• 1. Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, China; 2. Department of Neurosurgery, Institute of Clinical Medicine, University of Tsukuba, Ibaraki 3058575, Japan; 3. Departments of Radiology, Institute of Clinical Medicine, University of Tsukuba, Ibaraki 3058575, Japan;
橋小腦角; 神經鞘瘤; 腦膜瘤; 磁共振波譜cerebellopontine angle; neurinoma; meningioma; magnetic resonance spectroscopy
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摘要:目的: 探討磁共振波譜(MRS)對鑒別橋小腦角神經鞘瘤與腦膜瘤的價值。 方法 :對8例神經鞘瘤和8例腦膜瘤病例進行MRI平掃和增強掃描,并采用點分辨波譜序列(PRESS,TR/TE=2000/136ms)進行單體素波譜分析。從事磁共振診斷專業的醫師根據腫瘤的MRI及MRS表現特征進行鑒別診斷。 結果 :盡管多數神經鞘瘤(5/8)和腦膜瘤(6/8)具有典型的MRI表現特征并僅經MRI即可得到正確鑒別,但部分病例(5/16)為不典型表現者,如腦膜瘤呈長T1長T2信號并伴有囊變,以及神經鞘瘤呈等信號、均勻強化且不伴有囊變或內聽道擴大者,鑒別診斷困難。MRS顯示腦膜瘤的膽堿/肌酸比值(Cho/Cr)(2.74±1.47)略高于神經鞘瘤(2.70±1.21),但差異無統計學意義。丙氨酸(Ala)在腦膜瘤中的出現率(4/8)顯著高于神經鞘瘤(0/8)(P lt;0.05),谷氨酸鹽/谷氨酰胺(Glx)在腦膜瘤中的出現率(5/8)也高于神經鞘瘤(2/8);而肌醇(Ins)在神經鞘瘤中的出現率(4/8)高于腦膜瘤(2/8)。結合MRS表現,在MRI上尚難鑒別的病例可被明確診斷,并與最終病理結果相符。 結論 : MRI有助于多數橋小腦角神經鞘瘤與腦膜瘤的鑒別診斷,但對不典型病例有一定局限性;MRS對不典型病例的鑒別具有重要的參考價值。
Abstract: Objective: To explore the value of magnetic resonance spectroscopy (MRS) in the differentiation of neurinoma and meningioma in the cerebellopontine angle. Methods : 16 cases, including 8 cases of meningiomas and 8 cases of neurinomas, underwent MRI (plan and gadoliniumenhanced scan) and singlevoxel proton MRS (PRESS series, TR/TE=2000/136ms). MRI and MRS results were reviewed and differential diagnoses were made by professional radiologists. Results : Although most cases (11/16) were typical and clearly classified on MRI, atypical cases were also observed, such as meningioma of long T1/T2 signal intensity with small cystic foci, and neurinoma of isointensity and homogenous enhancement without cystic change or enlargement of internal acoustic meatus. The choline to creatine ratio (Cho/Cr) of meningioma (2.74±1.47) was higher than that of neurinoma (2.70±1.21), however the difference was not significant (P gt;0.05). Alanine was observed in 4/8 meningiomas but none of neurinomas (P lt;0.05), and glutamine/glutamate was more frequently visualized in meningiomas (5/8) than in neurinomas (2/8), whilemyoinositol was more frequently observed in neurinomas (4/8) than in meningiomas (2/8). With MRS, cases difficult to differentiate were clearly and correctly classified. Conclusion : Although most CPA neurinomas and meningiomas can be diagnosed by MRI, MRS is useful for the differential diagnosis of atypical cases.

Citation： YUE Qiang,Yasushi Shibata,Hiraku Kawamura,et al.. Usefulness of Magnetic Resonance Spectroscopy in the Differentiation of Neurinoma and Meningioma of the Cerebellopontine Angle. West China Medical Journal, 2009, 24(10): 2701-. doi: Copy

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