摘要
目的 探讨扩散加权成像和MRS 对病毒性脑炎和脑低级星形细胞瘤的鉴 别诊断价值。方法 19例病毒性脑炎和21 例脑低级星形细胞瘤在治疗前或手术前 接受了常规MRI、DWI及MRS检查。病毒性 脑炎经临床生化检查及治疗随访证实, 脑低级星形细胞瘤病例经手术及病理证 实。测量和比较两组病例DWI的表观扩散 系数(ADC)值Cho/Cr,NAA/Cr和Cho/NAA。 结果 病毒性脑炎和低级别胶质瘤的平均 ADC值分别为(1.471±0.032)×10-3mm2 /s 和(1.079±0.201)×10-3mm2 /s(P<0.01), Cho/Cr值分别为(2.442±0.648) 和(3.992±0.965)(P<0.01),Cho/ NAA值分别为(3.623±1.221)和 (6.585±2.52)(P<0.01)和NAA/Cr值分 别为(2.088±0.484)和(1.292±0.465) (P<0.01)。结论 DWI和MRS对鉴别病毒性 脑炎和脑低级星形细胞瘤具有重要的临床 价值,可作为常规MR检查重要的补充。
Objective To explore the diagnostic value of DWI and MRS for assessment of virus encephalitis versus low-grade glioma. Methods Nineteen patients with virus encephalitis and 20 patients with low-grade glioma were enrolled in this retrospective study. All the study subjects were performed conventional MRI scanning, DWI and MRS sequences. Patients with virus encephalitis were confirmed by clinical biochemical examination and following up, and patients with low-grade glioma were confirmed by histopathology. The values of apparent diffuse coefficient (ADC), Cho/Cr, NAA/Cr and Cho/NAA were measured and compared between virus encephalitis and low-grade glioma group. Results ADC value of virus encephalitis and low-grade glioma group was (1.471±0.032)×10-3mm2 /s and (1.079±0.201)×10-3mm2 /s (P<0.01), respectively. Value of Cho/Cr was (2.442±0.648) and (3.992±0.965)(P<0.01), respectively. Value of Cho/NAA was (3.623±1.221) and (6.585±2.52)(P<0.01), respectively. Value of NAA/ Cr was (2.088±0.484) and (1.292±0.465)(P<0.01). Conclusion There was important clinical value for differential diagnosis of virus encephalitis and low-grade glioma by DWI and MRS, which would play an important role in complementing conventional MRI scan sequences.
【关键词】病毒性脑炎;低级胶质瘤; DWI;MRS
【中图分类号】R445.2;R739.41
【文献标识码】A
【DOI】 10.3969/j.issn.1672- 5131.2018.01.005
前言
病毒性脑炎是一种常见的中枢系统感染性病变,由病毒直接侵犯 脑实质引起,病毒包括单纯疱疹病毒、肠道病毒、粘液病毒等,在磁 共振(magnetic resonance imaging,MRI)上表现多种多样[1]。而病毒 性脑炎的一个重要的鉴别诊断是低级别胶质瘤,如果临床症状及影像 学表现典型,那么MRI诊断并不是很困难。然而,当病毒性脑炎和低 级别胶质瘤MRI表现不典型时,则MRI很难做出准确的定性诊断[2-3]。 MRI由于具有较高的组织分辨率,现已被广泛应用于中枢神经系统。 扩散加权成像(diffusion weighted imaging,DWI)能够反映活体组 织内水分子的微观运动状况,对脑血管疾病也已经有比较明确的诊断 价值,且DWI用于病毒性脑炎诊断的研究已有文献报道[4];磁共振波 谱(Hydrogen proton magnetic resonance spectroscopy,1 H-MRS) 可以根据代谢物浓度的变化鉴别正常脑组织和颅内病变,在疾病发生 的早期对其进行诊断和病情监控,是一种很有潜力的活体生化分析技 术[5-7]。本研究通过应用DWI联合MRS对病毒性脑炎和低级别胶质瘤的诊 断效能,旨在提高医学影像科医生对病毒性脑炎和低级别胶质瘤的鉴 别诊断能力。
中国CT和MRI杂志
第16卷, 第 1 期
2018年01月
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