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目的探讨磁共振波谱(MRS)与胶质母细胞瘤(GBM)特征分子的相关性,为GBM的临床评估、个性化治疗方案的选择及预后评价提供依据。方法回顾性分析本院60例经手术病理证实的GBM患者的1H-MRS表现,测量病灶实质区域的Cho/Cr、NAA/Cr及Cho/NAA值。同时,对60例患者的病理切片进行免疫组织化学染色,得到EGFR、IDH-1、P53、PTEN和NEFL特征性变化,根据染色面积进行评分。分析Cho/Cr、NAA/Cr及Cho/NAA与上述分子表达变化的相关性。结果 5个分子指标中,NEFL表达与Cho/NAA、Cho/Cr呈显著负相关(R~2=-0.836,P<0.001,R~2=-0.427,P=0.001)。ROC曲线分析表明当Cho/NAA值<4.214时,GBM可能为神经元亚型的特异度和敏感度分别为89.5%和90.9%;当Cho/Cr值<3.795时,GBM可能为神经元亚型特异度和敏感度分别为72.7%和73.7%。其余4个分子表达与1H-MRS代谢产物均无明显相关性。结论1H-MRS参数可反映NEFL的表达,NEFL是GBM神经元亚型的特征性改变,因而1H-MRS可作为反映GBM神经元亚型的重要影像学标志。
Objective To investigate the relationship between magnetic resonance spectroscopy (MRS) and characteristic molecules of glioblastoma (GBM), and to provide evidence for the clinical evaluation of GBM, the selection of individualized treatment options and the prognosis evaluation. Methods The 1H-MRS findings of 60 pathologically confirmed GBM patients in our hospital were retrospectively analyzed. The Cho / Cr, NAA / Cr and Cho / NAA values were measured in the parenchyma of the lesion. At the same time, the pathological sections of 60 patients were immunohistochemically stained, and the characteristic changes of EGFR, IDH-1, P53, PTEN and NEFL were obtained and scored according to the staining area. The correlation between Cho / Cr, NAA / Cr, Cho / NAA and the above molecular expression changes was analyzed. Results Among the five molecular markers, NEFL expression was negatively correlated with Cho / NAA and Cho / Cr (R ~ 2 = -0.836, P <0.001, R ~ 2 = -0.427, P = 0.001). ROC curve analysis showed that the sensitivity and specificity of GBM may be 89.5% and 90.9% respectively when Cho / NAA value is less than 4.214; GBM may be neuronal subtype when Cho / Cr value is less than 3.795 The specificity and sensitivity were 72.7% and 73.7% respectively. There was no significant correlation between the other four molecules and the metabolites of 1H-MRS. Conclusion 1H-MRS parameters can reflect the expression of NEFL, NEFL is a characteristic change of GBM neuron subtypes, so 1H-MRS can be used as a reflection of GBM neuron isoforms important imaging signs.