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[目的]分析脑胶质瘤氢质子磁共振波谱(~1H-MRS)表现,通过受试者工作特征曲线(receiver operating characteristic curve,ROC)来确定~1H-MRS各项代谢产物对胶质瘤分级的诊断效能。[方法 ]经病理证实的脑胶质瘤患者55例,按世界卫生组织(WHO)2007年胶质瘤分类分级标准,其中低级胶质瘤(Ⅰ、Ⅱ级)27例,高级胶质瘤(Ⅲ、Ⅳ级)28例;所有患者在术前行3.0T ~1H-MRS检查,检测肿瘤实质部分胆碱复合物(choline,Cho)/肌酸(creatine,Cr)、N-乙酰天门冬氨酸复合物(N-acetyl aspartic acid,NAA)/Cho、NAA/Cr值,并用ROC曲线分析各指标对胶质瘤分级诊断的敏感度、特异性及最佳诊断阈值。[结果]57例胶质瘤Cho/Cr值均较对侧正常脑组织升高,NAA/Cho及NAA/Cr值较对侧降低。低、高级胶质瘤肿瘤实质部分Cho/Cr、NAA/Cho比值差异有统计学意义(P<0.05),而NAA/Cr比值无统计学差异(P>0.05)。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=0.600,P<0.001),而NAA/Cho比值与肿瘤级别呈显著负相关(r=-0.573,P<0.001),NAA/Cr值与肿瘤级别无明显相关(P>0.05)。Cho/Cr、NAA/Cho、NAA/Cr的ROC曲线下面积(area under curve,AUC)分别为0.847、0.831、0.530。取Cho/Cr=2.796为阈值鉴别不同级别脑胶质瘤,其敏感度为75.0%,特异性为85.2%;取NAA/Cho=0.349为阈值鉴别不同级别脑胶质瘤,其敏感度为85.2%,特异性为78.6%;NAA/Cr值对鉴别不同级别胶质瘤诊断意义不大。[结论]~1H-MRS能反映胶质瘤细胞的生化物质代谢情况,结合ROC曲线分析,Cho/Cr及NAA/Cho比值对胶质瘤分级诊断具有较大价值,可为脑胶质瘤术前分级诊断提供定量指标。
[Objective] To analyze the expression of hydrogen proton magnetic resonance spectroscopy (~ 1H-MRS) in glioma and to determine the effect of various metabolites of ~ 1H-MRS on glioma Hierarchical diagnostic performance. [Methods] Fifty-five patients with pathologically confirmed gliomas were enrolled in this study. According to WHO classification of glioma in 2007, 27 cases were classified as low grade gliomas (grade Ⅰ and Ⅱ), high grade glioma Ⅲ, Ⅳ). All patients underwent 3.0T ~ 1H-MRS before operation to detect the contents of choline (Cho) / creatine (Cr), N-acetyl aspartate NAA / Cho, NAA / Cr values were analyzed. The sensitivity, specificity and optimal diagnostic threshold of each index were also analyzed by ROC curve. [Results] The Cho / Cr values of 57 cases of glioma were higher than those of the contralateral normal brain tissue, and the values of NAA / Cho and NAA / Cr were decreased. There were significant differences in Cho / Cr and NAA / Cho ratios between low and advanced gliomas (P <0.05), but NAA / Cr ratio had no significant difference (P> 0.05). The ratio of Cho / Cr in the parenchyma of glioma was positively correlated with tumor grade (r = 0.600, P <0.001), while the NAA / Cho ratio was negatively correlated with tumor grade (r = -0.573, P <0.001 ), There was no significant correlation between NAA / Cr value and tumor grade (P> 0.05). The area under curve (AUC) of Cho / Cr, NAA / Cho and NAA / Cr were 0.847, 0.831 and 0.530, respectively. The sensitivity and specificity of Cho / Cr = 2.796 for differentiating different grades of gliomas were 75.0% and 85.2%, respectively. The threshold of NAA / Cho = 0.349 was used to discriminate different grades of gliomas with a sensitivity of 85.2 %, Specificity of 78.6%; NAA / Cr value of differential diagnosis of different grades of glioma is of little significance. [Conclusion] ~ 1H-MRS can reflect the biochemical metabolism of glioma cells, combined with ROC curve analysis, Cho / Cr and NAA / Cho ratio of glioma grading diagnosis of great value, for glioma surgery Pre-grade diagnosis provides quantitative indicators.