CAJ | 학술논문

目的：探讨Cho相对水平在胶质瘤术前分级的价值及与肿瘤细胞增殖活性的相关性。材料与方法搜集行1H-MRS检查并经病理证实的脑胶质瘤患者58例，分为Ⅰ～Ⅱ级(低级别)、Ⅲ级、Ⅳ级3组，其中Ⅲ～Ⅳ级为高级别胶质瘤。选取肿瘤实质Cho/Cr最大处及对侧正常表现白质为感兴趣区，获得肿瘤实质Cho/NAA、Cho/Cr、rCho/NAA及rCho/Cr值。根据Ki-67标记指数将Ki-67分级定义为阴性(－)、弱阳性(+)、阳性(++)和强阳性(+++)4级。分析不同级别胶质瘤肿瘤实质Cho相对水平各参数的组间差异性并采用受试者特征曲线(ROC)确定诊断阈值。分析Ki-67级别与胶质瘤肿瘤级别、Cho相对水平各参数的相关性。结果Ⅲ级及Ⅳ级胶质瘤实质部分Cho相对水平各参数显著高于Ⅰ～Ⅱ级胶质瘤(P<0.05)，但Ⅲ级与Ⅳ级间无统计学差异性(P>0.05)，高低级别胶质瘤各参数组间有统计学差异性(P<0.05)；区分高低级别胶质瘤的Cho相对水平各指标中，Cho/NAA的诊断准确率最高，为81.0%，诊断界值为3.04，rCho/Cr曲线下面积最大，为0.823。不同级别胶质瘤Ki-67分级存在显著差异性，两者呈显著正相关(r=0.741， P<0.05)。Cho/NAA、Cho/Cr及rCho/Cr与Ki-67分级呈轻度正相关(r分别为0.313、0.444和0.336，P均<0.05)。结论 Cho相对水平可作为反映胶质瘤细胞增殖状态、评价肿瘤恶性程度的指标。
목적：탐토Cho상대수평재효질류술전분급적개치급여종류세포증식활성적상관성。재료여방법수집행1H-MRS검사병경병리증실적뇌효질류환자58례，분위Ⅰ～Ⅱ급(저급별)、Ⅲ급、Ⅳ급3조，기중Ⅲ～Ⅳ급위고급별효질류。선취종류실질Cho/Cr최대처급대측정상표현백질위감흥취구，획득종류실질Cho/NAA、Cho/Cr、rCho/NAA급rCho/Cr치。근거Ki-67표기지수장Ki-67분급정의위음성(－)、약양성(+)、양성(++)화강양성(+++)4급。분석불동급별효질류종류실질Cho상대수평각삼수적조간차이성병채용수시자특정곡선(ROC)학정진단역치。분석Ki-67급별여효질류종류급별、Cho상대수평각삼수적상관성。결과Ⅲ급급Ⅳ급효질류실질부분Cho상대수평각삼수현저고우Ⅰ～Ⅱ급효질류(P<0.05)，단Ⅲ급여Ⅳ급간무통계학차이성(P>0.05)，고저급별효질류각삼수조간유통계학차이성(P<0.05)；구분고저급별효질류적Cho상대수평각지표중，Cho/NAA적진단준학솔최고，위81.0%，진단계치위3.04，rCho/Cr곡선하면적최대，위0.823。불동급별효질류Ki-67분급존재현저차이성，량자정현저정상관(r=0.741， P<0.05)。Cho/NAA、Cho/Cr급rCho/Cr여Ki-67분급정경도정상관(r분별위0.313、0.444화0.336，P균<0.05)。결론 Cho상대수평가작위반영효질류세포증식상태、평개종류악성정도적지표。
Objective: To investigate the value of the relative level of choline measured by proton magnetic resonance spectroscopy in the preoperative evaluation of cerebral gliomas grading and the correlation with cell proliferation in gliomas. Materials and Methods: Fifty-eight patients with cerebral gliomas confirmed by histopathology were collected. All patients were performed with 1H-MRS. On the basis of the histopathological diagnosis, the patients were classiifed into three groups:gradeⅠ—Ⅱ(low-grade), 25 cases, gradeⅢ, 19, gradeⅣ, 14. Those whose grades wereⅢorⅣwere classiifed into high-grade gliomas group that included 33 cases. The regions of the maximum Cho/Cr value in solid portion of the tumors and the contralateral normal white matter were selected as regions of interest (ROI). The values of Cho/NAA, Cho/Cr, relative Cho/NAA (rCho/NAA) and relative Cho/Cr (rCho/Cr) of ROIs were obtained. Ki-67 grading was defined as follow:labeling index (LI)<5%is negative (-), 5%≤LI<25%is weakly positive(+), 25%≤LI<50%is positive (++), and LI≥50%is strongly positive (+++). The differences of parameters of the relative level of choline among three groups were analyzed, if the parameters of the relative level of choline had no signiifcant difference between gradeⅢandⅣgliomas, we compared the difference between low-grade and high-grade gliomas. The optimum diagnostic thresholds of the parameters were achieved by using receiver operating characteristic curve (ROC), and we calculated the area under the curve (AUC), sensitivity, speciifcity and accuracy. The correlation between Ki-67 grading and glioma grading, and the correlation between Ki-67 grading and parameters of the relative level of choline were analyzed. Result:The Cho/NAA, Cho/Cr, rCho/NAA and rCho/Cr values of solid portions of tumor of gradeⅢand gradeⅣgliomas were signiifcantly higher than that of gradeⅠ—Ⅱgliomas (P<0.05), however, there was no signiifcant difference between gradeⅢand gradeⅣgliomas (P>0.05). There were signiifcant differences between low-grade and high-grade gliomas (P<0.05). In the parameters of the relative level of choline to differentiate high-grade gliomas from low-grade gliomas, the accuracy of Cho/NAA was the highest, which equaled to 81.0%, and the threshold was 3.04. The AUC of rCho/Cr was maximum, which was 0.823, and the threshold and accuracy were 2.70 and 77.6%, respectively. There was signiifcant difference between different grade gliomas in Ki-67 grading, and there was a positive correlation between Ki-67 grading and gliomas grading (r=0.741, P<0.05). Cho/NAA, Cho/Cr and rCho/Cr had positive correlation with Ki-67 grading (r were 0.313, 0.444 and 0.336, respectively, P<0.05). Conclusions:The relative level of choline is a great indicator that can indicate the state of gliomas cell proliferation and evaluate the level of malignant, it is helpful for classiifcation of cerebral gliomas grading before operation.