磁共振波谱分析在高级别和低级别星形细胞瘤中的鉴别诊断：儿童和成人肿瘤的比较。
MR spectroscopy differentiation between high and low grade astrocytomas: a comparison between paediatric and adult tumours.
机构信息
Neuroradiology Department of the Johann Wolfgang Goethe University, Frankfurt/Main, Germany.
出版信息
Eur J Paediatr Neurol. 2011 May;15(3):214-21. doi: 10.1016/j.ejpn.2010.11.003. Epub 2010 Dec 9.
OBJECTIVE
To investigate whether pathologically similar astrocytomas in adults and children may also show metabolic similarities in proton magnetic resonance spectroscopy ((1)H-MRS) and whether the MRS data could help to differentiate between low and high grade gliomas for the different groups.
MATERIAL AND METHODS
Twelve children (5 WHO II astrocytomas, 7 WHO III astrocytomas) and 37 adults (21 WHO II astrocytomas, 16 WHO III astrocytomas) were included in this study. MR spectroscopic data were evaluated retrospectively using normalized measures of total choline (tCho), N-acetyl-aspartate (NAA) and total creatine (tCr). These metabolites were used to differentiate between WHO II and WHO III astrocytomas in children and adults. Histopathological grading was performed using WHO criteria. (1)H-MRS was carried out prior to the commencement of any treatment. Signal intensities of tCho, NAA and tCr were normalized to their values in contralateral brain tissue. The resulting concentration ratios were then used to calculate the change in the intratumoural ratio of NAA to tCho. A Mann-Whitney U-Test was performed to evaluate differences within the respective groups.
RESULTS
In both groups, loss of NAA and increase of tCho were more pronounced in WHO III than in WHO II astrocytoma. The best discriminator to differentiate between low and high grade gliomas was found to be the ratio of NAA/tCho (p < 0.01).
CONCLUSION
The normalized metabolite signal intensities ratio NAA to tCho is the most accurate in differentiating between low and high grade astrocytomas in both children and adults.
目的
研究成人和儿童中组织学相似的星形细胞瘤是否也存在质子磁共振波谱（1H-MRS）代谢相似性，以及 MRS 数据是否有助于区分不同组别的低级别和高级别胶质瘤。
材料和方法
本研究纳入了 12 名儿童（5 例 WHO II 级星形细胞瘤，7 例 WHO III 级星形细胞瘤）和 37 名成人（21 例 WHO II 级星形细胞瘤，16 例 WHO III 级星形细胞瘤）。使用归一化的总胆碱（tCho）、N-乙酰天冬氨酸（NAA）和总肌酸（tCr）测量值对 MR 光谱数据进行回顾性评估。这些代谢物用于区分儿童和成人的 WHO II 级和 WHO III 级星形细胞瘤。采用 WHO 标准进行组织病理学分级。1H-MRS 在任何治疗开始前进行。tCho、NAA 和 tCr 的信号强度与其对侧脑组织的值进行归一化。然后，使用归一化后的浓度比来计算肿瘤内 NAA 与 tCho 的比值变化。使用 Mann-Whitney U 检验评估各组内的差异。
结果
在两组中，与 WHO II 级星形细胞瘤相比，WHO III 级星形细胞瘤中 NAA 丢失和 tCho 增加更为明显。区分低级别和高级别胶质瘤的最佳鉴别指标是 NAA/tCho 比值（p < 0.01）。
结论
在儿童和成人中，区分低级别和高级别星形细胞瘤最准确的指标是 NAA 与 tCho 的归一化代谢物信号强度比值。
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