常規MRI 與31P MR 波譜在骨及軟組織
腫塊中的鑒別診斷價值
劉宏偉 楊貞振 李傳亭 呂玉波
【摘要】 目的 探討常規MRI 與31P MR 波譜( MRS) 對骨及軟組織腫塊的鑒別診斷價值。方法
在1. 5 T場強下, 對16 例健康志愿者及35 例骨及軟組織腫塊患者分別行常規MRI 與31P MRS 檢查,
測定波譜中各代謝產物的峰下面積, 計算各代謝產物與β-三磷酸腺苷( β-ATP) 的比值, 以及根據無
機磷( Pi) 的化學位移相對于磷酸肌酸( PCr ) 的改變測定細胞內pH 值。結果 良惡性兩組腫塊在大
小、信號均勻性、境界及對周圍結構的侵犯等方面差異無統計學意義( P 值均> 0. 05) , 其MRI 特征有
很大重疊性。對照組的磷酸單酯/β-三磷酸腺苷( PME/ β-ATP) 、磷酸二酯( PDE) / β-ATP、低能磷酸鹽
( LEP) / β-ATP、PCr / β-ATP、細胞內pH 值分別為0. 33 ±0. 21、0. 64 ±0. 27、1. 62 ±0. 67、3. 12 ±0. 78、
7. 08 ±0. 16, 良性腫塊組的PME/ β-ATP、PDE/ β-ATP、LEP/ β-ATP、PCr / β-ATP、pH 值分別為0. 55 ±
0. 31、0. 81 ±0. 31、2. 03 ±0. 87、1. 65 ±0. 65、7. 18 ±0. 23, 惡性腫塊組的PME/ β-ATP、PDE / β-ATP、低
能磷酸鹽( LEP) /β-ATP、PCr / β-ATP、pH 值分別為1. 73 ±0. 40、1. 73 ±0. 45、4. 31 ±1. 18、1. 44 ±0. 54、
7. 32 ±0. 29。與對照組比較, 惡性腫塊組的PME / β-ATP( P < 0. 01) 、PDE /β-ATP ( P < 0. 01) 、LEP / β-
ATP( P < 0. 01) 、細胞內pH 值( P < 0. 05) 升高, 良性及惡性腫塊組的PCr /β-ATP( P < 0. 01) 均降低, 差
異均具有統計學意義。與對照組比較, 良性腫塊組PME/ β-ATP、PDE/ β-ATP、LEP/ β-ATP 、pH 值均有
所升高, 但差異無統計學意義( P 值均> 0. 05) 。與良性腫塊組比較, 惡性腫塊組的PME/ β-ATP、
PDE/ β-ATP、LEP/ β-ATP 升高, 差異有統計學意義( P 值均< 0. 01 ) ; 惡性腫塊組的細胞內PH 值較良
性腫塊組升高, 但差異無統計學意義( P > 0. 05) 。以良性腫塊的PME /β-ATP 均值的1. 8 倍作為鑒別
良惡性腫塊的標準, 則對腫塊潛在惡性評估的敏感性為88. 89% , 特異性為94. 12% 。結論 31 P MRS
對骨及軟組織腫塊的診斷及鑒別診斷具有重要價值, 是1 種簡單、無創、有效的補充檢查手段。
【關鍵詞】 骨腫瘤; 軟組織腫瘤; 磁共振波譜學
The value of MRI and 31 P MRS in differentia l diagnosis of bone and soft tissue tumor s LIU
Hong-wei* , YANG Zhen-zhen, LI Chuan-ting, L􊙂Yu-bo. Shandong University Medical College, Shandong
Medical Imaging Resea rch Institute, Jinan 250012, China ( * Now in: 253000 Department of Ra diology,
Dezhou People′s Hospital, Sha ndong)
【Abstra ct 】 Objective To explore the value of MRI and 31P MRS in differential diagnosis of bone
and soft tissue tumors. Methods MRI and 31P MRS were performed in 35 bone and soft tissue tumor
patients and 16 healthy volunteers at 1. 5 T. The areas under the peak of various metabolite in spectra were
measured. The spectra were analyzed by taking peak areas relative to peak area of β-ATP and by calculating
the pH from the Pi shift relative to PCr. Results The differences of the size, signal intensity homogeneity,
border and involvement of surround structure between benign and malignant lesions had no statistically
significant differences ( P > 0. 05) . There was great overlap in the MR imaging characteristics of benign and
malignant lesions. The mean peak area rations of PME/ β-ATP、PDE /β-ATP、LEP / β-ATP、PCr / β-ATP、
intracellular pH in control group were 0. 33 ±0. 21、0. 64 ±0. 27、1. 62 ±0. 67、3. 12 ±0. 78、7. 08 ±0. 16.
The mean peak area rations of PME/ β-ATP、PDE / β-ATP、LEP / β-ATP、PCr / β-ATP、intracellular pH in
benign group were 0. 55 ±0. 31、0. 81 ±0. 31、2. 03 ±0. 87、1. 65 ±0. 65、7. 18 ±0. 23. The mean peak area
rations of PME/ β-ATP、PDE/ β-ATP、LEP / β-ATP、PCr / β-ATP、intracellular pH in malignant group were
1. 73 ±0. 40、1. 73 ±0. 45、4. 31 ±1. 18、1. 44 ±0. 54、7. 32 ±0. 29. Compared with control group, the mean
peak area rations of PME / β-ATP ( P < 0. 01 ) 、PDE / β-ATP ( P < 0. 01 ) 、LEP / β-ATP ( P < 0. 01 ) 、
intracellular pH( P < 0. 05) in malignant group increased significantly and PCr / β-ATP( P < 0. 01) in benign
and malignant group decreased significantly. The mean peak area rations of PME / β-ATP、PDE/ β-ATP、
LEP / β-ATP and intracellular pH in benign group were higher than that of the normal group but did not reach
statistical significance( P > 0. 05) . The mean peak area rations of PME/ β-ATP、PDE / β-ATP、LEP / β-ATP
in malignant group were significantly higher than that in benign group ( P < 0. 01 ) . Intracellular pH in
malignant group was higher than that in benign group but did not reach statistical significance ( P > 0. 05) .
If we set a standard at 1. 8 time of the mean of the PME/ β-ATP ration in the benign group, then the
sensitivity of this discrimination for diagnosing a malignancy was 88. 89% and the specificity was 94. 12%.
Conclusion 31P MRS has important value in diagnosis and differential diagnosis of bone and soft tissue
tumors. It should be a simple, non-invasively, effective diagnostic method.
【Key wor ds】 Bone neoplasms; Soft tissue neoplasms; Magnetic resonance spectroscopy

常規MRI 與31P MR 波譜在骨及軟組織--骨格.rar