fù)發(fā)對(duì)應(yīng)右側(cè)額葉對(duì)應(yīng)右側(cè)額葉mrsmrscrcrchochonnannachochonnannadepartment of neurosurgerypeking university peoples hospital腦膜瘤無(wú)神經(jīng)元，故理論上無(wú)腦膜瘤無(wú)神經(jīng)元，故理論上無(wú)naanaa峰峰膽堿膽堿(cho)(cho)升高升高 出現(xiàn)特征性丙氨酸出現(xiàn)特征性丙氨酸(ala)(ala)峰峰可出現(xiàn)谷氨酸可出現(xiàn)谷氨酸(glx)(glx)峰峰 強(qiáng)化區(qū)域外沒(méi)有病理性波譜強(qiáng)化區(qū)域外

14、沒(méi)有病理性波譜liplip峰出現(xiàn)提示惡性腦膜瘤可能峰出現(xiàn)提示惡性腦膜瘤可能 -有時(shí)可見(jiàn)較低的峰，原因是腫瘤侵犯正常腦組織或部分容積效應(yīng)所致有時(shí)可見(jiàn)較低的峰，原因是腫瘤侵犯正常腦組織或部分容積效應(yīng)所致 -各型腦膜瘤中沒(méi)有顯著性差異各型腦膜瘤中沒(méi)有顯著性差異chochocr2cr2crcralaalannanna-對(duì)腫瘤細(xì)胞具有化學(xué)抵抗作用對(duì)腫瘤細(xì)胞具有化學(xué)抵抗作用-并非所有腦膜瘤均會(huì)出現(xiàn)并非所有腦膜瘤均會(huì)出現(xiàn)-非侵襲性腫瘤的特征非侵襲性腫瘤的特征naanaa消失消失chocho升高升高出現(xiàn)丙氨酸出現(xiàn)丙氨酸alaala峰峰瘤周的瘤周的mrsmrs表現(xiàn)表現(xiàn)chochochochonaanaacrcr

15、crcralaalanaanaa下降至消失下降至消失chocho明顯升高明顯升高crcr明顯下降明顯下降出現(xiàn)丙氨酸出現(xiàn)丙氨酸alaala峰峰瘤周的瘤周的mrsmrs表現(xiàn)表現(xiàn)chochochochonaanaacrcrcrcralaalanaanaachochocrcrcr2cr2nnanna周邊區(qū)接近正常周邊區(qū)接近正常實(shí)質(zhì)區(qū)實(shí)質(zhì)區(qū)naanaa峰消失峰消失chocho峰明顯增高峰明顯增高可見(jiàn)特征性的丙氨酸可見(jiàn)特征性的丙氨酸alaala峰峰chochoalaalacr2cr2nnanna實(shí)質(zhì)區(qū)實(shí)質(zhì)區(qū)naanaa峰消失峰消失chocho峰增高峰增高可見(jiàn)丙氨酸可見(jiàn)丙氨酸alaala、乳酸乳酸lacla

16、c、脂質(zhì)、脂質(zhì)liplip、谷氨酸谷氨酸glxglx、峰峰chochoglxglxglxglxalaalalipliplaclacglxglxlaclac水腫區(qū)水腫區(qū)亦可見(jiàn)亦可見(jiàn)glxglx、laclac峰峰 chochoglxglxglxglxalaala水腫區(qū)水腫區(qū)可見(jiàn)谷氨酸可見(jiàn)谷氨酸glxglx峰峰可見(jiàn)丙氨酸可見(jiàn)丙氨酸alaala峰峰 chocholiplipglxglxglxglx壞死區(qū)壞死區(qū)脂質(zhì)脂質(zhì)liplip為第一高峰為第一高峰 chochonnannacrcr對(duì)側(cè)正常區(qū)對(duì)側(cè)正常區(qū) 未見(jiàn)未見(jiàn)naanaa峰顯示峰顯示chocho峰升高峰升高谷氨酸谷氨酸glxglx峰呈梯狀峰呈梯狀谷氨

17、酸谷氨酸glxglx峰較顯著峰較顯著可見(jiàn)丙氨酸可見(jiàn)丙氨酸alaala峰峰可見(jiàn)乳酸可見(jiàn)乳酸lac/lac/脂質(zhì)脂質(zhì)liplip峰峰chochoglxglxglxglxalaalaliplip瘤體區(qū)瘤體區(qū)腫瘤復(fù)發(fā)時(shí)，由于進(jìn)行性生長(zhǎng)腫瘤的邊緣巨噬細(xì)腫瘤復(fù)發(fā)時(shí)，由于進(jìn)行性生長(zhǎng)腫瘤的邊緣巨噬細(xì)胞吞噬不移動(dòng)的腦脂質(zhì)和壞死腫瘤細(xì)胞分解代謝，胞吞噬不移動(dòng)的腦脂質(zhì)和壞死腫瘤細(xì)胞分解代謝，脂質(zhì)脂質(zhì)liplip明顯增加明顯增加腫瘤復(fù)發(fā)常繼發(fā)正常血管網(wǎng)的破壞，乳酸腫瘤復(fù)發(fā)常繼發(fā)正常血管網(wǎng)的破壞，乳酸laclac含量含量增加增加 cho/crcho/cr比值在殘留和復(fù)發(fā)的腫瘤中明顯高于術(shù)后比值在殘留和復(fù)發(fā)的腫瘤中明顯高

18、于術(shù)后反應(yīng)性損傷區(qū)反應(yīng)性損傷區(qū)department of neurosurgerypeking university peoples hospital 轉(zhuǎn)移瘤特點(diǎn)：轉(zhuǎn)移瘤特點(diǎn)：naanaa消失，消失，chocho明顯增高，明顯增高，crcr下降，下降，cho/crcho/cr比值升高，可出現(xiàn)乳酸比值升高，可出現(xiàn)乳酸laclac峰和脂質(zhì)峰和脂質(zhì)liplip峰峰 轉(zhuǎn)移瘤和膠質(zhì)瘤瘤體強(qiáng)化部分各代謝物比值相似轉(zhuǎn)移瘤和膠質(zhì)瘤瘤體強(qiáng)化部分各代謝物比值相似 瘤周瘤周cho/crcho/cr比值是鑒別膠質(zhì)瘤和轉(zhuǎn)移瘤的重要手比值是鑒別膠質(zhì)瘤和轉(zhuǎn)移瘤的重要手段；轉(zhuǎn)移瘤強(qiáng)化之外區(qū)域沒(méi)有病理性波譜段；轉(zhuǎn)移瘤強(qiáng)化之外區(qū)

19、域沒(méi)有病理性波譜 兩種腫瘤瘤周區(qū)病理上是不一樣的：膠質(zhì)瘤周圍有腫瘤細(xì)胞的散兩種腫瘤瘤周區(qū)病理上是不一樣的：膠質(zhì)瘤周圍有腫瘤細(xì)胞的散在浸潤(rùn)，轉(zhuǎn)移瘤瘤周無(wú)腫瘤細(xì)胞存在在浸潤(rùn)，轉(zhuǎn)移瘤瘤周無(wú)腫瘤細(xì)胞存在department of neurosurgerypeking university peoples hospital分類分類膽堿膽堿chocho峰峰 肌酸肌酸crcr峰峰 肌醇肌醇mimi峰峰 脂質(zhì)脂質(zhì)liplip峰峰 cho/crcho/cr值值 瘤周波譜形態(tài)瘤周波譜形態(tài) 膠質(zhì)瘤膠質(zhì)瘤 明顯明顯升高升高輕度輕度下降下降 可見(jiàn)可見(jiàn)7.047.048.18 8.18 2.282.281.241.24較

20、大的較大的chocho峰峰 轉(zhuǎn)移瘤轉(zhuǎn)移瘤 與正常與正常相似相似明顯明顯下降下降 無(wú)無(wú) 9.609.608.03 8.03 0.760.760.23 0.23 與正常相似與正常相似p0.05p0.05對(duì)側(cè)正常區(qū)對(duì)側(cè)正常區(qū)腫瘤周圍區(qū)腫瘤周圍區(qū)與正常波譜相與正常波譜相似似 腫瘤強(qiáng)化區(qū)腫瘤強(qiáng)化區(qū)naanaa降低降低chocho升高升高chocho crcrchochocrcrchochocrcrnnannannannannanna roi roi選擇選擇腫瘤強(qiáng)化區(qū)腫瘤強(qiáng)化區(qū)腫瘤周圍區(qū)腫瘤周圍區(qū)對(duì)側(cè)正常區(qū)對(duì)側(cè)正常區(qū)chocho明顯升高明顯升高naanaa明顯降低明顯降低crcr明顯下降明顯下降 對(duì)側(cè)正常

21、對(duì)側(cè)正常mrsmrschochonaanaacrcrliplipchocho roi roi選擇選擇在增強(qiáng)部分及對(duì)在增強(qiáng)部分及對(duì)側(cè)正常腦實(shí)質(zhì)部側(cè)正常腦實(shí)質(zhì)部分選取感興趣區(qū)分選取感興趣區(qū)crcrnaanaachocho峰略降低峰略降低naanaa及及crcr峰顯示峰顯示不清不清出現(xiàn)明顯的脂質(zhì)出現(xiàn)明顯的脂質(zhì)liplip峰峰 對(duì)側(cè)正常對(duì)側(cè)正常mrsmrschochonaanaacrcrliplipchocho roi roi選擇選擇在增強(qiáng)部分及對(duì)在增強(qiáng)部分及對(duì)側(cè)正常腦實(shí)質(zhì)部側(cè)正常腦實(shí)質(zhì)部分選取感興趣區(qū)分選取感興趣區(qū)naanaa峰顯著降低峰顯著降低crcr峰顯著降低峰顯著降低chocho峰明顯增高峰明

22、顯增高可見(jiàn)脂質(zhì)可見(jiàn)脂質(zhì)liplip峰峰 周邊水腫區(qū)周邊水腫區(qū)mrsmrs與正常與正常mrsmrs無(wú)顯著無(wú)顯著區(qū)別區(qū)別chochonaanaacrcrliplipchocho roi roi選擇選擇 在腫瘤實(shí)質(zhì)區(qū)在腫瘤實(shí)質(zhì)區(qū) 和周邊水腫區(qū)和周邊水腫區(qū)cr2cr2naanaacrcrcr2cr2主要表現(xiàn)為向下主要表現(xiàn)為向下的乳酸的乳酸laclac雙峰雙峰降低非常明顯的降低非常明顯的crcr峰和峰和naanaa峰峰可見(jiàn)見(jiàn)高尖的脂可見(jiàn)見(jiàn)高尖的脂質(zhì)質(zhì)liplip峰峰naa,cr,chonaa,cr,cho峰均峰均減低減低 laclacliplipdepartment of neurosurgerypek

23、ing university peoples hospital 中樞神經(jīng)系統(tǒng)淋巴瘤特點(diǎn)：中樞神經(jīng)系統(tǒng)淋巴瘤特點(diǎn)：naanaa幾乎完全喪幾乎完全喪失，失，crcr降低，降低，chocho和乳酸和乳酸laclac升高明顯，脂升高明顯，脂質(zhì)質(zhì)liplip峰出現(xiàn)，肌醇峰出現(xiàn)，肌醇mimi表現(xiàn)正常表現(xiàn)正常 明顯升高的脂質(zhì)明顯升高的脂質(zhì)liplip峰是原發(fā)性中樞神經(jīng)系峰是原發(fā)性中樞神經(jīng)系統(tǒng)淋巴瘤特征表現(xiàn)統(tǒng)淋巴瘤特征表現(xiàn) 與膠質(zhì)瘤類似，在與膠質(zhì)瘤類似，在 增強(qiáng)區(qū)域以外仍可增強(qiáng)區(qū)域以外仍可 測(cè)得病理波譜測(cè)得病理波譜cr2cr2chochocrcrnaanaaliplipchochonaanaacrcrlipl

24、ipnaanaa及及crcr明顯消失明顯消失chocho明顯升高明顯升高出現(xiàn)特征的脂質(zhì)出現(xiàn)特征的脂質(zhì)liplip峰峰 roiroi選擇選擇1 1、2 2選擇在增強(qiáng)區(qū)；選擇在增強(qiáng)區(qū)；3 3選擇在瘤周區(qū)；選擇在瘤周區(qū)；4 4選擇在正常區(qū)選擇在正常區(qū) 強(qiáng)化區(qū)可見(jiàn)強(qiáng)化區(qū)可見(jiàn) naanaa峰降低峰降低chocho峰升高峰升高脂質(zhì)脂質(zhì)liplip峰出峰出現(xiàn)現(xiàn) 瘤周區(qū)瘤周區(qū)近于正常近于正常chochonaanaacrcrliplipchochochochochochocrcrcrcrcrcrnaanaanaanaanaanaaliplip正常區(qū)正常區(qū)瘤周區(qū)瘤周區(qū)腫瘤強(qiáng)化區(qū)腫瘤強(qiáng)化區(qū) roiroi選擇選擇1 1、2 2選擇在增強(qiáng)區(qū)；選擇在增強(qiáng)區(qū)；3 3選擇在瘤周區(qū)；選擇在瘤周區(qū)；4 4選擇在正常區(qū)選擇在正常區(qū) 強(qiáng)化區(qū)可見(jiàn)強(qiáng)化區(qū)可見(jiàn) naanaa峰及峰及crcr峰峰 明顯降低明顯降低chocho峰升高峰升高liplip峰出現(xiàn)峰出現(xiàn) 瘤周區(qū)瘤周區(qū)近于正常近于正常chochonaanaaliplipchochochochochochocrcrcrcrnaanaanaanaaliplip腫瘤強(qiáng)化區(qū)腫瘤強(qiáng)化區(qū)正常區(qū)正常區(qū)瘤周區(qū)瘤周區(qū) liplip出現(xiàn)特征的脂質(zhì)出現(xiàn)特征的脂質(zhì)liplip峰峰department of neurosurgerypeking