Wilken B, Helms G, Christen H J, Behnke J, Frahm J, Hanefeld F
Department of Pediatrics and Pediatric Neurology, Georg August University, Göttingen, Germany.
Childs Nerv Syst. 1996 Oct;12(10):626-9. doi: 10.1007/BF00261659.
Noninvasive localized proton magnetic resonance spectroscopy (MRS) was used for differential diagnosis of a focal brain lesion in a 2.5-year-old girl. The clinical signs were a mild head tilt and neck pain. Magnetic resonance imaging (MRI) revealed a lesion in the right hemisphere of the cerebellum, but its nature remained obscure. In this lesion quantitative determinations of cerebral metabolites by fully relaxed, short-echo-time proton MRS revealed markedly lowered N-acetylaspartate (NAA) and pronounced elevations of choline-containing compounds (Cho) and myo-inositol (Ins), whereas metabolite concentrations in cortical gray matter and white matter were within normal ranges. The metabolite pattern of the lesion indicated loss of vital neuroaxonal tissue (low NAA) and enhanced glial proliferation (high Cho and Ins), which, together with the MRI morphology, suggested a brain tumor. The diagnosis was established by neurosurgical exploration and total extirpation of the tumor. Histology confirmed an astrocytoma (WHO II). After 2 weeks' recovery the child was discharged with no neurological signs.
采用无创性局部质子磁共振波谱（MRS）对一名2.5岁女童的局灶性脑病变进行鉴别诊断。临床症状为轻度头部倾斜和颈部疼痛。磁共振成像（MRI）显示小脑右半球有一病变，但其性质仍不明确。在该病变中，通过完全弛豫、短回波时间质子MRS对脑代谢物进行定量测定，结果显示N-乙酰天门冬氨酸（NAA）明显降低，含胆碱化合物（Cho）和肌醇（Ins）显著升高，而皮质灰质和白质中的代谢物浓度在正常范围内。病变的代谢物模式表明重要神经轴突组织丧失（NAA降低）和胶质细胞增殖增强（Cho和Ins升高），这与MRI形态学表现一起提示为脑肿瘤。通过神经外科探查和肿瘤全切术确诊。组织学检查证实为星形细胞瘤（世界卫生组织II级）。经过2周的恢复，患儿出院时无神经症状。
