周建兵++祝跃明

[摘要] 目的 探讨鼻咽癌多体素氢质子磁共振波谱的表现及其临床价值。 方法 选择2010年2月～2013年2月在浙江大学医学院附属第二医院收治的鼻咽癌患者110例（观察组），另选择同期来该院行健康体检的100例健康体检者（正常组），利用1.5T symphony超导型磁共振成像机行头颈部波谱扫描，记录并分析结果。将观察组的图像观察兴趣区分为瘤体区、瘤周区、对照区，观察其波谱图的变化状态。同时记录N-乙酰天门冬氨酸（NAA）、胆碱（Cho）和肌酸（Cr）等代谢物波峰值。计算三区域的NAA/Cho、NAA/Cr及Cho/Cr等比值。 结果 T2WI及多体素氢质子磁共振波谱显示：正常组颌面部肌肉在δ1.0～1.4处可见宽大的脂质峰；观察组在δ3.0～3.6可见宽大的脂质峰，体素大小为1.6～11.5 cm3，平均（4.9±0.4）cm3。观察组对照区NAA/Cho、NAA/Cr均明显高于瘤体区、瘤周区，差异均有统计学意义（P < 0.05），Cho/Cr明显低于瘤体区、瘤周区，差异有统计学意义（P < 0.05）；三个区域NAA/Cho、NAA/Cr、Cho/Cr比较差异有统计学意义（P < 0.05）。 结论 Cho/Cr比值可以作为鼻咽癌诊断的标准之一。

[关键词] 多体素氢质子磁共振波谱；鼻咽癌；胆碱/肌酸

[中图分类号] R739.63 [文献标识码] A [文章编号] 1673-7210（2014）10（a）-0028-04

Expression and clinical value of 1H-MRS for nasopharyngeal carcinoma

ZHOU Jianbing1 ZHU Yueming2

1.The Second People's Hospital of Yuhuan County in Taizhou City， Zhejiang Province， Yuhuan 317605， China； 2.The Central Hospital of Huzhou City， Zhejiang Province， Huzhou 313000， China

[Abstract] Objective To explore the expression and its clinical value of 1H-MRS for nasopharyngeal carcinoma. Methods From February 2010 to February 2013， in the Second Hospital Affiliated to Zhejiang University School of Medicine， 110 patients with nasopharyngeal carcinoma were chosen as the observation group， at the same time， 100 healthy people with physical examination in this hospital were chosen as normal group， 1.5T symphony type superconducting magnetic resonance imaging on the research object line of head and neck spectrum scanning was used， the resalts were recorded and analyzed. In the observation group， interest in the image observation area was divided into tumors area， week of tumor area and control area for three different areas， change of the spectrum on the spectrogram was observed. The corresponding PPM position for N-acetyl aspartic acid （NAA）， choline （Cho） and creatine （Cr）， and other metabolites crest value were recorded， and input into SAS statistical software package. Tumor entity， tumor weeks respectively calculated area and control area NAA/Cho， NAA/Cr， Cho/Cr ratio， etc were counted. Results T2WI 1H-MRS showed： in normal group the maxillofacial muscles at δ1.0-1.4 was wide lipid peak； in observation group that at δ3.0-3.6 with wide was lipid peak， voxel size was 1.6-11.5 cm3， with average of （4.9±0.4） cm3. In observation group， the control area NAA/Cho， NAA/Cr were significantly higher than that of tumors， tumor weeks district， the difference was statistically significant （P < 0.05）， Cho/Cr was significantly lower than that of the week of tumors， tumor area， the difference was statistically significant （P < 0.05）. Three regional comparison between groups， the differences of NAA/Cho， NAA/Cr， Cho/Cr were statistically significant （P < 0.05）. Conclusion Cho/Cr ratio can be used as one of the standard for diagnosis of nasopharyngeal carcinoma.

[Key words] 1H-MRS； Nasopheryngeal carcinoma； Cho/Cr

鼻咽癌作为我国最常见的恶性肿瘤之一，原发于鼻咽黏膜被覆上皮，病理上主要以低分化鳞状细胞癌，颈淋巴结转移率高。随着CT、MR等影像学技术及TPS系统的应用，人们逐渐认识到鼻咽癌原发肿瘤体积和颈淋巴结转移规律对放疗效果的影响。多体素氢质子磁共振波谱能很好地反映肿瘤代谢疾病的范围与边界。氢质子波谱通过化学位移的变化可显示出机体的主要代谢物，并且能较容易地分辨研究中所观察的脂质峰等，同时基线较平稳，信噪比较高。为了进一步探讨多体素氢质子磁共振波……