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Detection of Metabolic Status by in Vivo 1H proton Magnetic Resonance Spectroscopy in Patients with Brain Tumors
使用活體氫質子磁振頻譜分析術偵測腦內腫瘤病人的代謝狀況
摘要
核磁共振(NMR)頻譜分析早在臨床使用磁振造影(MRI)以前就被用來偵測各種化學物質。自從1980年代晚期以來，磁振造影頻譜分析術(MRS)已由於MRI的發展而愈趨普遍。先前在標本NMR與活體MRS所做的研究與累積的經驗，證實了在人體不同範圍的臨床使用功效。我們做此項合併MRI與活體MRS研究的目的在評估不同顱內腫瘤的代謝狀況。 我們前瞻性的以Single-Voxel Proton Brain Spectroscopy Exam (PROBE/SV)來評估本院在2000年及2001年間的所有顱內腫瘤病患。一共有8位多形神經膠母細胞瘤、5位星狀細胞瘤、3位腦膜瘤、4位肺癌合併顱內轉移以及15位正常對照者收集在此一研究中。我們評估了顱內腫瘤的N-acetylaspartate (NAA)、Creatine (Cr)和Choline (Cho)等代謝物尖峰的頻譜並和正常對照者比較。 與正常受試者比較，NAA/Cho的定量尖峰比在多形神經膠母細胞瘤、星狀細胞瘤、腦膜瘤與顱內轉移病人皆呈現明顯的降低。而NAA/Cr及Cr/Cho尖峰比亦在神經膠母細胞瘤與星狀細胞瘤明顯降低，但是Cho/Cr尖峰卻是昇高的。在肺癌顱內轉移的病患，其NAA/Cho明顯的較多形神經膠母細胞瘤為高。 當磁振造影檢查在顱內偵測到局部腫塊病灶時，若頻譜分析術發現NAA/Cho比明顯的降低，以及NAA/Cr及Cr/Cho比亦為降低時，多形神經膠母細胞瘤或是星狀細胞瘤腫瘤必須要高度懷疑。如果此一腫塊呈現較高的NAA/Cho尖峰比，同時病患已知有其他原發惡性腫瘤時，在多形神經膠母細胞瘤、星狀細胞瘤與腦膜瘤中必須要懷疑到顱內轉移。雖然頻譜不是鑑別顱內腫瘤的良好工具，但由代謝物尖峰的特別變化，對於與其他顱內疾病的區別，仍然很有幫助。
並列摘要
Nuclear magnetic resonance (NMR) has been used to detect the chemicals earlier before the clinical application of magnetic resonance imaging (MRI). Since late 1980s, magnetic resonance spectroscopy (MRS) became popular with the advancement of MRI. Previous studies on in vitro NMR and in vivo MRS elucidate the effectiveness of its clinical application in different areas. We performed this study, which combines MRI and in vivo MRS, to evaluate the metabolic status of different brain tumors. We prospectively evaluated the patients with brain tumor by Single-Voxel Proton Brain Spectroscory Exam (PROBE/SV) in 2000 and 2001. Eight glioblastoma multiformes, 5 astrocytomas, 3 meningiomas, 4 lung carcinomas with brain metastases, and 15 normal brains as the control group were included in this study. The spectra of metabolite peaks of the N-acetylaspartate (NAA), Creatine (Cr) and Choline (Cho) of the brain tumors were evaluated and compared with that of the control group. As compared with the control group, the quantitative peak ratio of NAA/Cho was significantly decreased in lesions of glioblastoma, astrocytoma, meningioma, and metastasis. The NAA/Cr and Cr/Cho peak ratios were also significantly decreased in glioblastoma and astrocytoma;on the contrary, the Cho/Cr peak ratio was increased. In patients with carcinoma of lung with brain metastasis, the NAA/Cho was significantly higher than the glioblastoma. When a focal mass lesion was detected on MRI, and the spectroscopy showed marked decrease of NAA/Cho, NAA/Cr and Cr/Cho rations, either astrocytoma or glioblastoma should be highly considered. If the mass lesion showed higher NAA/Cho peak ratio, and the patient already had a primary malignancy, metastasis was the most likely diagnosis ns compared with glioblastoma, astrocytoma and meningioma.