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目的评估磁共振氢质子波谱分析1 H-MRS对于术前胶质瘤病理分级的理想阈值。方法分析经手术病理证实的76例胶质瘤病人,其中低级别(Ⅰ~Ⅱ级)胶质瘤36例,其中Ⅰ级4例,Ⅱ级32例,高级别(Ⅲ~Ⅳ级)胶质瘤40例,其中Ⅲ级25例,Ⅳ级15例。通过后处理波谱分析,检测肿瘤实性部分最大Cho/Cr值。高低级别胶质瘤最大Cho/Cr值比较采用t检验分析,绘制受试者操作特征(receiver operating characteristic,ROC)曲线确定鉴别高级别与低级别胶质瘤的Cho/Cr的理想阈值。结果胶质瘤肿瘤实性部分最大Cho/Cr值与病理级别呈正相关(相关系数R=0.60101),低级别和高级别胶质瘤肿瘤实性部分最大Cho/Cr值分别为2.4492±1.3658、5.0960±2.7366(CI±Se),差异有统计学意义(P<0.0001)。以胶质瘤实性部分最大Cho/Cr值鉴别高级别与低级别胶质瘤时,所获得ROC曲线下面积值为0.8378,以3.93作为理想阈值时,其灵敏度为76.9%,特异度为83.8%。结论胶质瘤1 H-MRS检查所获得的波谱图像,能够反映肿瘤细胞的增殖程度,肿瘤实性部分最大Cho/Cr值与其病理分级呈正相关,1 H-MRS检查对于术前评估胶质瘤的病理分级具有很高价值。
Objective To assess the ideal threshold for histopathological classification of preoperative glioma by 1 H-MRS by magnetic resonance (1H) proton spectroscopy. Methods Totally 76 patients with glioma confirmed by surgery and pathology were included in the study. There were 36 cases with low grade Ⅰ ~ Ⅱ grade gliomas, including 4 cases of grade Ⅰ, 32 cases of grade Ⅱ and grade Ⅲ ~ Ⅳ gliomas Tumor in 40 cases, of which 25 cases of grade Ⅲ, Ⅳ grade 15 cases. The maximum Cho / Cr value of the solid part of the tumor was detected by post-processing spectral analysis. The maximum Cho / Cr value of high-low grade glioma was compared by t-test analysis. The receiver operating characteristic (ROC) curve was drawn to determine the ideal Cho / Cr threshold for differentiating high grade glioma and low grade glioma. Results The maximum value of Cho / Cr in solid part of glioma was positively correlated with pathological grade (correlation coefficient R = 0.60101). The maximum Cho / Cr value of solid part in low grade and high grade glioma was 2.4492 ± 1.3658 and 5.0960 ± 2.7366 (CI ± Se), the difference was statistically significant (P <0.0001). When the maximum Cho / Cr value of glioma was used to differentiate high grade and low grade gliomas, the area under the ROC curve was 0.8378, and the sensitivity was 76.9% and the specificity was 83.8 %. Conclusions The H-MRS examination of glioma images can reflect the degree of proliferation of tumor cells. The maximum Cho / Cr value of the solid part of the tumor is positively correlated with the pathological grade. The 1 H-MRS examination of gliomas The pathological grade has a high value.