氢质子波谱分析Cho／Cr值评估胶质瘤病理分级的理想阈值研究

目的评估磁共振氢质子波谱分析1H—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4（）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（receiveroperatingcharacteristic，R（Ⅺ）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±S），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1HMRS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，1H—MRS检查对于术前评估胶质瘤的病理分级具有很高价值。

Ideal Cho/Cr Threshold of 1H-MRS in Evaluation of the Pathological Grade in Gliomas

Objective To assess the ideal maximum value of Cho/Cr threshold of 1H-MRS for gliomas preoperative value of histological grade. Methods A total of 76 cases with gliomas confirmed by surgery and pathology were studied, among whom 36 were low grade （ I -II ） and 40 were high grade （III-IV）, and 4, 32, 25 and 15 were grade I , II , III and IV respectively. Pseudo color pictures of Cho/Cr were obtained by 1H-MRS on the post processing workstation, and the maximum Cho/Cr values of solid part were calculated. Comparison of maximum Cho/Cr values of different grads of tumors were assessed using t test. Receiver operating characteristic （ROC） curve was used to determine the ideal thresh old of Cho/Cr between high-grade and low-grade gliomas. Results The maximum value of Cho/Cr in the solid part of the gliomas was positively related with pathological grads （R = 0.60 101）, the maximum Cho/Cr values of highgrade and low-grade gliomas were （2. 4492 ± 1. 3658） and （5. 0960 ±2. 7366） respectively which were significantly different （P〈0. 0001）. When using the maximum Cho/Cr values of the solid part of the tumor to identify the high level and low-grade gliomas, the area under the ROC curve was 0. 8378. When using 3.93 as the ideal threshold, the sensitivity and specifici- ty was 76. 9% and 83.8% respectively. Conclusion The Cho/Cr map obtained by 1H-MRS examination can reflect the generation degree of tumor cell. Cho/Cr value of the solid part of the tumor is positively correlated with the histological grade. 1 H-MRS examination has high value for preoperative evaluation of gliomas.