The relationship between Cho/NAA and glioma metabolism: implementation for margin delineation of cerebral gliomas

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• 作者：Jun Guo (1)
  Chengjun Yao (2)
  Hong Chen (3)
  Dongxiao Zhuang (2)
  Weijun Tang (4)
  Guang Ren (4)
  Yin Wang (3)
  Jinsong Wu (2)
  Fengping Huang (2)
  Liangfu Zhou (2)
  
• 关键词：Cho/NAA ; Glioma boundary ; 1H ; MRSI ; Tumour infiltration ; Needle biopsy ; Metabolism
• 刊名：Acta Neurochirurgica
• 出版年：2012
• 出版时间：August 2012
• 年：2012
• 卷：154
• 期：8
• 页码：1361-1370
• 全文大小：696KB
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• 作者单位：Jun Guo (1)
  Chengjun Yao (2)
  Hong Chen (3)
  Dongxiao Zhuang (2)
  Weijun Tang (4)
  Guang Ren (4)
  Yin Wang (3)
  Jinsong Wu (2)
  Fengping Huang (2)
  Liangfu Zhou (2)
  
  1. Shanghai Medical College, Fudan University, Shanghai, 200040, China
  2. Glioma Surgery Division, Department of Neurologic Surgery, Huashan Hospital, Shanghai Medical College, Fudan University, No.12 Central Wulumuqi Road, Jing鈥檃n District, Shanghai, 200040, China
  3. Department of Neuropathology, Fudan University, Shanghai, 200040, China
  4. Department of Radiology, Huashan Hospital, Shanghai, China
  

文摘

Background The marginal delineation of gliomas cannot be defined by conventional imaging due to their infiltrative growth pattern. Here we investigate the relationship between changes in glioma metabolism by proton magnetic resonance spectroscopic imaging (1H-MRSI) and histopathological findings in order to determine an optimal threshold value of choline/N-acetyl-aspartate (Cho/NAA) that can be used to define the extent of glioma spread. Method Eighteen patients with different grades of glioma were examined using 1H-MRSI. Needle biopsies were performed under the guidance of neuronavigation prior to craniotomy. Intraoperative magnetic resonance imaging (MRI) was performed to evaluate the accuracy of sampling. Haematoxylin and eosin, and immunohistochemical staining with IDH1, MIB-1, p53, CD34 and glial fibrillary acidic protein (GFAP) antibodies were performed on all samples. Logistic regression analysis was used to determine the relationship between Cho/NAA and MIB-1, p53, CD34, and the degree of tumour infiltration. The clinical threshold ratio distinguishing tumour tissue in high-grade (grades III and IV) glioma (HGG) and low-grade (grade II) glioma (LGG) was calculated. Results In HGG, higher Cho/NAA ratios were associated with a greater probability of higher MIB-1 counts, stronger CD34 expression, and tumour infiltration. Ratio threshold values of 0.5, 1.0, 1.5 and 2.0 appeared to predict the specimens containing the tumour with respective probabilities of 0.38, 0.60, 0.79, 0.90 in HGG and 0.16, 0.39, 0.67, 0.87 in LGG. Conclusions HGG and LGG exhibit different spectroscopic patterns. Using 1H-MRSI to guide the extent of resection has the potential to improve the clinical outcome of glioma surgery.