脑星形细胞瘤3D多体素~1H-MRS术前分级与病理对照研究
发布时间:2018-05-20 21:31
本文选题:脑星形细胞瘤 + 氢质子磁共振波谱 ; 参考:《浙江大学》2014年硕士论文
【摘要】:目的: 分析脑星形细胞瘤的氢质子3D多体素磁共振波谱(proton magnetic resonance spectroscopy,1H-MRS)表现,研究NAA, Cho, Cr, Lac and Lip等主要代谢物数据,测量NAA/Cr, NAA/Cho, Cho/Cr, Lac/Cr的比值变化,初步研究脑星形细胞瘤1H-MRS术前分级诊断及其与病理级别相关性。 方法: 收集自2009年1月至2014年3月在浙江大学医学院附属第二医院住院经手术病理证实的45例脑星形细胞瘤患者,性别构成为男患者29例,女患者16例,年龄范围10-65岁,平均年龄为45岁。患者首发症状:头痛或头晕44例,单侧或双侧肢体无力20例,抽搐发作13例,病程最短时间为5小时,最长达3年,内对照部位设为肿瘤对侧正常脑组织。所有入组患者之前均无手术及放化疗史。研究设备采用GE3.0T高场磁共振成像系统,所有患者均先行常规磁共振成像扫描,随后进行3D多体素1H-MRS检查,采集数据的感兴趣区(region of interest, ROI)设定于肿瘤瘤体区,正常对照区及瘤周区。波谱技术选择点分辨波谱分析法(PRESS)采集相关信号,然后将采集的MRS原始数据传送到后处理工作站进行处理,分别得到N-乙酰天门冬氨酸(NAA),胆碱(Cho),肌酸(Cr),脂质(Lip),肌醇(mI)和乳酸(Lac)等化合物峰高度及峰下面积,进一步通过计算NAA/Cr, NAA/Cho, Cho/Cr, Lac/Cr等比值,根据手术病理结果,依照WHO2007年新分类诊断标准分成两组:分别为高级别脑星形细胞瘤组(n=28)及低级别脑星形细胞瘤组(n=17)。分析脑星形细胞瘤波谱表现及高低级别组间差异。 结果: 脑星形细胞瘤3D多体素1H-MRS主要表现为胆碱(Cho)见显著增高,N-乙酰天门冬氨酸(NAA)明显下降,肌酸(Cr)基本稳定,可轻度上升或下降。在低级别星形细胞瘤组检测出3例Lac峰,而在高级别星形细胞瘤组12例出现Lac峰,同时高级别组11例出现Lip峰;脑星形细胞瘤肿瘤组织与对照侧正常脑组织的NAA/Cho, Cho/Cr, NAA/Cr比值存在显著性差异(P0.05); NAA/Cho、NAA/Cr比值在高低级别脑星形细胞瘤瘤周近区存在显著性差异(P0.05); NAA/Cho、 NAA/Cr比值在高级别脑星形细胞瘤和低级别脑星形细胞瘤的肿瘤组织有统计学差异(P0.05),肿瘤瘤体区NAA/Cho比值与肿瘤的级别呈负相关(r=-0.542,P0.05),NAA/Cr与肿瘤级别负相关(r=-0.502, P0.05), Cho/Cr比值与肿瘤的级别呈正相关(r=0.420,P0.05)。结论: 3D多体素1H-MRS能够为脑星形细胞瘤术前分级提供定量诊断依据,肿瘤组织与对照侧正常脑组织的NAA/Cr, NAA/Cho, Cho/Cr比值存在显著性差异;高级别脑星形细胞瘤和低级别脑星形细胞瘤肿瘤组织的NAA/Cr, NAA/Cho比值有统计学差异,高低级别脑星形细胞瘤瘤周近区NAA/Cr, NAA/Cho比值存在显著性差异,脑星形细胞瘤的病理级别与多代谢物比值有相关性,代谢物比值可作为分级诊断依据,可以为临床治疗方案的制定提供帮助,具有临床应用价值。
[Abstract]:Objective: The proton 3D multibody-voxel magnetic resonance spectroscopy (1H-MRS) of brain astrocytoma was analyzed, and the main metabolites such as NAA, Cho, Cr, Lac and Lip were studied. The ratios of NAA / Cr, NAA / Cr, Chor / Cr, Lac/Cr were measured. To study the preoperative grade diagnosis of astrocytoma by 1H-MRS and its correlation with pathological grade. Methods: From January 2009 to March 2014, 45 patients with brain astrocytoma confirmed by surgery and pathology were admitted to the second affiliated Hospital of the School of Medicine of Zhejiang University. There were 29 male and 16 female patients, aged 10-65 years. The average age is 45 years. The initial symptoms were headache or dizziness in 44 cases, unilateral or bilateral limb weakness in 20 cases, convulsion in 13 cases. The shortest course of disease was 5 hours and the longest was 3 years. All the patients had no history of surgery and chemotherapy before admission. The GE3.0T high-field magnetic resonance imaging system was used in the study. All the patients were scanned by conventional magnetic resonance imaging (MRI), and then the 3D multivoxel 1H-MRS was performed. The region of interest of interest, ROI) of the collected data was located in the tumor area. Normal control area and surrounding tumor area. The point resolution spectrum analysis method (PRESS) is used to collect the related signals, and then the collected MRS raw data is transmitted to the post-processing workstation for processing. The peak height and area under the peak of N- acetyl aspartate, choline chorus, creatine, lipids, inositol and lactate Lacs were obtained, and the ratios of NAA / Cr, NAA / P ChoC, Chor / CrCr, Lac/Cr and so on were calculated according to the results of surgery and pathology. According to the new classification and diagnosis criteria of WHO2007's year, they were divided into two groups: high grade astrocytoma group (n = 28) and low grade brain astrocytoma group (n = 17). The spectrum of astrocytoma and the difference between high and low grade groups were analyzed. Results: In brain astrocytoma, the main 1H-MRS of 3D polypeptide was choline chondrocytoma. The increase of NAA of N-acetylaspartate was obviously decreased, the creatine Cr) was stable, and the content of creatine was slightly increased or decreased. Lac peak was detected in 3 cases in low grade astrocytoma group, Lac peak in 12 cases in high grade astrocytoma group and Lip peak in 11 cases in high grade astrocytoma group. There were significant differences in the ratios of NAA / ChoR, Cho-Cr, NAA/Cr between the tumor tissues of brain astrocytoma and the normal brain tissues of the control side (P0.05), the ratio of NAA / Cho-NAA / Cr / Cr in the proximal area around the tumors of brain astrocytomas of high and low grade had significant difference (P0.05A), and the ratios of na / Choand NAA/Cr in the high-grade brain astrocytomas were significantly different (P < 0.05). There was a significant difference in tumor tissue between tumor and low grade astrocytoma (P 0.05). The ratio of NAA/Cho in tumor area was negatively correlated with the grade of tumor. There was a negative correlation between the ratio of NAA / Cr and the grade of tumor. There was a positive correlation between the ratio of Cho/Cr and the grade of tumor. Conclusion: 3D multivoxel 1H-MRS could provide quantitative diagnostic basis for preoperative grading of brain astrocytoma. There were significant differences in the ratios of NAA / Cr, NAA / Choand Cho/Cr between tumor tissues and normal brain tissues of the control side. The ratio of NAA / Cr, NAA/Cho in high grade brain astrocytoma and low grade brain astrocytoma was significantly different from that in high grade brain astrocytoma and low grade brain astrocytoma, and the ratio of NAA / Cr and NAA/Cho was significantly different between high grade brain astrocytoma and low grade brain astrocytoma. The pathological grade of astrocytoma is correlated with the ratio of multiple metabolites. The ratio of metabolites can be used as the basis of grading diagnosis and can provide help for the formulation of clinical treatment plan. It has clinical application value.
【学位授予单位】:浙江大学
【学位级别】:硕士
【学位授予年份】:2014
【分类号】:R445.2;R739.4
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