恶性脑胶质瘤中1H-MRS与5-ALA荧光强度的相关性研究
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摘要
目的:探讨恶性脑胶质瘤中氢质子磁共振波谱(1H-MRS)与5-氨基乙酰丙酸(5-ALA荧光强度的相关性。方法:选择2012年9月至2018年1月在我院神经外科诊治的恶性脑胶质瘤患者32例,进行1H-MRS检查与5-ALA荧光强度检测,对检测数据进行回顾性分析。结果:在32例患者中,常规MRI表现为不均匀强化,周围T2上高信号,肿瘤边界不清,瘤周水肿显著。胶质瘤的肿瘤实质区典型波谱表现为胆碱(Choline,Cho)峰显著升高,N-乙酰天门冬氨酸(N-acetylaspartate,NAA)峰显著降低,肌酸(Creatine,Cr)峰降低不显著,NAA/Cr比值降低,Cho/NAA、Cho/Cr比值升高,与对侧正常区对比差异有统计学意义(P<0.05)。低级别组瘤体区的Cho/NAA、Cho/Cr、NAA/Cr比值与高级别组对比差异也有统计学意义(P<0.05)。胶质瘤的肿瘤实质区PpIX荧光强度值为2.79±0.49,对侧正常区为1.84±0.51,肿瘤实质区显著高于对侧正常区(t=6.398,P=0.008)。Pearson系数分析显示肿瘤实质区的PpIX荧光强度与NAA/Cr呈显著负相关性(P <0.05),与Cho/Cr、Cho/NAA成显著正相关性(P <0.05)。结论:恶性脑胶质瘤中1H-MRS与5-ALA荧光强度有显著相关性。
Objective: To investigate the correlation between the proton magnetic resonance spectroscopy( 1 H-MRS) and the 5-aminolevulinic acid( 5-ALA) fluorescence intensity in malignant gliomas. Methods:From September 2012 to January 2018. 32 patients with malignant glioma were selected,all the patients were examined by 1 H-MRS and 5-ALA fluorescence intensity,and were given the correlation analysis. Results: In the 32 patients,the conventional MRI were showed uneven enhancement,high signal around T2,unclear tumor border and significant edema around the tumor. The typical spectrum of tumor parenchyma of glioma were showed significant reduction in NAA peak,Cho peak significantly were increased,Cr peak were decreased not significantly,the Cho/NAA,Cho/Cr ratio were increased,NAA/Cr ratio were decreased,and compared the contralateral normal region were statistically significantly difference( P <0.05). The Cho/NAA,Cho/Cr and NAA/Cr ratios in the low level group were also significantly different from those in the high level group( P <0.05). The PpIX fluorescence intensity in the tumor parenchyma of glioma were 2.79±0.49,and the contralateral normal area were 1.84±0.51,so the tumor parenchyma region were significantly higher than that of the contralateral normal region( t = 6.398,P = 0.008). The Pearson coefficient analysis showed that the fluorescence intensity of PpIX in the tumor parenchyma were negatively correlated with NAA/Cr( P <0.05),and were significant positive correlation with Cho/Cr and Cho/NAA( P <0.05). Conclusion: There was a significant correlation between 1 H-MRS and 5-ALA fluorescence intensity in malignant glioma.
Objective: To investigate the correlation between the proton magnetic resonance spectroscopy( 1 H-MRS) and the 5-aminolevulinic acid( 5-ALA) fluorescence intensity in malignant gliomas. Methods:From September 2012 to January 2018. 32 patients with malignant glioma were selected,all the patients were examined by 1 H-MRS and 5-ALA fluorescence intensity,and were given the correlation analysis. Results: In the 32 patients,the conventional MRI were showed uneven enhancement,high signal around T2,unclear tumor border and significant edema around the tumor. The typical spectrum of tumor parenchyma of glioma were showed significant reduction in NAA peak,Cho peak significantly were increased,Cr peak were decreased not significantly,the Cho/NAA,Cho/Cr ratio were increased,NAA/Cr ratio were decreased,and compared the contralateral normal region were statistically significantly difference( P <0.05). The Cho/NAA,Cho/Cr and NAA/Cr ratios in the low level group were also significantly different from those in the high level group( P <0.05). The PpIX fluorescence intensity in the tumor parenchyma of glioma were 2.79±0.49,and the contralateral normal area were 1.84±0.51,so the tumor parenchyma region were significantly higher than that of the contralateral normal region( t = 6.398,P = 0.008). The Pearson coefficient analysis showed that the fluorescence intensity of PpIX in the tumor parenchyma were negatively correlated with NAA/Cr( P <0.05),and were significant positive correlation with Cho/Cr and Cho/NAA( P <0.05). Conclusion: There was a significant correlation between 1 H-MRS and 5-ALA fluorescence intensity in malignant glioma.
引文
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[2]刘叶秋,于韬.磁共振功能成像在高级别胶质瘤疗效监测的研究进展[J].磁共振成像,2018,9(2):147~152.
[3] An Z,Tiwari V,Ganji SK,et al. Echo-planar spectroscopic imaging with dual-readout alternated gradients(DRAG-EPSI)at 7 T:Application for 2-hydroxyglutarate imaging in glioma patients[J]. MagnReson Med,2018,79(4):1851~1861.
[4]王新伟,赵智伟.MRS在界定脑胶质瘤病理级别和病变范围中的诊断价值[J].中国实用神经疾病杂志,2017,20(4):83~85.
[5]胡丽娟,廖凯兵.应用ROC曲线评价3.0T1H-MRS对脑胶质瘤分级的诊断效能[J].肿瘤学杂志,2017,23(3):194~198.
[6] Su C,Liu C,Zhao L,et al. Amide proton transfer imaging allows detection of glioma grades and tumor proliferation:comparison with Ki-67 expression and proton MR spectroscopy imaging[J].AJNR Am Neuroradiol,2017,38(9):1702~1709.
[7] Jiang S,Eberhart CG,Zhang Y,et al. Amide proton transfer-weighted magnetic resonance image-guided stereotactic biopsy in patients with newly diagnosed gliomas[J]. Eur Cancer,2017,9(83):9~18.
[8] Mahboob SO,Eljamel M. Intraoperative image-guided surgery in neuro-oncology with specific focus on high-grade gliomas[J].Future Oncol,2017,13(26):2349~2361.
[9]田海龙,祖玉良,何伟,等.磁共振波谱联合荧光素钠导航显微手术切除幕上高级别胶质瘤的随访结果和临床意义[J].中国医学科学院学报,2017,39(5):643~648.
[10] Anselmi M,Catalucci A,Felli V,et al. Diagnostic accuracy of proton magnetic resonance spectroscopy and perfusion-weighted imaging in brain gliomas follow-up:a single institutional experience[J]. Neuroradiol,2017,30(3):240~252.
[11] Coburger J,Nabavi A,Konig R,et al. Contemporary use of intraoperative imaging in glioma surgery:a survey among EANS members[J].ClinNeurol Neurosurg,2017,12(163):133~141.