Correlation of magnetic resonance spectroscopic and growth characteristics within Grades II and III gliomas
Correlation of magnetic resonance spectroscopic and growth characteristics within Grades II and III gliomas
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DOI：
10.3171/jns.2007.106.4.660
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发表时间：
2007-04-01
影响因子：
4.1
通讯作者：
Nelson, Sarah J.
中科院分区：
文献类型：
--
作者：
McKnight, Tracy R.;Lamborn, Kathleen R.;Nelson, Sarah J.
Object.准确诊断世界卫生组织II级和III级胶质瘤对于有效治疗此类病变患者至关重要。细胞密度增加和有丝分裂活性是区分III级和II级胶质瘤的组织学特征。由于增加的细胞增殖和密度都有助于体内磁共振（MR）光谱峰对应于胆碱-comaining化合物（Cho），作者假设多体素MR光谱可能有助于识别具有最具侵略性生长特征的肿瘤区域，这将是活检的最佳位置。他们研究了使用一个或多个MR光谱参数来预测MIB-I细胞增殖指数（PI）、末端脱氧核苷酸转移酶介导的脱氧尿苷三磷酸缺口末端标记细胞死亡指数（DI）、细胞密度以及同一肿瘤不同区域内的增殖与细胞死亡比率（PUDI）的能力。假定为II级或III级胶质瘤的患者在手术前接受3D MR光谱成像，肿瘤内的两个或三个区域根据其光谱特征进行活检检索。在图像引导下切除肿瘤时，取活检标本，用化学方法测定PI、DI和细胞密度。作者发现Cho和N-乙酰天冬氨酸（NAA）的相对水平与同一肿瘤不同区域内的细胞密度、PI和PI/DI比值相关，并且这种相关性适用于非增强肿瘤亚群。在Cho/NAA值范围较大的肿瘤中，无论是否存在造影剂增强，这种相关性都更强。研究结果表明，使用磁共振波谱识别区域的侵略性生长在假定的II级或III级胶质瘤，将是合适的目标检索诊断活检标本的有效性。
Object. The accurate diagnosis of World Health Organization Grades II and III gliomas is crucial for the effective treatment of patients with such lesions. Increased cell density and mitotic activity are histological features that distinguish Grade III from Grade II gliomas. Because increased cellular proliferation and density both contribute to the in vivo magnetic resonance (MR) spectroscopic peak corresponding to choline-comaining compounds (Cho), the authors hypothesized that multivoxel MR spectroscopy might help identify the tumor regions with the most aggressive growth characteristics, which would be optimal locations for biopsy. They investigated the ability to use one or more MR spectroscopic parameters to predict the MIB-I cell proliferation index (PI), the terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick-end labeling cell death index (DI), the cell density, and the ratio of proliferation to cell death (PUDI) within different regions of the same tumor.Methods. Patients with presumed Grades II or III glioma underwent 3D MR spectroscopic imaging prior to surgery, and two or three regions within the tumor were targeted for biopsy retrieval based on their spectroscopic features. Biopsy specimens were extracted from the tumor during image-guided resection, and the PI, DI, and cell density were assessed in the specimens using immunohistochernical methods.Conclusions. The authors found that the relative levels of Cho and N-acetylaspartate (NAA) correlated with the cell density, PI, and PI/DI ratio within different regions of the same tumor and that the association held for the subpopulation of nonenhancing tumors. The association was stronger in tumors with large ranges of Cho/NAA values, irrespective of the presence of contrast enhancement. The findings demonstrate the validity of using MR spectroscopy to identify regions of aggressive growth in presumed Grade II or III gliomas that would be suitable targets for retrieving diagnostic biopsy specimens.