Abstract
BackgroundThe marginal delineation of gliomas cannot be defined by conventional imaging due to their infiltrative growth pattern. Here we investigate the relationship between changes in glioma metabolism by proton magnetic resonance spectroscopic imaging (1H-MRSI) and histopathological findings in order to determine an optimal threshold value of choline/N-acetyl-aspartate (Cho/NAA) that can be used to define the extent of glioma spread.MethodEighteen patients with different grades of glioma were examined using 1H-MRSI. Needle biopsies were performed under the guidance of neuronavigation prior to craniotomy. Intraoperative magnetic resonance imaging (MRI) was performed to evaluate the accuracy of sampling. Haematoxylin and eosin, and immunohistochemical staining with IDH1, MIB-1, p53, CD34 and glial fibrillary acidic protein (GFAP) antibodies were performed on all samples. Logistic regression analysis was used to determine the relationship between Cho/NAA and MIB-1, p53, CD34, and the degree of tumour infiltration. The clinical threshold ratio distinguishing tumour tissue in high-grade (grades III and IV) glioma (HGG) and low-grade (grade II) glioma (LGG) was calculated.ResultsIn HGG, higher Cho/NAA ratios were associated with a greater probability of higher MIB-1 counts, stronger CD34 expression, and tumour infiltration. Ratio threshold values of 0.5, 1.0, 1.5 and 2.0 appeared to predict the specimens containing the tumour with respective probabilities of 0.38, 0.60, 0.79, 0.90 in HGG and 0.16, 0.39, 0.67, 0.87 in LGG.ConclusionsHGG and LGG exhibit different spectroscopic patterns. Using 1H-MRSI to guide the extent of resection has the potential to improve the clinical outcome of glioma surgery.
Highlights
Delineating the boundaries of cerebral gliomas plays a vital role in glioma surgery because maximal resection of gliomas contributes greatly to prolonged survival, reduced rates of recurrence and morbidity [5, 29]
In HGG, higher Cho/NAA ratios were associated with a greater probability of higher MIB-1 counts, stronger CD34 expression, and tumour infiltration
Using 1H-MRSI to guide the extent of resection has the potential to improve the clinical outcome of glioma surgery
Summary
Delineating the boundaries of cerebral gliomas plays a vital role in glioma surgery because maximal resection of gliomas contributes greatly to prolonged survival, reduced rates of recurrence and morbidity [5, 29]. Other studies, using biopsy findings to confirm histopathological data, reported that the extent of spread of glioma exceeded that defined by T2-weighted signal change [10, 31]. Compared with singlevoxel 1H-MRS, multi-voxel 1H-MRS is advanced in detecting the spatial distribution of metabolic changes in brain lesions because of its successive feature It provides consecutive information about biochemical transformations in areas with low tumour infiltration and can be used to assist treatment planning [16, 33]. We investigate the relationship between changes in glioma metabolism by proton magnetic resonance spectroscopic imaging (1H-MRSI) and histopathological findings in order to determine an optimal threshold value of choline/N-acetyl-aspartate (Cho/NAA) that can be used to define the extent of glioma spread. Haematoxylin and eosin, and immunohistochemical staining with IDH1, MIB-1, p53, CD34 and glial fibrillary acidic protein (GFAP) antibodies were performed on all samples
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