Evaluation Of Human Glioma Using In Vivo Proton Magnetic Resonance Spectroscopy Combined With Expression Of Cyclooxygenase-2:A Preliminary Clinical Trial

Object:With the latest classification and grading standards of the central nervous system(CNS)tumor published by Word Health Organization(WHO),more and more micro level evaluation of glioma has become the clinical standard and research direction.The aim of the experiment was to investigate the in vivo proton magnetic resonance spectroscopy('H-MRS)and cyclooxygenase-2(COX-2)expression in human glioma,and to explore the relationship and effect between them.Thus we can advance their roles in diagnostic mapping and monitoring of glioma biological behavior,and provide more accurate evaluation for individualized treatmentMaterial and Methods:Thirty-nine patients with different grades of supratentorial glioma(WHO ?-?)receiving treatment in the department of neurosurgery of Qilu Hospital of Shandong University from September 2014 to April 2016.There were 23 males and 16 females,age from 24 to 66 years old,and the average age was 47.All cases were single primary glioma without any treatment before.Patients underwent plain and enhanced MRI scanning and multi voxel 1H-MRS examination at 3.0T.The ratio of Cho/Cr,NAA/Cr,and Cho/NAA were measured on both tumor side and normal brain at anatomy symmetrical position as the control area.Analysis of tumor morphology and metabolism of 1 H-MRS were independently assessed by two experienced radiologists.The samplings were picked up in the solid area of the tumor.Each sample was divided into two parts:the pathology diagnosis and COX-2 immunohistochemical staining.Data analysis was applied SPSS 17 software.The relationship between 1H-MRS and COX-2 was assessed using parametric and non-parametric tests,including correlation analysis,COX survival risk model,and the risk analysis of prognosis in patients with high-grade gliomas after radiotherapy.Results:1.The expression of COX-2 was significantly different between low and high grade gliomas(P<0.01).Different levels of COX-2 were positively correlated with tumor Cho/Cr(r = 0.49,P = 0.013)and showed no significant correlation with gender,age,and tumor location.2.Cho/Cr,NAA/Cr and Cho/NAA in tumor area were significantly different from those in normal control(P<0.01).The ratios showed significant difference(P<0.01)between low and high grade glioma3.Univariate analysis showed that high COX-2 expression was associated with shorter survival(P = 0.048)in patients with high-grade gliomas who underwent tumor resection and postoperative radiotherapy.Multivariate survival analysis showed that COX-2,Cho/Cr and age were important prognostic factors for patients with high-grade gliomas.Conclusion:1.The expression level of COX-2 in human gliomas was positively correlated with the Cho/Cr value in the in vivo 1H-MRS.2.They are associated with overall survival in patients with high-grade gliomas after surgery and radiotherapy,and can be combined as a joint role to provide more information to assess the biological behavior of glioma.