Proton magnetic resonance spectroscopy in patients with glial tumors: A multicenter study
Proton magnetic resonance spectroscopy in patients with glial tumors: A multicenter study
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DOI：
10.3171/jns.1996.84.3.0449
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发表时间：
1996-03-01
影响因子：
4.1
通讯作者：
Zimmerman, RA
中科院分区：
文献类型：
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作者：
Negendank, WG;Sauter, R;Zimmerman, RA
作者代表了一个由15个机构组成的合作小组，该小组研究了使用H-1磁共振（MR）波谱在体内观察到的代谢特征来表征神经胶质型脑肿瘤的可行性。这些机构提供了盲态、集中的MR波谱数据处理沿着，并对MR波谱体素放置、脑成分和污染、使用当前世界卫生组织标准的组织病理学分型和临床数据进行了独立的集中审查。使用自旋回波技术进行质子H-1-MR波谱分析，以获得肿瘤中8 cc体素的光谱，并在可行时在对侧大脑中获得光谱。86例可评估，其中41例有对侧脑频谱。与脑相比，神经胶质肿瘤具有显著升高的胆碱信号强度、降低的肌酸信号强度和降低的N-乙酰天冬氨酸强度。胆碱信号强度在星形细胞瘤和间变性星形细胞瘤中最高，肌酸信号强度在胶质母细胞瘤中最低。然而，无论是表达相对于大脑或肿瘤内的比例，这些代谢特征表现出很大的变化，在每个亚型的胶质细胞特纳。由此产生的重叠排除了区分低级别和高级别肿瘤的诊断准确性。虽然H-1-MR光谱体素的污染程度由大脑代谢物的浓度和比例有显着的影响，选择的情况下，最小的污染并没有减少这些重叠。因此，每种类型和级别的肿瘤是代谢异质性组。乳酸盐很少发生，在所有等级。另一方面，移动的脂质出现在41%的高级别肿瘤中，在胶质母细胞瘤中发现了更高的平均量。这一结果，再加上最近的证明，即肿瘤内的移动的脂质与显微镜下的肿瘤细胞坏死相关，导致的假设，移动的脂质在体内观察到的H-1-MR波谱可能独立与个别患者的预后。
The authors represent a cooperative group of 15 institutions that examined the feasibility of using metabolic features observed in vivo with H-1-magnetic resonance (MR) spectroscopy to characterize brain tumors of the glial type. The institutions provided blinded, centralized MR spectroscopy data processing along with independent central review of MR spectroscopy voxel placement, composition and contamination by brain, histopathological typing using current World Health Organization criteria, and clinical data. Proton H-1-MR spectroscopy was performed using a spin-echo technique to obtain spectra from 8-cc voxels in the tumor and when feasible in the contralateral brain. Eighty-six cases were assessable, 41 of which had contralateral brain spectra. Glial tumors had significantly elevated intensities of choline signals, decreased intensities of creatine signals, and decreased intensities of N-acetylaspartate compared to brain. Choline signal intensities were highest in astrocytomas and anaplastic astrocytomas, and creatine signal intensities were lowest in glioblastomas. However, whether expressed relative to brain or as intratumoral ratios, these metabolic characteristics exhibited large variations within each subtype of glial turner. The resulting overlaps precluded diagnostic accuracy in the distinction of low- and high-grade tumors. Although the extent of contamination of the H-1-MR spectroscopy voxel by brain had a marked effect on metabolite concentrations and ratios, selection of cases with minimal contamination did not reduce these overlaps. Thus, each type and grade of tumor is a metabolically heterogeneous group. Lactate occurred infrequently and in all grades. Mobile lipids, on the other hand, occurred in 41% of high-grade tumors with higher mean amounts found in glioblastomas. This result, coupled with the recent demonstration that intratumoral mobile lipids correlate with microscopic tumor cell necrosis, leads to the hypothesis that mobile lipids observed in vivo in H-1-MR spectroscopy may correlate independently with prognosis of individual patients.