Application Value Of Multivoxel ~1H-MRS In IDH Genotyping,WHO Grading And Ki-67 Expression Of Glioma

【Object】Isocitrate dehydrogenase(IDH)genotyping,World Health Organization(WHO)classification and nuclear proliferation associated antigen(Ki-67)expression status of glioma are closely related to the choice of treatment and prognosis of patients.Preoperative accurate evaluation of IDH has very important clinical significance.This study explored the application value of multivoxel(MV)~1H-magnetic resonance spectroscopy(~1H-MRS)in IDH genotyping,WHO grading and Ki-67 expression of glioma.【Methods】The clinical and imaging data of 57 gliomas who were surgically confirmed and eligible for enrollment at the Department of Neurosurgery of our hospital between July 2018 and February 2023 were retrospectively reviewed,including low-grade gliomas(LGG)(grade II,n=17),high-grade gliomas(HGG)(grade III to IV,n=40),IDH mutated tumors(n=24),and IDH wild-type tumors(n=33).All patients underwent conventional magnetic resonance imaging(MRI)with unenhanced+enhancement and multivoxel ~1H-MRS before surgery and had histopathological and IDH1 gene,Ki-67,and other immunohistochemical findings after surgery.The enrolled subjects were classified into four groups according to the criteria of the 2016WHO classification of tumors of the central nervous system(revised version 4),""low-grade glioma(grade II,n=17)and high-grade glioma(grades III to IV,n=40)"",""and""IDH gene mutated(n=24)and IDH gene wild-type(n=33)""were analyzed and compared among different grades Differences in patient demographics(gender and age),N-acetyl aspartate(NAA)/creatine(Cr),choline(Cho)/Cr,Cho/NAA,and Ki-67 index expression between glioma groups with different IDH gene status were assessed by Spearman correlation Correlation between different IDH genotyped gliomas and Ki-67 index expression.【Results】1.The mean age of the low-grade glioma Group[38.5±10.5 years]was lower than that of the high-grade glioma Group[53.9±15.0 years],which was statistically significant(P<0.01);There was no significant difference in gender between the two groups(P>0.05).The mean age of the IDH mutant glioma group was lower[39.0±10.0 years]than that of the IDH wild type glioma Group[58.8±14.4 years],with statistically significant differences between the two groups(P<0.01)and no significant differences between the genders(P>0.05).2.The Cho/Cr and Cho/NAA ratio in high-grade glioma Group[3.17±0.41,4.74±0.63]were higher than those in low-grade glioma Group[2.15±0.52,2.37±0.59],the difference was statistically significant(P<0.01),and the NAA/Cr ratio in high-grade glioma Group[0.82±0.04]was lower than that in low-grade glioma Group[0.91±0.02],the difference was statistically significant(P<0.01).The IDH wild-type glioma group had a higher Cho/NAA ratio[3.62±0.16]than the mutant glioma group,and the difference was statistically significant(P<0.01).However,there was no significant difference in NAA/Cr and Cho/Cr ratios between groups(P>0.05).3.The high-grade glioma group had a higher Ki-67 overexpression rate[90%]than the low-grade glioma Group[0%],which was statistically significant(P<0.01),and the IDH wild-type glioma group had a higher Ki-67 overexpression rate[93%]than the IDH mutant glioma Group[21%],which was significantly different(P<0.01).4.The correlation between each statistically significant index Cho/NAA,Cho/Cr,and NAA/Cr by ~1H-MRS and the Ki-67 index of gliomas between the two groups was significant(P<0.01),with correlation coefficient r values of 0.886,-0.733,-0.399.A statistically significant correlation(P<0.01)was found between Cho/NAA and Ki-67 in IDH mutated,wild-type gliomas,with a correlation coefficient of 0.386.【Conclusions】1.Multivoxel ~1H-MRS imaging technology can be used as an effective supplement to the traditional magnetic resonance examination to improve the ability of IDH genotyping and grading diagnosis of glioma.2.Cho/Cr,Cho/NAA and NAA/Cr have great clinical value in differentiating the grading of glioma.Cho/NAA may have certain clinical value in differentiating IDH genotyping of glioma.3.In the differentiation of glioma grade,Cho/Cr and Cho/NAA ratio were positively correlated with Ki-67 index expression of glioma,and NAA/Cr was negatively correlated with Ki-67 index expression.In differentiating IDH genotyping of glioma,Cho/NAA ratio was positively correlated with Ki-67 index expression of glioma.