Wang Chien-Kuo, Li Chun-Wei, Hsieh Tsyh-Jyi, Chien Sang-Hsiung, Liu Gin-Chung, Tsai Kun-Bow
Department of Medical Imaging, Chung-Ho Memorial Hospital, Kaohsiung Medical University, 100 Tzyou 1st Rd, Kaohsiung 807, Taiwan.
Radiology. 2004 Aug;232(2):599-605. doi: 10.1148/radiol.2322031441.
To determine if in vivo detection of choline by using hydrogen 1 (1H) magnetic resonance (MR) spectroscopy with dynamic contrast material-enhanced MR imaging can help differentiate between benign and malignant musculoskeletal tumors.
MR imaging was performed in 36 consecutive patients with bone and soft-tissue tumors larger than 1.5 cm in diameter. Examinations were performed at 1.5 T with a surface coil appropriate for the location of the lesions. Single-voxel 1H MR spectroscopy was performed by using a point-resolved spectroscopic sequence with echo times of 40, 135, and 270 msec. The volume of interest within lesions was positioned on the areas of early enhancement (<8 seconds after arterial enhancement) according to the findings of dynamic contrast-enhanced MR imaging with subtraction. The criterion for determining whether choline was present in a lesion was a clearly identifiable peak at 3.2 ppm in at least two of the three spectra acquired at echo times. MR spectroscopic results and histopathologic findings were determined in blinded fashion and compared with kappa statistics. P <.001 was considered to indicate a significant difference.
Choline was detected in 18 of 19 patients with malignant tumors and in three of 17 patients with benign lesions. The three benign lesions included one perineurioma, one giant cell tumor, and one abscess. Choline was not detected in 14 patients with benign lesions nor in one patient with a densely ossifying low-grade parosteal osteosarcoma. In vivo 1H MR spectroscopy characterized bone and soft-tissue tumors, resulting in a sensitivity of 95%, specificity of 82%, and accuracy of 89% (P <.001).
Choline can be reliably detected in large malignant bone and soft-tissue tumors by using a multiecho point-resolved spectroscopic protocol. 1H MR spectroscopy can help differentiate malignant from benign musculoskeletal tumors by revealing the presence or absence of water-soluble choline metabolites.
确定通过使用氢1（1H）磁共振（MR）波谱结合动态对比剂增强MR成像在体内检测胆碱是否有助于鉴别良性和恶性肌肉骨骼肿瘤。
对36例连续的直径大于1.5 cm的骨和软组织肿瘤患者进行MR成像检查。在1.5 T下使用适合病变部位的表面线圈进行检查。采用点分辨波谱序列，回波时间分别为40、135和270毫秒，进行单体素1H MR波谱分析。根据动态对比增强MR成像减影结果，将病变内的感兴趣体积置于早期强化区域（动脉强化后<8秒）。确定病变中是否存在胆碱的标准是在回波时间采集的三个谱图中至少有两个在3.2 ppm处有清晰可辨的峰。以盲法确定MR波谱结果和组织病理学结果，并与kappa统计量进行比较。P <.001被认为表明有显著差异。
19例恶性肿瘤患者中有18例检测到胆碱，17例良性病变患者中有3例检测到胆碱。3例良性病变包括1例神经束膜瘤、1例巨细胞瘤和1例脓肿。14例良性病变患者和1例致密骨化的低级别骨旁骨肉瘤患者未检测到胆碱。体内1H MR波谱对骨和软组织肿瘤进行了特征性分析，敏感性为95%，特异性为82%，准确性为89%（P <.001）。
通过使用多回波点分辨波谱方案，可在大型恶性骨和软组织肿瘤中可靠地检测到胆碱。1H MR波谱可通过揭示水溶性胆碱代谢物的存在与否，帮助鉴别恶性和良性肌肉骨骼肿瘤。
