术前氢质子磁共振波谱主要代谢物水平与术中胶质母细胞瘤荧光强度的比较

发布时间：2018-03-19 06:46

本文选题：胶质母细胞瘤　切入点：氢质子磁共振波谱　出处：《中国医学科学院学报》2017年04期 　论文类型：期刊论文

【摘要】：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。
[Abstract]:Objective to compare and analyze the main metabolites of 1H-MRS before proton magnetic resonance spectroscopy imaging (PMRS) and the fluorescence intensity of glioblastoma labeled with fluorescein sodium fluorescein (FLS) during the operation, and to explore the changes of tissue metabolism level of GBM with different fluorescence intensities. Methods from April 1st 2014 to December 31st 2015, the new diagnosis of GBM by plain contrast enhanced MRI was performed with 1H-MRS and FLs labeled surgery. The tumor boundary Ki67 immunohistochemistry was performed in the patients with pathologically confirmed GBM after operation. The main metabolites of 1H-MRS and the fluorescence intensity of the tumor were compared and analyzed. Results 33 cases were included in the study. The preoperative diagnostic results of 1H-MRS suggested that the peak of N-acetylaspartate NAA was significantly decreased in 25 cases of high grade gliomas. There were significant differences between Cho / NAA NAA / creatine Cr) and Cho/Cr in different tumor regions. The results showed that there were 29 cases of total excision and 4 cases of acute encephalocele without acute encephalocele after operation. Routine pathological findings of 28 cases were consistent with that of 1H-MRS diagnosis. The fluorescence intensity of tumor parenchyma region was higher than that of tumor boundary and edema around tumor. 1H-MRS metabolite analysis results were different:. The difference of peak height of GBM and Cho in fluorescence intensity is different. The peak height of GBM / NAA is not different. There is no significant difference in peak height of GBM with different fluorescence intensity. There is no significant difference in the height of GBM peak and the height of Cho peak is different. The height of NAA and Cho in peri-neoplastic edema of GBM with different intensity of fluorescence is not significant. The peak height of NAA and Cho in peri-neoplastic edema of GBM with different intensity of fluorescence is not different, and there is no significant difference in the height of GBM peak with different fluorescence intensity. There was no significant difference in GBM / NAA between the two groups. The immunohistochemical results showed that the expression of Ki67 was different in different fluorescent development boundaries. Conclusion the fluorescence intensity of GBM tumors is higher than that of other regions, and the expression of Ki67 is higher than that of other regions. [WT5HZ] [WT5 "HZ] [WT5" BZ] [WT5 "BZ] [WT5" HZ]. In the treatment of GBM with different fluorescence intensity GBMs with different metabolic levels and FLs markers, the metabolic information provided by 1H-MRS should be paid more attention to, and the correlation between them should be further discussed.
【作者单位】：山东大学齐鲁医院神经外科;
【基金】：山东大学齐鲁医院(青岛)科研启动基金(QDKY2015LH01)~~
【分类号】：R739.41

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