Department of Neurosurgery, Medical University Vienna, Vienna, Austria.
J Neurol Neurosurg Psychiatry. 2011 May;82(5):512-20. doi: 10.1136/jnnp.2010.205229. Epub 2010 Oct 22.
In diffusely infiltrating gliomas (DIG), positron emission tomography (PET) imaging is a powerful method for detection of anaplastic foci. Recently, (1)H-magnetic resonance spectroscopy chemical shift imaging (CSI) using choline/creatine (Cho/Cr) or choline/N-acetylaspartate (Cho/NAA) ratios has emerged as a new non-invasive, widely available alternative. The authors therefore correlated CSI with (11)C-methionine (MET)-PET data in a series of DIG with non-significant contrast-enhancement (CE).
Thirty-two patients with DIG were examined with single-slice CSI on a T MRI and MET-PET. Maximum pathological intratumoural ratios of CSI (=CSI(max)) and maximum tumour-to-normal-brain PET ratios (=PET(max); T/N ratio) were determined. Coregistration of MRI with CSI and PET was performed, and the topographic overlap of CSI(max) and PET(max) was analysed. Histological criteria of anaplasia as well as cell proliferation rate were assessed in tumour samples inside and outside CSI(max).
CSI showed a pathological ratio in all patients, whereas PET demonstrated a pathological T/N ratio in 21/32 patients. Topographical correlation of CSI(max) and PET(max) revealed a ≥ 50% overlap in 18/21 and <50% overlap in 3/21 patients, respectively. Cho/Cr(max) and Cho/NAA(max) showed a ≥ 50% overlap in 24/32 and a <50% overlap in 8/32 patients. Cell proliferation rate was significantly higher inside than outside the CSI(max) (13.6% vs 6.9%, p<0.001).
The results indicate that CSI is a promising method for detection of anaplastic foci within DIG with non-significant CE. Intraoperative use of CSI by multimodal neuronavigation may increase the reliability of detection of malignant areas in glioma surgery and therefore optimise allocation of patients to adjuvant treatments.
在弥漫性浸润性神经胶质瘤（DIG）中，正电子发射断层扫描（PET）成像对于检测间变灶是一种强有力的方法。最近，使用胆碱/肌酸（Cho/Cr）或胆碱/N-乙酰天门冬氨酸（Cho/NAA）比值的（1）H 磁共振波谱化学位移成像（CSI）已成为一种新的非侵入性、广泛可用的替代方法。因此，作者在一系列无明显对比增强（CE）的 DIG 患者中，将 CSI 与（11）C-蛋氨酸（MET）-PET 数据进行了相关性研究。
对 32 例 DIG 患者进行单次切面 MRI 和 MET-PET 扫描，测定 CSI（=CSI(max)）和肿瘤与正常脑 PET 比值（=PET(max)；T/N 比值）的最大肿瘤内比值。对 MRI 与 CSI 和 PET 进行配准，分析 CSI(max)和 PET(max)的拓扑重叠情况。在 CSI(max)内和外的肿瘤样本中评估组织学的间变标准和细胞增殖率。
CSI 在所有患者中均显示出病理性比值，而 PET 在 21/32 例患者中显示出病理性 T/N 比值。CSI(max)和 PET(max)的拓扑相关性显示，18/21 例患者的重叠率≥50%，3/21 例患者的重叠率<50%。Cho/Cr(max)和 Cho/NAA(max)在 24/32 例患者中重叠率≥50%，8/32 例患者中重叠率<50%。细胞增殖率在 CSI(max)内明显高于 CSI(max)外（13.6%比 6.9%，p<0.001）。
结果表明，CSI 是一种很有前途的方法，可用于检测无明显 CE 的 DIG 中的间变灶。通过多模态神经导航术中使用 CSI，可能会提高恶性区域在胶质瘤手术中检测的可靠性，从而优化患者接受辅助治疗的分配。
