Walecki Jerzy, Tarasów Eugeniusz, Kubas Bozena, Czemicki Zbigniew, Lewko Janusz, Podgórski Jan, Sokól Maria, Grieb Pawel
Department of Radiology, Medical Academy of Bialystok, ul. Sklodowskiej 24a, 15-276 Bialystok Poland.
Acad Radiol. 2003 Feb;10(2):145-53. doi: 10.1016/s1076-6332(03)80038-7.
The determination of tumor boundaries, especially in high-grade glioma, is critically important for the proper planning of treatment, but the standard diagnostic imaging methods do not enable precise delimitation of the extent of tumor cell infiltration into the surrounding tissue. The objective of this study was to assess the usefulness of hydrogen-1 (H-1) magnetic resonance (MR) spectroscopy for determining the extent of gliomatous infiltrate in the "uncertain zone'--the peritumoral area that appears unchanged on standard diagnostic MR images.
The study group consisted of 64 patients with cerebral glioma scheduled for tumor resection and subsequent radiation therapy. All patients were examined prior to resection with MR imaging and MR spectroscopy. MR spectra were obtained from examination of the solid part of the tumor and from two peritumoral volumes of interest located approximately along the axis of surgical access to the tumor. MR spectra obtained from a group of 32 healthy volunteers were used as control data.
Analysis of the consequent voxels in the peritumoral zone revealed statistically significant differences in lipid/creatine and lactate/creatine metabolite ratios between patient subgroups with recurrent malignant lesions and without recurrent lesions. Significant differences also were found between the patient group and the control group in most metabolite ratios assessed.
H-1 MR spectroscopic demonstration of metabolic changes in the peritumoral zone can guide treatment for cerebral glioma, enabling the physician to identify patients who have a high risk of recurrence.
确定肿瘤边界，尤其是在高级别胶质瘤中，对于正确的治疗规划至关重要，但标准诊断成像方法无法精确界定肿瘤细胞浸润到周围组织的范围。本研究的目的是评估氢-1（H-1）磁共振（MR）波谱在确定“不确定区”（标准诊断MR图像上看似未改变的瘤周区域）胶质瘤浸润范围方面的实用性。
研究组由64例计划进行肿瘤切除及后续放疗的脑胶质瘤患者组成。所有患者在切除术前均接受了MR成像和MR波谱检查。MR波谱取自肿瘤实体部分以及沿手术入路至肿瘤轴线大致定位的两个瘤周感兴趣区。从32名健康志愿者组获得的数据用作对照数据。
对瘤周区域后续体素的分析显示，有复发性恶性病变的患者亚组与无复发性病变的患者亚组之间，脂质/肌酸和乳酸/肌酸代谢物比率存在统计学显著差异。在评估的大多数代谢物比率方面，患者组与对照组之间也发现了显著差异。
H-1 MR波谱显示瘤周区域的代谢变化可指导脑胶质瘤的治疗，使医生能够识别具有高复发风险的患者。
