Clinical Application Of Combining Multivoxel-2d And Single-voxel Proton Spectroscopy In Grading Gliomas

OBJECTIVE: To explore the clinical value of the Single-VoxelProton Spectroscopy based on multivoxel-2D Proton Spectroscopy ingrading gliomas.METHODS:26case of patients with gliomas who confirmed byhistopathology were examined before operations using conventionalMRI,multivoxel-2D and Single-Voxel Proton Spectroscopy, three wayswere used to choose the ROI(region of interest) for Cho/NAA measured.First way: In the multivoxel-2D Proton Spectroscopy，chose the solid partof tumor or the most obvious enhancement area for Cho/NAA measured.Second way: In the multivoxel-2D Proton Spectroscopy, use the software ofFunctool spectroscopy-2D Brain to gain the distribution imaging-anatomyimaging (DIAI) color overplay map of Cho/NAA, choose the maximumdistribution area of Cho/NAA for ROI，and the ratio of (Cho/NAA)maxweremeasured. Third way: gain the maximum distribution area of Cho/NAA asthe same as the second way, then take the area as the ROI for Single-Voxel Proton Spectroscopy scan and measure the Cho/NAA. Contrast all theresult to the histopathology, and map the ROC curve of Cho/NAAmeasured according to the three methods for ROI selection in the guidanceof gliomas grading. Compare the value of the Cho/NAA in the guidance ofgliomas grading with the different three methods.RESULTS:(1) The area under the ROC curve mapped by theCho/NAA measured according to the three methods for ROI selection are0.738,0.863and0.982,respectively. The area under the ROC curve of thethree methods mapped by the Cho/NAA has signification differencescompared with0.5（P<0.05）. In the guidance of gliomas grading，the firstway shows a sensitivity of64.3%, specificity of66.7%, the second wayshows a sensitivity of85.7%and a specificity of75.0%,while the third wayshow a sensitivity of92.9%, a specificity of91.7%.(3)The Cho/NAA of26case measured by the three methods were1.930±0.726,2.637±0.832and3.092±1.374, respectively. Signification differences were shown amongthe Cho/NAA measured according to the three methods of ROIselection(P<0.05).Combine the comparison results of the under area ofROC curve and the sensitivity and specificity of Cho/NAA measured bythe three methods in the guidance of gliomas grading. The value of thethird way to choose the ROI for Cho/NAA measured is the highest in theguidance of gliomas grading.CONCLUSION:(1) The Cho/NAA measured according to the three methods for ROI selection is valuable in the guidance of gliomasgrading.(2)The Cho/NAA of the Single-Voxel Proton Spectroscopy basedon multivoxel-2D Proton Spectroscopy is most valuable in the guidance ofgliomas grading, and can improve the accuracy of glioma grading.