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在磁共振波谱成像中靶向脂质含量最高的区域可能会提高立体定向活检的诊断率。

Targeting regions with highest lipid content on MR spectroscopy may improve diagnostic yield in stereotactic biopsy.

作者信息

Ng Wai Hoe, Lim Tchoyoson

机构信息

Department of Neurosurgery, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore.

出版信息

J Clin Neurosci. 2008 May;15(5):502-6. doi: 10.1016/j.jocn.2007.04.005. Epub 2008 Mar 10.

Abstract

Gliomas are heterogeneous brain tumors and prognosis and treatment are dependent on the highest histological grade present. Stereotactic biopsy is associated with an inherent risk of sampling error. Magnetic resonance spectroscopy (MRS) uses clinical MR scanners to provide chemical in addition to conventional information. MRS studies in brain tumors have found increased levels of choline-containing compounds (Cho) and decreased levels of N-acetylaspartate (NAA), creatine (Cr) and phosphocreatine (PCr) which are all associated with increased grade of glioma. We propose the use of MRS-guided stereotactic biopsy of astrocytomas to increase diagnostic yield and reduce the sampling error rate. MRS was performed on two patients undergoing stereotactic biopsy for suspected astrocytoma. Spectral peak heights of the metabolites Cho at 3.2 parts per million (ppm) chemical shift, NAA at 2.0 ppm and lipid (Lip) at 1.2 ppm, were measured. Biopsy targets were selected from the voxels with the highest Cho/NAA and normalised against Cho levels in the contralateral normal tissue, as well as those with highest lipid content. The biopsies were taken and tissue diagnosis was obtained via standard histological techniques. Histological grade was found to be different in one case: the region with a high Lip/Cr and Cho/NAA ratios showed glioblastoma, whereas the region with high Cho/NAA but low Lip/Cr ratios showed anaplastic astrocytoma. The second patient had high Cho/NAA ratio but low Lip/Cr ratio in both targets and the histology revealed anaplastic astrocytoma in both samples. MRS is a useful biomedical imaging tool for diagnosing and grading astrocytomas. Targeting regions with highest lipid content can potentially improve the diagnostic yield and minimize sampling error in stereotactic biopsy.

摘要

胶质瘤是异质性脑肿瘤,其预后和治疗取决于所呈现的最高组织学分级。立体定向活检存在抽样误差的固有风险。磁共振波谱(MRS)使用临床磁共振扫描仪,除了提供传统信息外,还能提供化学信息。对脑肿瘤的MRS研究发现,含胆碱化合物(Cho)水平升高,而N-乙酰天门冬氨酸(NAA)、肌酸(Cr)和磷酸肌酸(PCr)水平降低,这些都与胶质瘤分级增加有关。我们建议使用MRS引导的星形细胞瘤立体定向活检,以提高诊断率并降低抽样误差率。对两名因疑似星形细胞瘤接受立体定向活检的患者进行了MRS检查。测量了代谢物Cho在化学位移3.2百万分之一(ppm)处、NAA在2.0 ppm处以及脂质(Lip)在1.2 ppm处的谱峰高度。活检靶点从Cho/NAA最高且相对于对侧正常组织中Cho水平进行归一化的体素中选择,以及脂质含量最高的体素中选择。进行活检并通过标准组织学技术获得组织诊断。在一个病例中发现组织学分级不同:Lip/Cr和Cho/NAA比值高的区域显示为胶质母细胞瘤,而Cho/NAA高但Lip/Cr比值低的区域显示为间变性星形细胞瘤。第二名患者的两个靶点中Cho/NAA比值高但Lip/Cr比值低,组织学显示两个样本均为间变性星形细胞瘤。MRS是诊断星形细胞瘤及其分级的一种有用的生物医学成像工具。针对脂质含量最高的区域进行活检可能会提高诊断率,并使立体定向活检中的抽样误差最小化。

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