| Objective:To study the value of Hydrogen proton Magnetic Resonance Spectroscopy(1H-MRS)in differential diagnosis and pathological grading of glioma on the basis of eonventional MRI.Methods:From May 1,2008 to May 31,2017,the clinical and imaging data of 52 cases of gliomas confirmed by conventional MRI were collected,and all patients were treated 1H-MRS before surgical treatment.According to pathology results,we divided the patients into glioma group and non-cancerous lesions group,42 patients with gliomas(high grade glioma,22 cases;low grade glioma,20 cases)and 10 cases of intracerebral nontumor lesions(granulomatous lesions,4cases;cerebral infarction,2 cases;venous vascular malformations,6 cases).Analysising 1H－MRS image data of all patients,Our test indicators include three categories,the first:N-acetyl aspartate(NAA)、Choline(Cho)、Creatine(Cr)、lactic acid + lipid(LL),the second:NAA/Cho、Cho/Cr、NAA/Cr,the third:rCho/Cr、rCho/NAA、rNAA/Cr(the metabolism ratio in lesions essence compared with the contralateral normal brain tissue area),we compared 1H－MRS metabolic index in each other group using statistical analysis software package.In addition,the relationship between 1H－MRS metabolic index and pathologic results were analyzed by Spearman nonparanetric correlation,and some good metabolic index were obtained.Afterwards,by depicting the receiver-operating characteristic curve(ROC)to evaluate the value of various metabolic index to identify glioma with non-cancerous lesions,and to separate high glioma from low glioma.Finally,we found diagnostic threshold of all good metabolic index.Results:1.The results of 1H－MRS in gliomas and intracerebral nontumor lesions.1.1 The comparison of index in glioma lesion area and lateral normal brain tissue:the results showed that there was no statistical difference of index(Cho,Cr,LL)between them,eompared with the lateral normal brain tissue,NAA decreased significantly.Cho/Cr and Cho/NAA increased,NAA/Cr decreased in glioma lesion area,and the differences were statistically significant(P<0.01).1.2 The comparison of index in intracerebral nontumor lesions and lateral normal brain tissue:there was no statistical difference of index(Cho,Cr,LL,NAA,NAA/Cr)between them,eompared with the contralateral normal brain tissue,Cho/Cr,Cho/NAA increased in lesion area of intracerebral nontumor lesions,(P<0.01).2.The comparison of 1H-MRS in gliomas and intracerebral nontumor lesions.2.1 The comparison of index in gliomas and intracerebral nontumor lesions:Cho/Cr、NAA/Cr、Cho/NAA、rCho/Cr、rCho/NAA in gliomas were bigger than those in intracerebral nontumor lesions,Cr、NAA/Cr relatively were lesser in intracerebral nontumor lesions,statistics analysis showed Cr、Cho/Cr、rCho/Cr were significant different between them(P<0.01).2.2 Analysis of the relationship between 1H-MRS metabolic index and neoplasia results:Spearman nonparametric correlation analysis showed that Cho/Cr、rCho/Cr were positively correlated with pathological changes,the correlation coefficient were 0.769(P<0.01)、0.621(P<0.01)respectively,while the correlation coefficient of Cr was-0.399(P<0.05)。2.3 Critical value of index to identify gliomas with intracerebral nontumor lesions:Depicting ROC curve for metabolic index Cho/Cr、rCho/Cr、Cr,we found that area under curve of Cho/Cr、rCho/Cr、Cr were 1(P＝0.000)、0.904(P=0.000)、0.241(P＝0.014).When Cho/Cr was 1.388,its sensitivity was 100.0%and specificity was 100.0%.NWhen rCho/Cr was 1.312,its sensitivity was 88.9%and specificity was 100.0%.S.The comparison of 1H-MRS in glioma Pathological grading.3.1 The comparison of index in different level glioma:Cho/Cr,rCho/Cr in low grade gliomas were far smaller than those in high grade gliomas,(P<0.01),while there were no obvious difference of Cho/NAA,NAA/Cr,rNAA,rCho/NAA/Cr between low grade glioma and high grade glioma.3.2 The correlation between index and gliomas grading:Spearman correlation analysis showed that Cho/Cr ratio was positively correlated(r=0.416,P=0.031),while rCho/Cr has little correlation with tumor grading(r = 0.029,P=0.886).3.3 Critical value of index to identify high grade glioma with low grade glioma;when Cho/Cr as gliomas grading index,the AUC is 0.7447(P =0.034),Cho/Cr optimal threshold is 2.443,the sensitivity was 54.5%,specificity of 87.5%.4.The comparison of 1H－MRS in low grade gliomas and intracerebral nontumor lesions.4.1 1H-MRS comparison in lesion area of low grade gliomas and intracerebral nontumor lesions:Cho/Cr,Cho/NAA,rCho,rCho/NAA/Cr in low grade gliomas were higher than those in intracerebral nontumor lesions,NAA/Cr and rNAA/Cr were relatively lower in intracerebral nontumor lesions,statistics analysis showed that only Cho/Cr is significant different between them(P<0.01).4.2 Analysis of the relationship between index and neoplasia results:Spearman nonparametric correlation analysis show that Cho/Cr was positively correlated with pathological changes,the correlation coefficient was 0.843,the correlation was strong,it could well distinguish whether the brain tissue is low-glioma or not.4.3 Critical value of index to identify low grade glioma with intracerebral nontumor lesions:Depicting the metabolic index Cho/Cr ROC curve,we found that area under curve of Cho/Cr was 1(P = 0.000).When Cho/Cr value was 1.388,its sensitivity was 100.0%and specificity was 100.0%.Conclusion:1.1H－MRS could improve the accuracy of diagnosis of glioma on the basis of conventional MRI,and provided a basis for glioma pathological grading.2.Cho/Cr,rCho/Cr haven clinical value in differential diagnosis of glioma.3.The cut-off value of Cho/Cr for differential diagnosis of gliomas and intracerebral nontumor lesions was 1.388.The cut-off value of rCho/Cr for differential diagnosis of gliomas and intracerebral nontumor lesions was 1.312.Both can be used as the important reference value for differential diagnosis of glioma.4.Cho/Cr can be used to identify high grade and low grade gliomas.The cut-off value of Cho/Cr for differential diagnosis of high grade and low grade gliomas was 2.443. |
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