颅内结核瘤的磁共振波谱分析：3.8 ppm处的单峰作为将其与恶性肿瘤区分开来的潜在标志物。
MR spectroscopy of intracranial tuberculomas: A singlet peak at 3.8 ppm as potential marker to differentiate them from malignant tumors.
作者信息
Morales Humberto, Alfaro David, Martinot Carlos, Fayed Nicolas, Gaskill-Shipley Mary
机构信息
Section of Neuroradiology, Department of Radiology, University of Cincinnati Medical Center, USA
Centro de Resonancia Magnetica (CEREMA), Peru.
出版信息
Neuroradiol J. 2015 Jun;28(3):294-302. doi: 10.1177/1971400915592077.
PURPOSE
The diagnosis of intracranial tuberculomas is often challenging. Our purpose is to describe the most common metabolic patterns of tuberculomas by MR spectroscopy (MRS) with emphasis on potential specific markers.
METHODS
Single-voxel MRS short echo time was performed in 13 cases of tuberculomas proven by histology and/or response to anti-mycobacterial therapy. For comparison MRS was also performed in 19 biopsy-proven malignant tumors (13 high-grade gliomas and six metastasis). Presence of metabolic peaks was assessed visually and categorical variables between groups were compared using chi-square. Metabolite ratios were compared using Mann-Whitney test and diagnostic accuracy of the metabolite ratios was compared using receiver-operating characteristic (ROC) curves analysis.
RESULTS
Spectroscopic peaks representing lipids and glutamate/glutamine (Glx) as well as a peak at ∼3.8 ppm were well defined in 77% (10/13), 77% (10/13) and 69% (nine of 13) of tuberculomas, respectively. Lipid and Glx peaks were also present in most of the malignant lesions, 79% (15/19) and 74% (14/19) respectively. However, a peak at ∼3.8 ppm was present in only 10% (two of 19) of the tumor cases (p < 0.001). Higher Cho/Cr and mI/Cr ratios helped discriminate malignant lesions with an area under the ROC curve of 0.86 (SE: 0.078, p < 0.002, CI: 0.7-1) and 0.8 (SE: 0.1, p < 0.009, CI: 0.6-1), respectively. Threshold values between 1.7-1.9 for Cho/Cr and 0.8-0.9 for mI/Cr provided high specificity (91% for both metabolites) and adequate sensitivity (75% and 80%, respectively) for discrimination of malignant lesions.
CONCLUSION
A singlet peak at ∼3.8 ppm is present in the majority of tuberculomas and absent in most malignant tumors, potentially a marker to differentiate these lesions. The assignment of the peak is difficult from our analysis; however, guanidinoacetate (Gua) is a possibility. Higher Cho/Cr and mI/Cr ratios should favor malignant lesions over tuberculomas. The presence of lipids and Glx is non-specific.
目的
颅内结核瘤的诊断常常具有挑战性。我们的目的是通过磁共振波谱（MRS）描述结核瘤最常见的代谢模式，重点关注潜在的特异性标志物。
方法
对13例经组织学证实和/或对抗结核治疗有反应的结核瘤患者进行了单体素短回波时间MRS检查。为作比较，还对19例经活检证实的恶性肿瘤（13例高级别胶质瘤和6例转移瘤）进行了MRS检查。通过视觉评估代谢峰的存在情况，并使用卡方检验比较组间的分类变量。使用曼-惠特尼检验比较代谢物比率，并使用受试者工作特征（ROC）曲线分析比较代谢物比率的诊断准确性。
结果
分别在77%（10/13）、77%（10/13）和69%（13例中的9例）的结核瘤中清晰显示出代表脂质和谷氨酸/谷氨酰胺（Glx）的波谱峰以及约3.8 ppm处的一个峰。脂质峰和Glx峰在大多数恶性病变中也存在，分别为79%（15/19）和74%（14/19）。然而，约3.8 ppm处的峰仅在10%（19例中的2例）的肿瘤病例中出现（p < 0.001）。较高的Cho/Cr和mI/Cr比率有助于鉴别恶性病变，ROC曲线下面积分别为0.86（标准误：0.078，p < 0.002，可信区间：0.7 - 1）和0.8（标准误：0.1，p < 0.009，可信区间：0.6 - 1）。Cho/Cr阈值在1.7 - 1.9之间以及mI/Cr阈值在0.8 - 0.9之间时，对鉴别恶性病变具有高特异性（两种代谢物均为91%）和足够的敏感性（分别为75%和80%）。
结论
大多数结核瘤中存在约3.8 ppm处的单峰，而大多数恶性肿瘤中不存在，这可能是区分这些病变的一个标志物。从我们的分析中难以确定该峰的归属；然而，胍基乙酸（Gua）是一种可能。较高的Cho/Cr和mI/Cr比率应更倾向于提示恶性病变而非结核瘤。脂质和Glx的存在是非特异性的。
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