氢质子磁共振波谱在脑胶质瘤中的应用

Application of ~1H-MR spectroscopy in crerbral glioma

目的探讨1H-MRS在预测各级别胶质瘤浸润范围及判断肿瘤级别的临床应用价值。方法回顾分析经术前活检或术后病理证实为脑胶质瘤的33例患者,按WHO(2007)脑胶质瘤诊断分级标准分为Ⅰ、Ⅱ、Ⅲ、Ⅳ级,其术前均行MRI及1H-MRS检查,对肿瘤瘤体区、瘤周区及正常区通过1H-MRS分析,比较4个级别胶质瘤不同区域代谢产物NAA、Cho、Cr及NAA/Cho、NAA/Cr、Cho/Cr比值差异。结果通过1H-MRS代谢物在各级别胶质瘤不同区域比较发现:判断Ⅰ级胶质肿瘤实体区域大小时,Cho、Cho/Cr、NAA/Cho在瘤体区和瘤周区之间变化有统计学意义(t值分别为4.14、4.01、5.18,P<0.025),判断肿瘤浸润范围时Cho、Cr、NAA/Cho、Cho/Cr在瘤周区和正常区之间变化有统计学意义(t值分别为5.81、10.68、5.75、6.60,P<0.025);判断Ⅱ级胶质肿瘤实体区域大小时,NAA、NAA/Cho、NAA/Cr的差异有统计学意义(t值分别为5.99、6.89、5.87,P<0.025),其判断肿瘤浸润范围时,Cho、NAA、Cr、NAA/Cho、NAA/Cr、Cho/Cr比值的差异有统计学意义(t值分别为16.94、8.66、30.30、21.57、6.13、17.94,P<0.025);判断Ⅲ、Ⅳ级胶质肿瘤实体区域大小时,Cho、NAA、NAA/Cho、NAA/Cr、Cho/Cr均有统计学意义(Ⅲ级t值分别为6.24、8.93、13.09、8.95、6.21,Ⅳ级t值分别为8.94、12.53、2.43、14.41、12.28、9.19,P<0.025),其判断肿瘤浸润范围时,Cho、NAA、Cr、NAA/Cho、NAA/Cr、Cho/Cr比值差异均有统计学意义(Ⅲ级t值分别为31.38、20.19、15.59、34.97、18.49、32.16,Ⅳ级t值分别为37.11、40.69、9.58、59.85、38.85、39.90,P<0.025)。随着肿瘤级别增加瘤体区NAA/Cho、NAA/Cr比值逐渐降低(F分别为403.9、159.46,P<0.05),Cho/Cr比值逐渐升高(F=119.91,P<0.05)。结论1H-MRS的分析,具有预测各级别胶质瘤浸润范围及术前初步判断肿瘤级别的潜能,为术前初步确定手术方案、切除范围、降低术后复发及预后判断,指导后续治疗具有一定意义。

ObjectiveTo investigate the application of1H-MR spectroscopy in predicting the value of each grade range and grading of glioma invasion.MethodsA restrospective analysis was conducted on the preoperative biopsy or posoperative pathology confirmed glioma in 33 cases. Cerebral gliomas were graded into four categories based on the standard of WHO（2007）： grade I, II, III and Ⅳ. All patients underwent MRI and1H-MR spectroscopy before operation. The1H-MR spectroscopy analysis was used to analysis metabolite NAA,Cho,Cr and NAA/Cho, NAA/Cr, Cho/Cr in the tumor area, peritumoral region and normal area.Results1H-MRS revealed that there were no significantly differences in Cho, Cho/Cr, NAA/Cho between the peritumoral region and tumor area of grade I glioma（P 0.025）. However, there were significantly differences in Cho, Cr, NAA/Cho, Cho/Cr ratio between peritumoral region and the normal brain tissue of grade I glioma（P0.025）. There were significantly differences in NAA, NAA/Cho, NAA/Cr ratio between peritumoral re-gion and the tumor area of grade II glioma（P 0.025）. There were statistically significantly differences in Cho, NAA, Cr,NAA/Cho, NAA/Cr, Cho/Cr ratio between the peritumoral region and normal brain tissue of Grade III or Ⅳglioma（P 0.025）. The ratio of Cho/Cr and NAA/Cho were correlated with the pathological grade（F values were 403.9 and 159.46,P〈0.05）, and the ratio of NAA/Cr and NAA/Cho were decreased gradually whereas the ratio of Cho/Cr was gradually increased（F=119.91,P〈0.05）.ConclusionThe1H-MR spectroscopy analysis has a predictive value in evaluating the level of glioma invasion and determining the grading of glioma before surgery, which is very helpful for the surgical plan and the scope of resection, thereby reducing the recurrence and prognosis of the patients after surgery.