磁共振波谱在诊断颅内肿瘤中的应用PPT通用课件

1、Department of NeurosurgeryPeking University Peoples HospitalDepartment of NeurosurgeryPeking University Peoples HospitalDepartment of NeurosurgeryDepartment of NeurosurgeryPeking University PeoplePeking University Peoples Hospitals HospitalDepartment of NeurosurgeryDepartment of NeurosurgeryPeking U

2、niversity PeoplePeking University Peoples Hospitals HospitalDepartment of NeurosurgeryDepartment of NeurosurgeryPeking University PeoplePeking University Peoples Hospitals HospitalDepartment of NeurosurgeryDepartment of NeurosurgeryPeking University PeoplePeking University Peoples Hospitals Hospital

3、Department of NeurosurgeryDepartment of NeurosurgeryPeking University PeoplePeking University Peoples Hospitals HospitalDepartment of NeurosurgeryDepartment of NeurosurgeryPeking University PeoplePeking University Peoples Hospitals HospitalDepartment of NeurosurgeryDepartment of NeurosurgeryPeking U

4、niversity PeoplePeking University Peoples Hospitals HospitalDepartment of NeurosurgeryPeking University Peoples HospitalDepartment of NeurosurgeryDepartment of NeurosurgeryPeking University PeoplePeking University Peoples Hospitals HospitalDepartment of NeurosurgeryDepartment of NeurosurgeryPeking U

5、niversity PeoplePeking University Peoples Hospitals HospitalDepartment of NeurosurgeryDepartment of NeurosurgeryPeking University PeoplePeking University Peoples Hospitals HospitalDepartment of NeurosurgeryDepartment of NeurosurgeryPeking University PeoplePeking University Peoples Hospitals Hospital

6、Department of NeurosurgeryDepartment of NeurosurgeryPeking University PeoplePeking University Peoples Hospitals HospitalDepartment of NeurosurgeryDepartment of NeurosurgeryPeking University PeoplePeking University Peoples Hospitals HospitalDepartment of NeurosurgeryDepartment of NeurosurgeryPeking U

7、niversity PeoplePeking University Peoples Hospitals HospitalDepartment of NeurosurgeryDepartment of NeurosurgeryPeking University PeoplePeking University Peoples Hospitals HospitalDepartment of NeurosurgeryDepartment of NeurosurgeryPeking University PeoplePeking University Peoples Hospitals Hospital

8、Department of NeurosurgeryDepartment of NeurosurgeryPeking University PeoplePeking University Peoples Hospitals HospitalDepartment of NeurosurgeryDepartment of NeurosurgeryPeking University PeoplePeking University Peoples Hospitals HospitalDepartment of NeurosurgeryDepartment of NeurosurgeryPeking U

9、niversity PeoplePeking University Peoples Hospitals HospitalNAANAAChoCho CrCrCr2Cr2正常正常Cho/CrCho/Cr、Cho/NAACho/NAA比值范围比值范围约为约为0.789-0.5450.789-0.545NAA/ChoNAA/Cho比值的比值的范围约为范围约为1.267-1.267-1.8351.835 Department of NeurosurgeryPeking University Peoples HospitalN-N-乙酰天门冬氨酸乙酰天门冬氨酸(NAA)(NAA)显著下降显著下降胆碱胆碱(

10、Cho)(Cho)显著升高显著升高 肌酸肌酸(Cr)(Cr)不变或轻度下降不变或轻度下降可出现乳酸盐（可出现乳酸盐（Lac/LipLac/Lip） NAA/CrNAA/Cr下降下降 NAA/ChoNAA/Cho减少减少Cho/CrCho/Cr升高升高 -肿瘤对神经元的破坏肿瘤对神经元的破坏 -肿瘤细胞增殖活跃和有丝分裂增加肿瘤细胞增殖活跃和有丝分裂增加-胶质瘤发生坏死胶质瘤发生坏死ChoChoCr2Cr2CrCrNNANNALacLac星形细胞瘤随胶质瘤级别增加，随胶质瘤级别增加，NAANAA逐渐下降，逐渐下降，ChoCho逐渐升高逐渐升高Cho/NAACho/NAA和和Cho/CrCho/C

11、r比值反映肿瘤级别比较稳定，比值反映肿瘤级别比较稳定， 在所有的胶质母细胞瘤中均升高在所有的胶质母细胞瘤中均升高 LacLac峰可出现于各级别组脑胶质瘤中，其峰值无峰可出现于各级别组脑胶质瘤中，其峰值无 显著差异显著差异Cho/NAA高级别胶质瘤高级别胶质瘤低级别胶质瘤低级别胶质瘤瘤体实质区瘤体实质区2.301.3522时，患者时，患者1 1年生存率为年生存率为20%20%，而，而Lac/NAALac/NAA值值21.31.3即可即可诊断胶质瘤复发，诊断胶质瘤复发，1.31.71Cho/Cr1.71或或/(/(和和)Cho/NAA1.71)Cho/NAA1.71作为区分复发和作为区分复发和坏死

12、的标准坏死的标准ChoCho明显增高及合并明显增高及合并LacLac、NAANAA、CrCr的异常，提示胶质的异常，提示胶质细胞瘤治疗后复发；治疗后细胞瘤治疗后复发；治疗后ChoCho下降或保持稳定者，下降或保持稳定者，则肿瘤生长受到抑制则肿瘤生长受到抑制 MRSMRS见依旧明显见依旧明显增高增高ChoCho峰、下降峰、下降的的CrCr峰峰表明肿瘤细胞仍表明肿瘤细胞仍存在存在对应右侧额叶对应右侧额叶MRSMRSCrCrCrCrChoChoChoChoNNANNAMRSMRS见见NNANNA、ChoCho、CrCr峰均消失峰均消失无复发迹象无复发迹象对应右侧额叶对应右侧额叶MRSMRSCrCrC

13、hoChoNNANNAMRIMRI提示原手术提示原手术病灶未见明显异常病灶未见明显异常MRSMRS见见ChoCho峰增高峰增高提示复发提示复发对应右侧额叶对应右侧额叶MRSMRSCrCrChoChoNNANNAChoChoNNANNADepartment of NeurosurgeryPeking University Peoples Hospital脑膜瘤无神经元，故理论上无脑膜瘤无神经元，故理论上无NAANAA峰峰胆碱胆碱(Cho)(Cho)升高升高 出现特征性丙氨酸出现特征性丙氨酸(Ala)(Ala)峰峰可出现谷氨酸可出现谷氨酸(Glx)(Glx)峰峰 强化区域外没有病理性波谱强化区域外

14、没有病理性波谱LipLip峰出现提示恶性脑膜瘤可能峰出现提示恶性脑膜瘤可能 -有时可见较低的峰，原因是肿瘤侵犯正常脑组织或部分容积效应所致有时可见较低的峰，原因是肿瘤侵犯正常脑组织或部分容积效应所致 -各型脑膜瘤中没有显著性差异各型脑膜瘤中没有显著性差异ChoChoCr2Cr2CrCrAlaAlaNNANNA-对肿瘤细胞具有化学抵抗作用对肿瘤细胞具有化学抵抗作用-并非所有脑膜瘤均会出现并非所有脑膜瘤均会出现-非侵袭性肿瘤的特征非侵袭性肿瘤的特征NAANAA消失消失ChoCho升高升高出现丙氨酸出现丙氨酸AlaAla峰峰瘤周的瘤周的MRSMRS表现表现ChoChoChoChoNAANAACrCr

15、CrCrAlaAlaNAANAA下降至消失下降至消失ChoCho明显升高明显升高CrCr明显下降明显下降出现丙氨酸出现丙氨酸AlaAla峰峰瘤周的瘤周的MRSMRS表现表现ChoChoChoChoNAANAACrCrCrCrAlaAlaNAANAAChoChoCrCrCr2Cr2NNANNA周边区接近正常周边区接近正常实质区实质区NAANAA峰消失峰消失ChoCho峰明显增高峰明显增高可见特征性的丙氨酸可见特征性的丙氨酸AlaAla峰峰ChoChoAlaAlaCr2Cr2NNANNA实质区实质区NAANAA峰消失峰消失ChoCho峰增高峰增高可见丙氨酸可见丙氨酸AlaAla、乳酸乳酸LacLa

16、c、脂质、脂质LipLip、谷氨酸谷氨酸GLXGLX、峰峰ChoChoGLxGLxGLxGLxAlaAlaLipLipLacLacGLxGLxLacLac水肿区水肿区亦可见亦可见GLxGLx、LacLac峰峰 ChoChoGLxGLxGLxGLxAlaAla水肿区水肿区可见谷氨酸可见谷氨酸GLxGLx峰峰可见丙氨酸可见丙氨酸AlaAla峰峰 ChoChoLipLipGLxGLxGLxGLx坏死区坏死区脂质脂质LipLip为第一高峰为第一高峰 ChoChoNNANNACrCr对侧正常区对侧正常区 未见未见NAANAA峰显示峰显示ChoCho峰升高峰升高谷氨酸谷氨酸GLxGLx峰呈梯状峰呈梯状谷氨

17、酸谷氨酸GlxGlx峰较显著峰较显著可见丙氨酸可见丙氨酸AlaAla峰峰可见乳酸可见乳酸Lac/Lac/脂质脂质LipLip峰峰ChoChoGLxGLxGLxGLxAlaAlaLipLip瘤体区瘤体区肿瘤复发时，由于进行性生长肿瘤的边缘巨噬细肿瘤复发时，由于进行性生长肿瘤的边缘巨噬细胞吞噬不移动的脑脂质和坏死肿瘤细胞分解代谢，胞吞噬不移动的脑脂质和坏死肿瘤细胞分解代谢，脂质脂质LipLip明显增加明显增加肿瘤复发常继发正常血管网的破坏，乳酸肿瘤复发常继发正常血管网的破坏，乳酸LacLac含量含量增加增加 Cho/CrCho/Cr比值在残留和复发的肿瘤中明显高于术后比值在残留和复发的肿瘤中明显高

18、于术后反应性损伤区反应性损伤区Department of NeurosurgeryPeking University Peoples Hospital 转移瘤特点：转移瘤特点：NAANAA消失，消失，ChoCho明显增高，明显增高，CrCr下降，下降，Cho/CrCho/Cr比值升高，可出现乳酸比值升高，可出现乳酸LacLac峰和脂质峰和脂质LipLip峰峰 转移瘤和胶质瘤瘤体强化部分各代谢物比值相似转移瘤和胶质瘤瘤体强化部分各代谢物比值相似 瘤周瘤周Cho/CrCho/Cr比值是鉴别胶质瘤和转移瘤的重要手比值是鉴别胶质瘤和转移瘤的重要手段；转移瘤强化之外区域没有病理性波谱段；转移瘤强化之外区

19、域没有病理性波谱 两种肿瘤瘤周区病理上是不一样的：胶质瘤周围有肿瘤细胞的散两种肿瘤瘤周区病理上是不一样的：胶质瘤周围有肿瘤细胞的散在浸润，转移瘤瘤周无肿瘤细胞存在在浸润，转移瘤瘤周无肿瘤细胞存在Department of NeurosurgeryPeking University Peoples Hospital分类分类胆碱胆碱ChoCho峰峰 肌酸肌酸CrCr峰峰 肌醇肌醇MIMI峰峰 脂质脂质LipLip峰峰 Cho/CrCho/Cr值值 瘤周波谱形态瘤周波谱形态 胶质瘤胶质瘤 明显明显升高升高轻度轻度下降下降 可见可见7.047.048.18 8.18 2.282.281.241.24较

20、大的较大的ChoCho峰峰 转移瘤转移瘤 与正常与正常相似相似明显明显下降下降 无无 9.609.608.03 8.03 0.760.760.23 0.23 与正常相似与正常相似P0.05P0.05对侧正常区对侧正常区肿瘤周围区肿瘤周围区与正常波谱相与正常波谱相似似 肿瘤强化区肿瘤强化区NAANAA降低降低ChoCho升高升高ChoCho CrCrChoChoCrCrChoChoCrCrNNANNANNANNANNANNA ROI ROI选择选择肿瘤强化区肿瘤强化区肿瘤周围区肿瘤周围区对侧正常区对侧正常区ChoCho明显升高明显升高NAANAA明显降低明显降低CrCr明显下降明显下降 对侧正常

21、对侧正常MRSMRSChoChoNAANAACrCrLipLipChoCho ROI ROI选择选择在增强部分及对在增强部分及对侧正常脑实质部侧正常脑实质部分选取感兴趣区分选取感兴趣区CrCrNAANAAChoCho峰略降低峰略降低NAANAA及及CrCr峰显示峰显示不清不清出现明显的脂质出现明显的脂质LipLip峰峰 对侧正常对侧正常MRSMRSChoChoNAANAACrCrLipLipChoCho ROI ROI选择选择在增强部分及对在增强部分及对侧正常脑实质部侧正常脑实质部分选取感兴趣区分选取感兴趣区NAANAA峰显著降低峰显著降低CrCr峰显著降低峰显著降低ChoCho峰明显增高峰明

22、显增高可见脂质可见脂质LipLip峰峰 周边水肿区周边水肿区MRSMRS与正常与正常MRSMRS无显著无显著区别区别ChoChoNAANAACrCrLipLipChoCho ROI ROI选择选择 在肿瘤实质区在肿瘤实质区 和周边水肿区和周边水肿区Cr2Cr2NAANAACrCrCr2Cr2主要表现为向下主要表现为向下的乳酸的乳酸LacLac双峰双峰降低非常明显的降低非常明显的CrCr峰和峰和NAANAA峰峰可见见高尖的脂可见见高尖的脂质质LipLip峰峰NAA,Cr,ChoNAA,Cr,Cho峰均峰均减低减低 LacLacLipLipDepartment of NeurosurgeryPek

23、ing University Peoples Hospital 中枢神经系统淋巴瘤特点：中枢神经系统淋巴瘤特点：NAANAA几乎完全丧几乎完全丧失，失，CrCr降低，降低，ChoCho和乳酸和乳酸LacLac升高明显，脂升高明显，脂质质LipLip峰出现，肌醇峰出现，肌醇MIMI表现正常表现正常 明显升高的脂质明显升高的脂质LipLip峰是原发性中枢神经系峰是原发性中枢神经系统淋巴瘤特征表现统淋巴瘤特征表现 与胶质瘤类似，在与胶质瘤类似，在 增强区域以外仍可增强区域以外仍可 测得病理波谱测得病理波谱Cr2Cr2ChoChoCrCrNAANAALipLipChoChoNAANAACrCrLipL

24、ipNAANAA及及CrCr明显消失明显消失ChoCho明显升高明显升高出现特征的脂质出现特征的脂质LipLip峰峰 ROIROI选择选择1 1、2 2选择在增强区；选择在增强区；3 3选择在瘤周区；选择在瘤周区；4 4选择在正常区选择在正常区 强化区可见强化区可见 NAANAA峰降低峰降低ChoCho峰升高峰升高脂质脂质LipLip峰出峰出现现 瘤周区瘤周区近于正常近于正常ChoChoNAANAACrCrLipLipChoChoChoChoChoChoCrCrCrCrCrCrNAANAANAANAANAANAALipLip正常区正常区瘤周区瘤周区肿瘤强化区肿瘤强化区 ROIROI选择选择1 1、2 2选择在增强区；选择在增强区；3 3选择在瘤周区；选择在瘤周区；4 4选择在正常区选择在正常区 强化区可见强化区可见 NAANAA峰及峰及CrCr峰峰 明显降低明显降低ChoCho峰升高峰升高LipLip峰出现峰出现 瘤周区瘤周区近于正常近于正常ChoChoNAANAALipLipChoChoChoChoChoChoCrCrCrCrNAANAANAANAALipLip肿瘤强化区肿瘤强化区正常区正常区瘤周区瘤周区 LipLip