Star-Lack J M, Adalsteinsson E, Adam M F, Terris D J, Pinto H A, Brown J M, Spielman D M
Lucas MRS Imaging Center, Department of Radiology, Stanford University, CA 94305, USA.
AJNR Am J Neuroradiol. 2000 Jan;21(1):183-93.
Current diagnostic methods for head and neck metastasis are limited for monitoring recurrence and assessing oxygenation. 1H MR spectroscopy (1H MRS) provides a noninvasive means of determining the chemical composition of tissue and thus has a unique potential as a method for localizing and characterizing cancer. The purposes of this investigation were to measure 1H spectral intensities of total choline (Cho), creatine (Cr), and lactate (Lac) in vivo in human lymph node metastases of head and neck cancer for comparison with normal muscle tissue and to examine relationships between metabolite signal intensities and tissue oxygenation status.
Volume-localized Lac-edited MRS at 1.5 T was performed in vivo on the lymph node metastases of 14 patients whose conditions were untreated and who had primary occurrences of squamous cell carcinoma. MRS measurements were acquired also from the neck muscle tissue of six healthy volunteers and a subset of the patients. Peak areas of Cho, Cr, and Lac were calculated. Tissue oxygenation (pO2) within the abnormal lymph nodes was measured independently using an Eppendorf polarographic oxygen electrode.
Cho:Cr ratios were significantly higher in the nodes than in muscle tissue (node Cho:Cr = 2.9 +/- 1.6, muscle Cho:Cr = 0.55 +/- 0.21, P = .0006). Lac was significantly higher in cancer tissue than in muscle (P = .01) and, in the nodes, showed a moderately negative correlation with median pO2 (r = -.76) over a range of approximately 0 to 30 mm Hg. Nodes with oxygenation values less than 10 mm Hg had approximately twice the Lac signal intensity as did nodes with oxygenation values greater than 10 mm Hg (P = .01). Cho signal intensity was not well correlated with pO2 (r = -.46) but seemed to decrease at higher oxygenation levels (>20 mm Hg).
1H MRS may be useful for differentiating metastatic head and neck cancer from normal muscular tissue and may allow for the possibility of assessing oxygenation. Potential clinical applications include the staging and monitoring of treatment.
目前用于头颈部转移灶的诊断方法在监测复发和评估氧合方面存在局限性。氢质子磁共振波谱（1H MRS）提供了一种确定组织化学成分的非侵入性方法，因此作为一种定位和鉴别癌症的方法具有独特的潜力。本研究的目的是测量头颈部癌患者体内淋巴结转移灶中总胆碱（Cho）、肌酸（Cr）和乳酸（Lac）的氢质子谱强度，以便与正常肌肉组织进行比较，并研究代谢物信号强度与组织氧合状态之间的关系。
对14例未经治疗且原发为鳞状细胞癌的患者的淋巴结转移灶进行了1.5T的容积定位乳酸编辑磁共振波谱检查。还从6名健康志愿者和部分患者的颈部肌肉组织中获取了磁共振波谱测量数据。计算了Cho、Cr和Lac的峰面积。使用Eppendorf极谱氧电极独立测量异常淋巴结内的组织氧合（pO2）。
淋巴结中的Cho:Cr比值显著高于肌肉组织（淋巴结Cho:Cr = 2.9±1.6，肌肉Cho:Cr = 0.55±0.21，P = 0.0006）。癌组织中的Lac显著高于肌肉（P = 0.01），并且在淋巴结中，在约0至30 mmHg的范围内，Lac与中位pO2呈中度负相关（r = -0.76）。氧合值低于10 mmHg的淋巴结的Lac信号强度约为氧合值高于10 mmHg的淋巴结的两倍（P = 0.01）。Cho信号强度与pO2的相关性不佳（r = -0.46），但在较高氧合水平（>20 mmHg）时似乎降低。
1H MRS可能有助于将转移性头颈部癌与正常肌肉组织区分开来，并可能实现评估氧合的可能性。潜在的临床应用包括分期和治疗监测。
