Herminghaus Sebastian, Dierks Thomas, Pilatus Ulrich, Möller-Hartmann Walter, Wittsack Jörg, Marquardt Gerhard, Labisch Christoph, Lanfermann Heinrich, Schlote Wolfgang, Zanella Friedhelm E
Department of Neurosurgery and Institute of Neuroradiology, Johann W. Goethe University, Frankfurt am Main, Germany.
J Neurosurg. 2003 Jan;98(1):74-81. doi: 10.3171/jns.2003.98.1.0074.
In this study, 1H magnetic resonance (MR) spectroscopy was prospectively tested as a reliable method for presurgical grading of neuroepithelial brain tumors.
Using a database of tumor spectra obtained in patients with histologically confirmed diagnoses, 94 consecutive untreated patients were studied using single-voxel 1H spectroscopy (point-resolved spectroscopy; TE 135 msec, TE 135 msec, TR 1500 msec). A total of 90 tumor spectra obtained in patients with diagnostic 1H MR spectroscopy examinations were analyzed using commercially available software (MRUI/VARPRO) and classified using linear discriminant analysis as World Health Organization (WHO) Grade I/II, WHO Grade III, or WHO Grade IV lesions. In all cases, the classification results were matched with histopathological diagnoses that were made according to the WHO classification criteria after serial stereotactic biopsy procedures or open surgery. Histopathological studies revealed 30 Grade I/II tumors, 29 Grade III tumors, and 31 Grade IV tumors. The reliability of the histological diagnoses was validated considering a minimum postsurgical follow-up period of 12 months (range 12-37 months). Classifications based on spectroscopic data yielded 31 tumors in Grade I/II, 32 in Grade III, and 27 in Grade IV. Incorrect classifications included two Grade II tumors, one of which was identified as Grade III and one as Grade IV; two Grade III tumors identified as Grade II; two Grade III lesions identified as Grade IV; and six Grade IV tumors identified as Grade III. Furthermore, one glioblastoma (WHO Grade IV) was classified as WHO Grade I/II. This represents an overall success rate of 86%, and a 95% success rate in differentiating low-grade from high-grade tumors.
The authors conclude that in vivo 1H MR spectroscopy is a reliable technique for grading neuroepithelial brain tumors.
在本研究中，对1H磁共振（MR）波谱作为神经上皮性脑肿瘤术前分级的可靠方法进行前瞻性测试。
利用组织学确诊患者的肿瘤波谱数据库，对94例未经治疗的连续患者采用单体素1H波谱（点分辨波谱；TE 135毫秒，TE 135毫秒，TR 1500毫秒）进行研究。使用市售软件（MRUI/VARPRO）对通过诊断性1H MR波谱检查获得的90例患者的肿瘤波谱进行分析，并采用线性判别分析将其分类为世界卫生组织（WHO）I/II级、WHO III级或WHO IV级病变。在所有病例中，分类结果与经系列立体定向活检或开放手术后根据WHO分类标准做出的组织病理学诊断进行匹配。组织病理学研究显示有30例I/II级肿瘤、29例III级肿瘤和31例IV级肿瘤。考虑到术后至少12个月（范围12 - 37个月）的随访期，验证了组织病理学诊断的可靠性。基于波谱数据的分类得出I/II级肿瘤31例、III级肿瘤32例和IV级肿瘤27例。错误分类包括2例II级肿瘤，其中1例被鉴定为III级，1例被鉴定为IV级；2例III级肿瘤被鉴定为II级；2例III级病变被鉴定为IV级；6例IV级肿瘤被鉴定为III级。此外，1例胶质母细胞瘤（WHO IV级）被分类为WHO I/II级。这代表总体成功率为86%，区分低级别和高级别肿瘤的成功率为95%。
作者得出结论，体内1H MR波谱是神经上皮性脑肿瘤分级的可靠技术。
