磁共振波谱在诊断颅内肿瘤中的应用ppt课件.ppt

1、Department of NeurosurgeryPeking University Peoples HospitalDepartment of NeurosurgeryPeking University Peoples HospitalDepartment of NeurosurgeryDepartment of NeurosurgeryPeking University Peoples HospitalPeking University Peoples HospitalDepartment of NeurosurgeryDepartment of NeurosurgeryPeking U

2、niversity Peoples HospitalPeking University Peoples HospitalDepartment of NeurosurgeryDepartment of NeurosurgeryPeking University Peoples HospitalPeking University Peoples HospitalDepartment of NeurosurgeryDepartment of NeurosurgeryPeking University Peoples HospitalPeking University Peoples Hospital

3、Department of NeurosurgeryDepartment of NeurosurgeryPeking University Peoples HospitalPeking University Peoples HospitalDepartment of NeurosurgeryDepartment of NeurosurgeryPeking University Peoples HospitalPeking University Peoples HospitalDepartment of NeurosurgeryDepartment of NeurosurgeryPeking U

4、niversity Peoples HospitalPeking University Peoples HospitalDepartment of NeurosurgeryPeking University Peoples HospitalDepartment of NeurosurgeryDepartment of NeurosurgeryPeking University Peoples HospitalPeking University Peoples HospitalDepartment of NeurosurgeryDepartment of NeurosurgeryPeking U

5、niversity Peoples HospitalPeking University Peoples HospitalDepartment of NeurosurgeryDepartment of NeurosurgeryPeking University Peoples HospitalPeking University Peoples HospitalDepartment of NeurosurgeryDepartment of NeurosurgeryPeking University Peoples HospitalPeking University Peoples Hospital

6、Department of NeurosurgeryDepartment of NeurosurgeryPeking University Peoples HospitalPeking University Peoples HospitalDepartment of NeurosurgeryDepartment of NeurosurgeryPeking University Peoples HospitalPeking University Peoples HospitalDepartment of NeurosurgeryDepartment of NeurosurgeryPeking U

7、niversity Peoples HospitalPeking University Peoples HospitalDepartment of NeurosurgeryDepartment of NeurosurgeryPeking University Peoples HospitalPeking University Peoples HospitalDepartment of NeurosurgeryDepartment of NeurosurgeryPeking University Peoples HospitalPeking University Peoples Hospital

8、Department of NeurosurgeryDepartment of NeurosurgeryPeking University Peoples HospitalPeking University Peoples HospitalDepartment of NeurosurgeryDepartment of NeurosurgeryPeking University Peoples HospitalPeking University Peoples HospitalDepartment of NeurosurgeryDepartment of NeurosurgeryPeking U

9、niversity Peoples HospitalPeking University Peoples 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NAANAAChoChoCrCrCr2Cr2NAANAA下降下降 ChoCho升高升高CrCr轻度下降轻度下降 左颞顶低级别胶质瘤ChoChoCrCrNAANAA显著下降至消失显著下降至消失ChoCho显著升高显著升高CrCr下降下降右枕部高级别胶质瘤NAANAA下降下降 ChoCho显著升高显著升高CrCr轻度下降轻度下降出现倒置的出现倒置的LacLac双峰双峰对侧相应部位对

12、侧相应部位的的MRSMRS表现正常表现正常ChoChoNAANAAChoChoNAANAACrCrCrCrLacLacNAANAA显著下降显著下降 ChoCho显著升高显著升高CrCr中度下降中度下降出现倒置的出现倒置的LacLac双峰双峰对侧相应部位对侧相应部位的的MRSMRS表现正常表现正常ChoChoNAANAAChoChoNAANAACrCrCrCrLacLacNAANAA显著下降显著下降 ChoCho显著升高显著升高CrCr中度下降中度下降1.32ppm1.32ppm处出现处出现倒置的倒置的LacLac峰峰出现出现MIMI（肌醇）（肌醇）峰峰ChoChoNAANAAChoChoNAA

13、NAACrCrCrCrLacLacLacLacMIMINAANAA下降下降 ChoCho峰升高峰升高CrCr变化不明显变化不明显未见未见Lip/LacLip/Lac峰峰对侧相应部位对侧相应部位的的MRSMRS表现正常表现正常ChoChoNAANAAChoChoNAANAACrCrCrCrCr2Cr2Cr2Cr2NAANAA、ChoCho、CrCr峰均下降峰均下降可见可见LipLip峰峰对侧相应部位对侧相应部位的的MRSMRS表现正常表现正常NNANNANNANNAChoChoCrCrCrCrCr2Cr2LipLipChoChoNAANAA、ChoCho、CrCr峰均下降峰均下降可见可见LipL

14、ip峰峰对侧相应部位的对侧相应部位的MRSMRS表现正常表现正常NAANAAChoChoCrCrCrCrLacLacNNANNANNANNAChoChoChoChoCrCrCrCrCr2Cr2LipLip肿瘤边界外肿瘤边界外正常组织正常组织瘤心坏死处瘤心坏死处见巨大见巨大LacLac峰峰肿瘤边界处肿瘤边界处肿瘤内部高肿瘤内部高活性代谢区活性代谢区瘤体谱线瘤体谱线Cho/NAA = 3.90Cho/NAA = 3.90Cho/Cr = 7.89 Cho/Cr = 7.89 近瘤周水肿谱线近瘤周水肿谱线Cho/NAA = 1.95Cho/NAA = 1.95Cho/Cr = 2.11Cho/Cr

15、= 2.11远瘤周水肿谱线远瘤周水肿谱线Cho/NAA = 1.40Cho/NAA = 1.40Cho/Cr = 1.92Cho/Cr = 1.92对侧正常谱线对侧正常谱线Cho/NAA = 0.94Cho/NAA = 0.94Cho/Cr = 1.25Cho/Cr = 1.25NNANNANNANNAChoChoChoChoCrCrLacLacNNANNANNANNAChoChoChoChoCrCrCrCrLacLacLacLacNNANNACrCrCr2Cr2NNANNACrCrCr2Cr2NNANNACrCrCr2Cr2ChoChoChoChoChoChoNNANNACrCrCr2Cr2

16、NNANNACrCrCr2Cr2NNANNACrCrCr2Cr2ChoChoChoChoChoChoLip/LacLip/LacNAANAAChoChoCrCrCr2Cr2LacLacNAANAA显著下降显著下降ChoCho显著升高显著升高出现出现LacLac峰峰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MRSMRSCr

17、CrChoChoNNANNAMRIMRI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

18、化区域外没有病理性波谱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ChoChoChoChoNAANAA

19、CrCrCrCrAlaAlaNAANAA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L

20、acLac、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

21、梯状谷氨酸谷氨酸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

22、中明显高于术后反应性损伤区反应性损伤区Department of NeurosurgeryPeking University Peoples HospitalDepartment of NeurosurgeryPeking University Peoples HospitalP0.05P0.05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 CrCrChoChoCrCrChoChoCrCrNNANNANNANNANNANNAChoCho明显升高明显升高NAANAA明显降低明显降低CrCr明显下降明

23、显下降 对侧正常对侧正常MRSMRSChoChoNAANAACrCrLipLipChoChoCrCrNAANAAChoCho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MRSMRSChoChoNAANAACrCrLipLipChoChoNAANAA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ChoChoNAANAACrCrLipLipChoChoCr2Cr2NAANAACr

24、CrCr2Cr2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 NeurosurgeryPeking University Peoples HospitalCr2Cr2ChoChoCrCrNAANAALipLipChoChoNAANAACrCrLipLipNAANAA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

25、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 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出现特征的脂质出现特征的脂质LipLip峰峰Department of NeurosurgeryPeking University Peoples HospitalDepartment of NeurosurgeryPeking University Peoples Hospital