脑胶质瘤~1H-MRS胆碱相对值与肿瘤增殖抗原Ki-67表达的关系

Correlation between Cho/Cr ratio and expression of Ki-67 in brain glioma

目的:用3.0T多体素~1H-MRS分析脑胶质瘤氢质子磁共振波谱表现,探讨低、高级别胶质瘤胆碱相对值(Cho/Cr)与肿瘤增殖抗原Ki-67表达的关系。方法:经病理证实的脑胶质瘤患者57例,其中低级别胶质瘤(Ⅰ、Ⅱ级)28例,高级别胶质瘤(Ⅲ、Ⅳ级)29例;所有患者在术前行3.0T ~1H-MRS检查,检测肿瘤实质部分Cho/Cr值,分析Cho/Cr值与胶质瘤病理级别的关系;术后病理切片行Ki-67免疫组织化学染色,测定Ki-67标记指数(Ki-67LI),分析Ki-67LI与胶质瘤病理级别及Cho/Cr值的相关性。结果:(1)低、高级别胶质瘤肿瘤实质部分Cho/Cr比值差异有统计学意义(P<0.001),脑胶质瘤肿瘤实质部分的Cho/Cr比值与肿瘤级别呈显著正相关(r=0.616,P<0.001)。Cho/Cr的ROC曲线下面积为0.856,取Cho/Cr=2.44为阈值鉴别不同级别脑胶质瘤,其敏感性为79.3%,特异性为82.1%。(2)低级别胶质瘤Ki-67LI为(3.41±2.35)%,高级别胶质瘤Ki-67LI为(19.78±11.45)%,两者差异有统计学意义(Z=-0.617,P<0.001);Ki-67LI与胶质瘤病理级别呈显著正相关(r=0.804,P<0.001),与Cho/Cr值呈显著正相关(r=0.490,P<0.001)。结论:脑胶质瘤Cho/Cr值与Ki-67的表达具有相关性,可作为术前无创评价肿瘤细胞增殖活性及恶性程度的影像学指标,有利于临床治疗方案的选择及预后的评估。

Objective： To study the 3.0T multivoxel proton magnetic spectroscopy（1H-MRS） findings in brain glioma and to investigate the correlation between Cho/Cr ratio and expression of Ki-67. Methods： Fifty-seven patients of brain gliomas were studied, including 28 cases of low-grade group（grade Ⅰ-Ⅱ）, 29 cases of high-grade group（grade Ⅲ-Ⅳ）. All of them underwent 3.0T 1H-MRS examination before operation. The Cho/Cr ratios were detected. We analyzed the correlation between Cho/Cr ratio and pathological grade of gliomas. Ki-67 immunohistochemical staining and Ki-67 labeling index（Ki-67LI） were measured after operation. We also analyzed the correlation between Ki-67LI and the pathological grade, the Cho/Cr ratio of gliomas. Results： ①Significant differences were found in the ratios of Cho/Cr between low grade gliomas and high grade gliomas（P〈0.001）. The ratio of Cho/Cr was positively correlated with the tumor grade（r=0.616, P〈0.001）. The area under the curve（AUC） of Cho/Cr was 0.856. The threshold value of Cho/Cr ratio for differential diagnosis high grade and low grade brain gliomas was 2.44, the sensitivity was 79.3%, the specificity was 82.1%. ②Ki-67LI of low grade glioma was （3.41±2.35）%, Ki-67LI of high grade glioma was （19.78±11.45）%, the difference was statistically significant（Z=-0.617, P〈0.001）. The Ki-67LI was positively correlated with the tumor grade and the Cho/Cr ratio（r=0.804, P〈0.001）. Conclusion： The Cho/Cr ratios of gliomas are correlated with the expression of Ki-67. It may be a useful image index, which can evaluate the proliferation activity and malignancy degree of glioma, without invasion. And it may be helpful in the clinical treatment and prognosis assessment.