| Objective: Glioma is the most common malignant tumor in the brain,the incidence is increasing year by year,and the treatment effect is not good,pathological grading and related immunohistochemical marker expression is closely related to the occurrence and development of glioma,among which Ki-67,CD34,IDH1 expression can reflect the tumor cell proliferation,microangiogenesis,treatment sensitivity and other characteristics,through the in-depth study of glioma molecular pathology,can guide patients accurate,individualized diagnosis and treatment.Conventional magnetic resonance examination can only carry out a single morphological study of lesions,magnetic magnetic resonance imaging(f MRI)technology combines imaging,anatomical and functional information,for non-invasive evaluation of tumor molecular pathological information provides a new technical means,this study aims to explore the application of brain f MRI in the pathological grading of glioma and its related immunohistochemical indexes,clinical features,and from clinical features,pathology The prognosis related factors of glioma were searched in the direction of imaging,which provided a basis for judging the pathological grade,predicting the curative effect,and interpreting the prognosis of glioma before noninvasive treatment.Methods: 1.Research object This study retrospectively analyzed a total of 54 patients(28 male and 26 female)who underwent neurosurgical treatment and were pathologically diagnosed as cerebral glioma in Jiangxi Cancer Hospital.with an average age of 46.19±12.37 years(26-74).The patients were treated between January 2017 and January 2022.Brain MRI examination including DSC-MRI and H1-MRS sequences was completed for all patients before treatment.Intracranial lesions were surgically removed within 1 week after MRI examination,and the expressions of CD34,Ki-67 and IDH1 genes were detected by histopathologic grading and immunohistochemical detection.The prognosis was recorded by craniocerebral MRI review.2.Image examination and image processing(1)Philips ingenia 3.0T magnetic resonance scanner was used for detection.After completing the routine scan sequence,tumor size,edema degree,and midline structure displacement were recorded(2)In cerebral blood volume(CBV)and cerebral blood flow(CBF)in the tumor area,the mean transit time(MTT)was measured by DSC-MRI.The above parameter results were fitted by AIF arterial input function.In addition,symmetrical CBV and CBF were automatically selected to measure,and r CBV(relative CBV)and r CBF(relative CBF)were calculated.The contents of N-Acetylaspartate(NAA),Choline(Cho)and Creatine(Cr)in tumor areas are calculated by H1-MRS scanning,and their ratios are calculated,including Cho/NAA,Cho/Cr and NAA/Cr.3.pathological examination The embedded pathological sections and HE staining of postoperative tumor tissues were obtained,and the diagnosis and grading were performed by pathologists Glioma was classified into low-grade glioma(Grade 1 or 2)and high-grade glioma(grade 3 or 4)according to the 2021 WHO classification criteria for central nervous system tumors,and with reference to tumor cell atypia,mitosis,proliferation density,necrosis,and microangiopaplasia.Immunohistochemistry was used to detect the expressions of CD34,Ki-67 and IDH1 proteins in the samples by relevant specific antibodies,and the expressions were counted and recorded by specially-assigned persons.4.Statistical analysis Using postoperative pathological diagnosis as the gold standard,the differences and correlations between quantitative parameters of DSC-MRI and H1-MRS,pathological grades and expression of biomarkers were analyzed.Univariate and multivariate analysis was used to study prognostic correlation factors of glioma,and SPSS23.0 statistical software was used for data analysis.Results: 1.Clinicopathological grading Among 54 gliomas,there were 17 cases of low-grade gliomas,including 17 cases of WHO grade 2 gliomas,including 14 cases of low-grade astrocytoma and 3 cases of oligodendroglioma.There were 37 cases of high-grade glioma,including 12 cases of WHO grade 3 glioma(7 cases of anaplastic oligodendroglioma,5 cases of anaplastic astrocytoma)and 25 cases of WHO grade 4 glioma,all of which were glioblastoma.2.Tumor size,peritumoral edema,and whether the tumor crosses the midline Among the 54 patients enrolled,20 cases had tumor diameter ≤ 3cmand 34 cases had tumor diameter > 3cm.Tumor growth across the midline was found in 12 patients and not in 42 patients.There were 8 cases of grade 0 peritumoral edema,11 cases of grade 1 peritumoral edema,21 cases of grade 2 peritumoral edema and 14 cases of grade 3 peritumoral edema 3.Differential analysis of quantitative parameters of DSC-MRI in different pathological grades of brain gliomas The r CBF values of low-grade glioma and high-grade glioma were 1.44±0.25 and 3.04±1.84,and the r CBV values were 1.63±0.81 and 3.83±1.29,respectively With the increase of tumor pathological grade,the r CBF and r CBV values showed an increasing trend.The r CBF of low-grade glioma was significantly lower than that of high-grade glioma(P=0.013),and the r CBV of low-grade glioma was significantly lower than that of high-grade glioma(P=0.043).There were no significant differences in MTT and TTP between the two groups(P>0.05)4.Difference analysis of quantitative parameters of H1-MRS in gliomas of different pathological grades The values of Cho/Cr and Cho/NAA in low and high glioma groups were(1.41±0.91 VS 2.53±0.68,1.32±0.62 VS 2.91±0.98),respectively,and the parameters were significantly different between the two groups(P<0.05).The ratio of Cho/Cr and Cho/NAA in the tumor area of high-grade glioma was significantly higher than that of low-grade glioma.There was no significant difference in NAA/Cr of glioma with different pathological grades(P>0.05).5.Comparison of expression levels of CD34,Ki-67 and IDH1 genes in gliomas of different pathological grades Ki-67 expression was low in 15 cases(88.24%)and high in 2 cases(11.76%)of 17 low-grade gliomas.Ki-67 expression was high in 37 high-grade gliomas(100%).CD34 was positive in 4 cases(23.53%)and negative in 13 cases(76.47%)in low-grade gliomas,positive in 30 cases(81.08%)and negative in 7 cases(18.92%)in high-grade gliomas.The expression levels of CD34 and Ki-67 in high-grade gliomas were higher than those in low-grade gliomas,and the IDH1-positive mutation rate was 64.7% in low-grade gliomas and 37.84% in high-grade gliomas.Positive mutations of IDH1-positive mutations were more common in low-grade gliomas.The difference between the two groups was statistically significant(P<0.05).6.Correlation analysis of quantitative parameters of DSC-MRI and H1-MRS with expressions of CD34,Ki-67 and IDH1 Spearman correlation analysis showed that r CBF was positively correlated with Ki-67(r=0.641,P<0.05),r CBV was positively correlated with CD34 expression(r=0.573,P<0.05),and r CBV was negatively correlated with the positive rate of IDH1 mutation(r=-0.507,P<0.05);The ratio of Cho/Cr and Cho/NAA increased,and the positive expression of Ki-67 increased,and there was a positive correlation between the two(r=0.587,P<0.05;r=0.639,P<0.05).There was no significant correlation between NAA/Cr ratio and the above immunohistochemical markers(P>0.05).7.Clinical,pathological and radiological features of glioma and prognostic risk factors In the study of prognostic risk factors in glioma patients,univariate analysis showed that age,tumor pathological grade,expression level of immunomolecular markers CD34,Ki-67 and IDH1,peritumoral edema,r CBF value,Cho/NAA ratio were correlated with patients’ PFS.Multivariate analysis showed that tumor pathological grade(P<0.001),immunomolecular marker Ki-67 index(P=0.034),IDH1 mutation(P=0.048),peritumoral edema degree(P=0.045),Cho/NAA(P<0.001)were all important factors affecting prognosis.Conclusion: 1.Quantitative parameters of functional magnetic resonance imaging DSC-MRI and H1-MRS were different among different pathological grades of glioma.2.Quantitative parameters of DSC-MRI and H1-MRS are correlated with expressions of CD34,Ki-67 and IDH1,and this technique can reflect tumor microstructure information such as the proliferation level of glioma cells and microvascular status.3.Tumor pathological grade,Ki-67 index,IDH1 mutation status,peritumoral edema degree and Cho/NAA in tumor area are related to the prognosis of patients,and are important prognostic factors of glioma. |
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