目的研究脑星形细胞瘤的 3T MRI 3D多体素1 H-MRS表现，通过分析 NAA，Cho，Cr，Lac and Lip，NAA/Cr, NAA/Cho, Cho/Cr比值变化，初步探讨脑 星形细胞瘤1H-MRS术前分级诊断及与其病 理级别相关性。方法 收集浙江大学医学 院附属第二医院和解放军第一一三医院经 手术及病理证实的45例脑星形细胞瘤患者 MRI资料，其中高级别脑星形细胞瘤组28 例，低级别脑星形细胞瘤组17例。通过计 算NAA/Cr，NAA/Cho, Cho/Cr等比值,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(P＜0.05); 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(P＜0.05)； 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(P<0.05)，肿瘤瘤体区 NAA/Cho比值与肿瘤的级别呈负相关(r=- 0.542，P<0.05)，NAA/Cr与肿瘤级别负相 关(r=-0.502，P<0.05)，Cho/Cr比值与肿 瘤的级别呈正相关(r=0.420，P<0.05)。 结论 3D多体素1 H-MRS能够为术前肿瘤分 级提供定量诊断依据，脑星形细胞瘤的病 理级别与其代谢物比值有相关性，具有重 要临床应用价值。

Objective This study was designed to approach the characteritics of astrocytoma 3D Mult-ivoxel 1 H-MRS and the correlation with grading diagnosis in preoperative grading by analyzing the contents changes of major metabolites such as NAA, Cho, Cr,Lac and Lip in astrocytoma 1 H-MRS, and jointly measuring ratio changes of NAA/ Cr, NAA/Cho, Cho/Cr. Methods A total of 45 patients of brain astrocytoma which were confirmed by postoperative pathological results were gathered in the Second Affiliated hospital of Zhejiang University School of Medicine and PLA NO.113 hospital. Seventeen cases of low-grade astrocytoma (Ⅰ-Ⅱgrade),28 cases of high-grade astrocytoma (Ⅲ-Ⅳ grade). NAA/Cr, NAA/Cho, Cho/Cr, Lac/Cr ratio were computed. Results The mainly manifestation of brain astrocytoma 1 H-MRS was significant differences in NAA/ Cho, Cho/Cr, NAA/Cr between solid area of astrocytoma and normal-area of opposite side(P＜0.05); There were significant differences in NAA/Cho, NAA/Cr in solid area of astrocytoma between low-grade astrocytoma group and high-grade astrocytoma group(P ＜0.05), There were significant differences in NAA/Cho, NAA/Cr in peritumoral edema area between low-grade astrocytoma group and high-grade astrocytoma group(P ＜0.05), Cho/Cr (r=0.420)of solid area of tumor was of positive correlation with the grade of tumor, and NAA/Cr, NAA/Cho (r=-0.502,-0.542)was of negative correlation. Conclusion 3D Multi-voxel 1 H-MRS contributes to the clinical diagnosis of brain astrocytoma. The values of chemical composition ratio of tumor was correlation with the grade of tumor, which provide quantify diagnosis basis for grading of brain astrocytoma before surgery, to sum up, has very significance clinical application value.