目的定量分析氢质子磁共振波谱(1H-MRS)代谢产物在脑实质区胶质瘤分级诊断中的诊断价值。材料与方法回顾性分析经病理证实的58例脑实质区胶质瘤的1H-MRS图像。按照世界卫生组织(WHO)2007标准，将病例分为两组：低级别胶质瘤组(Ⅰ～Ⅱ级，24例)和高级别胶质瘤组(Ⅲ～Ⅳ级，34例)。测量肿瘤实质区代谢物及对侧相应脑组织代谢物的含量并进行统计学分析。结果(1)58例脑胶质瘤实质区的rCho、Cho/Cr较对侧正常区均不同程度升高，其余代谢物及比值呈不同程度降低。在两组胶质瘤中，肿瘤实质区rNAA、Cho/Cr、NAA/Cr、NAA/Cho值及Lac峰存在显著差异(P<0.05)。(2)肿瘤实质区rCho、Cho/Cr与肿瘤级别呈正相关，rNAA、NAA/Cr、NAA/Cho与肿瘤级别呈负相关，其中rNAA及NAA/Cho的相关性较高，相关系数r分别为－0.555、－0.616。(3)经ROC分析发现rNAA、NAA/Cr、NAA/Cho鉴别胶质瘤分级的曲线下面积大于0.5，肿瘤实质区rNAA鉴别胶质瘤分级的最佳截断值为0.20(敏感度为100%，特异度为61.8%)；肿瘤实质区NAA/Cr鉴别胶质瘤分级的最佳截断值为0.35(敏感度为100%，特异度为55.9%)；肿瘤实质区NAA/Cho鉴别胶质瘤分级的最佳截断值为0.19(敏感度为91.7%，特异度为67.6%)。结论依据1H-MRS定量参数分析，肿瘤实质区NAA、NAA/Cr、NAA/Cho鉴别脑实质区胶质瘤分级具有很高的灵敏度和稍高特异度，有助于脑实质区胶质瘤的分级诊断，而肿瘤实质区rCho、Cho/Cr在脑实质区胶质瘤分级的诊断价值还有待进一步研究。%Objectives:To study the value of quantitative analysis of proton magnetic resonance spectroscopy (1H-MRS) metabolites in diagnosis of Brain Parenchyma glioma grading. Materials and Methods:The 1H-MRS metabolites of total 58 Brain Parenchyma gliomas conifrmed by pathology were analyzed retrospectively. According to the 2007 World Health Organization (WHO) standards, all cases were divided into two groups including low-grade gliomas group (gradeⅠ—Ⅱ, 24 cases) and high-grade gliomas group (gradeⅢ—Ⅳ, 35 cases). Then concentrations of all metabolites in the tumor area and the contralateral brain tissue were analyzed statistically and compared. Results:(1) In total 59 glioma cases;Cho and Cho/Cr in tumor area were increased compared to that in the contralateral one while the other metabolites and metabolic ratio were decreased. There were signiifcant differences in rNAA, Cho/Cr,NAA/Cr, NAA/Cho, and Lac between low-grade and high-grade glioma tumor(P<0.05). (2) rCho and Cho/Cr in the solid area of gliomas were positively related with pathological grading, rNAA, NAA/Cr, and NAA/Cho were negatively correlated with pathological grading. rNAA and NAA/Cho had higher correlation than the others, and the r correlation coefifcient was 0.555 and 0.616 respectively. (3) The area under the curve (AUC) of rNAA, NAA/Cr and NAA/Cho for identifying glioma grading were greater than 0.5 by the ROC analysis. The cutoff point of rNAA for identifying glioma grading was set at 0.20 with 100%sensitivity and 61.8%speciifty. The cutoff point of NAA/Cr for identifying glioma grading was set at 0.35 with 100%sensitivity and 55.9%speciifcity. The cutoff point of NAA/Cho for identifying glioma grading was set at 0.19 with 91.7% sensitivity and 67.6% specificity. Conclusions:According to quantitative analysis of 1H-MRS parameters, the measurements of NAA, NAA/Cr, and NAA/Cho which have high sensitivity and moderate speciifcity can provide additional information about the diagnosis of glioma grading, whereas the diagnosis value of rCho and Cho/Cr in glioma grading still needs further research.
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