目的 评估氢质子磁共振波谱 (1 H-MRS)在颅脑常见肿瘤诊断及鉴别诊 断中的应用价值。方法 分析经手术病理 证实的61例颅内高级别胶质瘤、转移瘤 及脑膜瘤三组病例1 H-MRS特点，并测量 所有病例的瘤核心、瘤周水肿区、对侧 正常脑白质感兴趣区的胆碱(Cho)、乙酰 天门冬氨酸(NAA)、肌酸(Cr)代谢产物的 峰值，计算Cho/NAA、Cho/Cr、NAA/Cr 三种参数的比值，分别比较三组病例各 参数之间的差异。结果 三类肿瘤瘤核心 及胶质瘤瘤旁水肿Cho/Cr、Cho/NAA均大 于对侧正常脑白质(P<0.01)，NAA/Cr均 小于对侧正常脑白质(P<0.01)，脑膜瘤 瘤核心NAA/Cr比胶质瘤、转移瘤明显减 低(P<0.01)，Cho/NAA比胶质瘤、转移瘤 明显增高(P<0.01)；胶质瘤瘤旁区Cho/ Cr、Cho/NAA比脑膜瘤、转移瘤明显增高 (P<0.01)，NAA/Cr比脑膜瘤、转移瘤明显 减低(P<0.01)。结论 作为常规MRI的有力 补充，瘤核心及瘤周水肿区的1 H-MRS对颅 内胶质瘤、脑膜瘤及转移瘤的诊断及鉴别 诊断具有积极的临床意义。

Objective To explore the value of 1 H-MRS in the diagnosis and differential diagnosis of different intracranial neoplasms. Methods MRI and 1 H-MRS was performed in 61 patients confirmed to be high grade glioma, meningioma and solitary metastases. For each case, the NAA, Cr and Cho was measured in enhanced region, peritumoral region and contralateral normal-appearing white matter (CNAWM), the Cho/NAA, Cho/Cr, NAA/Cr was calculated and compared among three ROIs respectively. Results Compare to the normal region, the Cho/Cr, Cho/NAA in enhanced region of three lesions and peritumoral of glioma were higher (P<0.01), NAA/Cr were lower (P<0.01). In enhanced region, NAA/Cr in meningioma was lower than glioma and metastases (P<0.01) and Cho/NAA was higher than them (P<0.01). In peritumoral region, Cho/Cr, Cho/NAA in glioma were higher than meningioma and metastases(P<0.01) and NAA/Cr was lower than them(P<0.01). Conclusion As a supplement of routine MRI, 1 H-MRS plays an important role in the differential diagnosis of different intracranial neoplasms.