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目的对比分析术前氢质子磁共振波谱成像(~1H-MRS)主要代谢物水平和术中荧光素钠(FLs)标记胶质母细胞瘤(GBM)的荧光强度,探讨不同荧光强度GBM组织代谢水平的变化,为GBM荧光手术治疗提供客观依据。方法对2014年4月1日至2015年12月31日磁共振扫描成像平扫+增强序列新诊断的GBM,完成~1H-MRS检查和FLs标记下手术治疗,术后病理确诊为GBM的病例行肿瘤边界Ki67免疫组织化学检测。对~1H-MRS主要代谢物水平与肿瘤荧光强度进行对比分析。结果 33例纳入研究,术前~1H-MRS诊断结果:25例提示为高级别胶质瘤,N-乙酰门冬氨酸(NAA)峰明显降低,胆碱(Cho)峰明显增高;Cho/NAA、NAA/肌酸(Cr)和Cho/Cr在不同肿瘤区域差异有统计学意义(P=0.02,P=0.01,P=0.00)。FLs标记手术结果:术中清晰看见组织荧光;29例全切、4例次全切;术后无急性脑膨出,癫痫发生2例。术后常规病理结果:28例确诊为GBM(22例与~1H-MRS诊断一致)。GBM肿瘤荧光显影结果:肿瘤实质区域荧光强度高于肿瘤边界和瘤周水肿(P=0.01)。~1H-MRS代谢物分析结果:不同荧光强度的GBM实质,NAA和Cho峰高度不同(P=0.01,P=0.02),Cho/NAA不同(P=0.01);不同荧光强度的GBM边界,NAA峰高度差异无统计学意义,Cho峰高度不同,Cho/NAA不同(P=0.02,P=0.00);不同荧光强度GBM瘤周水肿中,NAA和Cho峰高度、Cho/NAA差异无统计学意义(P=0.23,P=0.09,P=0.14)。GBM肿瘤边界免疫组织化学结果:不同荧光显影边界,Ki67表达程度不同(P=0.03)。结论 GBM肿瘤实质荧光强度高于其他区域,不同荧光强度的GBM,代谢水平不同;FLs标记下实施GBM手术治疗,需重视术前~1H-MRS提供的代谢信息,并就两者的相关性做进一步探讨。
Objective To compare and analyze the levels of major metabolites of preoperative 1H-MRS (~ 1H-MRS) and intraoperative FLs-labeled glioma (GBM), and to explore the relationship between the different fluorescence intensities of GBM tissue metabolism Level changes, provide an objective basis for GBM fluorescence surgery. Methods The newly diagnosed GBM of magnetic resonance imaging (MRI) scan from April 1, 2014 to December 31, 2015 was performed. The patients underwent ~ 1H-MRS examination and FLs-labeled surgery, and pathologically confirmed cases of GBM Tumor boundary Ki67 immunohistochemical detection. The level of ~ 1H-MRS metabolites and tumor fluorescence intensity were compared. Results 33 cases were included in the study. The results of preoperative ~ 1H-MRS diagnosis: 25 cases showed high-grade gliomas, the NAA peak and the Cho peak were significantly increased; Cho / NAA, NAA / Cr and Cho / Cr were significantly different in different tumor regions (P = 0.02, P = 0.01, P = 0.00). FLs labeling surgery results: intraoperative fluorescence was clearly seen tissue; 29 cases of complete resection, 4 cases of subtotal resection; no acute encephalocele after surgery, epilepsy in 2 cases. Postoperative routine pathological results: 28 cases were diagnosed as GBM (22 cases with ~ 1H-MRS diagnosis consistent). GBM tumor fluorescence imaging results: the real area of tumor fluorescence intensity higher than the tumor boundary and peritumoral edema (P = 0.01). ~ 1H-MRS metabolites analysis results: GBM essence of different fluorescence intensity, NAA and Cho peak height difference (P = 0.01, P = 0.02), Cho / NAA different (P = 0.01); GBM border with different fluorescence intensity, NAA There was no significant difference in peak height between the two groups. Cho peak height and Cho / NAA were different (P = 0.02, P = 0.00). There was no significant difference in peak height of NAA and Cho and Cho / NAA between different fluorescence intensity GBM edema (P = 0.23, P = 0.09, P = 0.14). GBM tumor border immunohistochemical results: different fluorescence imaging border, Ki67 expression levels (P = 0.03). Conclusion GBM tumor fluorescence intensity is higher than other regions, different fluorescence intensity of GBM, different metabolic levels; FLs labeled GBM surgery, the need to pay attention to preoperative ~ 1H-MRS metabolic information provided, and the correlation between the two do Further Discussion.