氢质子磁共振波谱在胶质瘤活检术中的应用

Application of Magnetic Resonance Spectroscopy in Needle Biopsy of Glioma

目的探讨氢质子磁共振波谱（proton magnetic resonance spectroscopy，1H-MRS）指导无框架立体定向穿刺活检的最优化代谢指标。方法选择2011年7月至2015年1月行1H-MRS影像自动融合的无框架立体定向穿刺活检术的胶质瘤患者。共57例，其中男32例，女25例，年龄13～77岁，平均46岁。统计分析各级别胶质瘤术前波谱代谢指标水平，并将其与术后病理级别进行相关性分析。结果胶质瘤Ⅱ级、Ⅲ级、Ⅳ级组间NAA值、Cho／NAA、Cho／Cr存在显著性差异，而cho、Cr、NAA／Cr不存在差异。与病理级别具有相关性的代谢指标有Cho／Cr：r=0．381（P=0．002）、Cho／NAA：r=0．468（P〈0．01）、NAA：r=-0．437（P〈0．01）、Cr：r=-0．266（P=0．032）。结论1H-MRS自动融合的无框架立体定向活检技术具有明显优势，均质瘤体内Cho／NAA最大值代谢热区可作为穿刺活检首选靶点。

Objective To investigate the correlation between the spectroscopic metabolic indices and the patholog- ical grading of gliomas, and to determine the best spectroscopic index to gain optimized targets using the technique of au- tomated proton magnetic resonance spectroscopy （1H--MRS） imaging guided frameless stereotactic biopsy. Methods Be- tween July 2011 and January 2015,142 patients with suspected glioma underwent the automated 1H--MRS imaging guid- ed frameless stereotactic biopsy to confirm the diagnosis. Fifty-seven patients were enrolled. Among them, 32 patients were male, 25 patients were female. Their age ranged from 13 years to 77 years and the median age was 47 years. The cor- relation of the metabolic indices in the region of biopsy targets and glioma grade were analyzed. Comparisons of metabolic indices in different grade were made. Results sixty-five samples were obtained by biopsy. According to the classification of WHO criteria, 39 （60%） samples were classified as low-grade gliomas including 38 with WHO grade Ⅱ and 1 with WHO grade I, whereas 26 samples were classified as high-grade gliomas including 18（28%） with WHO grade Ⅲ and 8 （12%） with WHO grade Ⅳ. The Cho/Cr and Cho/NAA ratios had a positive correlation with the pathological grading, whereas NAA and Cr value had a negative correlation with pathological grading. The correlation between Cho/NAA ratio and tumor grading was the most robust. There were significant differences in NAA value, Cho/NAA and Cho/Cr ratios but not in Cho, Cr value nor NAA/Cr ratios among grade Ⅱ, grade III and grade IV gliomas. The levels of Cho/NAA ratio and Cho/Cr ratio were significantly different between grade Ⅱ and grade Ⅲ group, and between grade Ⅱ and grade IV gliomas. Conclusions The automated 1H-MRS imaging guided frameless stereotactic biopsy has advantage in biopsy surgery. For q-l--MRS imaging guided biopsy, the target of the Cho/NAA ratio hot spot is the first choice in homogenous glioma.