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目的探讨星形细胞瘤质子 MR 波谱(~1H-MRS)表现与肿瘤增殖潜力的相关性。方法术前进行 MRI 和~1H-MRS 检查且经手术病理证实的34例星形细胞瘤患者,其中Ⅰ、Ⅱ级(低级别)26例,Ⅲ、Ⅳ级(高级别)8例。34例星形细胞瘤患者中有21例(低级别17例,高级别4例)为均质性肿瘤。增殖细胞核抗原(PCNA)免疫组织化学染色,研究 PCNA 在高、低级别星形细胞瘤中的表达水平,并与星形细胞瘤~1H-MRS 的胆碱(Cho)/N-乙酰天冬氨酸(NAA)、Cho/肌酸和磷酸肌酸(Cr)相比较,明确两者间的关系。结果 21例均质性肿瘤中,高级别星形细胞瘤的 Cho/NAA、Cho/Cr(中位数分别为4.895、4.845)比低级别(中位数分别为2.920、2.000)明显升高(Z=-2.597,P=0.009;Z=-2.687,P=0.007);且 Cho/NAA、Cho/Cr 与 PCNA 的表达[吸光度(A)值中位数7.880]呈明显正相关(r=0.607,P=0.003;r=0.457,P=0.038)。但全部34例星形细胞瘤中高、低级别 Cho/NAA(中位数分别为3.965、2.890)、Cho/Cr(分别为3.080、1.960)的差异无统计学意义;Cho/NAA、Cho/Cr的比值与 PCNA 的表达(A 值中位数为8.100)不相关(r=0.060,P=0.738;r=0.125,P=0.480)。结论运用~1H-MRS 检测均质性星形细胞瘤中 Cho 的含量对于术前活体预测星形细胞瘤的恶性程度很有价值,从而能间接判断星形细胞瘤的某些生物学行为及预后。
Objective To investigate the correlation between proton MR spectroscopy (~ 1H-MRS) and the potential of tumor proliferation. Methods Thirty-four patients with astrocytoma who were confirmed by MRI and 1H-MRS before surgery were studied. Among them, there were 26 cases of grade Ⅰ and Ⅱ (low grade) and 8 cases of grade Ⅲ and Ⅳ (grade). Twenty-one of 34 astrocytoma patients (17 in the low-grade group and 4 in the high-grade group) were homogeneous tumors. Proliferating cell nuclear antigen (PCNA) immunohistochemical staining of PCNA expression in high and low grade astrocytoma, and astrocytoma ~ 1H-MRS of choline (Cho) / N-acetyl aspartate Acid (NAA), Cho / creatine and creatine phosphate (Cr) compared to clear the relationship between the two. Results Cho / NAA and Cho / Cr (median 4.895, 4.845, respectively) were significantly higher in low and high grade astrocytomas (median 2.920, 2.000, respectively) in 21 cases of homogeneous tumors Z = -2.597, P = 0.009; Z = -2.687, P = 0.007). The Cho / NAA, Cho / Cr and PCNA expression were positively correlated with the median 7.880 of absorbance (r = 0.607 , P = 0.003; r = 0.457, P = 0.038). However, Cho / Cr (3.080, 1.960, respectively) was not significantly different between high and low grade Cho / NAA in all 34 cases of astrocytomas (median 3.965,2.890, Cho / Cr (R = 0.060, P = 0.738; r = 0.125, P = 0.480) was not associated with PCNA expression (median A value of 8.100). Conclusions The use of ~ 1H-MRS to detect the content of Cho in homogeneous astrocytomas is valuable for predicting the malignancy of astrocytomas before surgery, which can indirectly determine some biological behaviors and prognosis of astrocytomas .