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• Clinical Article •
The relative level of choline: the value in the preoperative evaluation of cerebral glioma grading and the correlation with cell proliferation in gliomas
SHI Da-fa  GUAN Li-ming  QI Xi-xun  WEI Wei  WANG Yu-rui  REN Si-xie  TONG Zhi-yong  LI Qing-chang 

DOI:10.3969/j.issn.1674-8034.2015.09.001.


[Abstract] Objective: To investigate the value of the relative level of choline measured by proton magnetic resonance spectroscopy in the preoperative evaluation of cerebral gliomas grading and the correlation with cell proliferation in gliomas.Materials and Methods: Fifty-eight patients with cerebral gliomas confirmed by histopathology were collected. All patients were performed with 1H-MRS. On the basis of the histopathological diagnosis, the patients were classified into three groups: grade Ⅰ—Ⅱ (low-grade), 25 cases, grade Ⅲ, 19, grade Ⅳ, 14. Those whose grades were Ⅲ or Ⅳ were classified into high-grade gliomas group that included 33 cases. The regions of the maximum Cho/Cr value in solid portion of the tumors and the contralateral normal white matter were selected as regions of interest (ROI). The values of Cho/NAA, Cho/Cr, relative Cho/NAA (rCho/NAA) and relative Cho/Cr (rCho/Cr) of ROIs were obtained. Ki-67 grading was defined as follow: labeling index (LI) <5% is negative (-), 5%≤LI<25% is weakly positive(+), 25%≤LI<50% is positive (++), and LI ≥50% is strongly positive (+++). The differences of parameters of the relative level of choline among three groups were analyzed, if the parameters of the relative level of choline had no significant difference between grade Ⅲ and Ⅳ gliomas, we compared the difference between low-grade and high-grade gliomas. The optimum diagnostic thresholds of the parameters were achieved by using receiver operating characteristic curve (ROC), and we calculated the area under the curve (AUC), sensitivity, specificity and accuracy. The correlation between Ki-67 grading and glioma grading, and the correlation between Ki-67 grading and parameters of the relative level of choline were analyzed.Result: The Cho/NAA, Cho/Cr, rCho/NAA and rCho/Cr values of solid portions of tumor of grade Ⅲ and grade Ⅳ gliomas were significantly higher than that of grade Ⅰ—Ⅱ gliomas (P<0.05), however, there was no significant difference between grade Ⅲ and grade Ⅳ gliomas (P>0.05). There were significant differences between low-grade and high-grade gliomas (P<0.05). In the parameters of the relative level of choline to differentiate high-grade gliomas from low-grade gliomas, the accuracy of Cho/NAA was the highest, which equaled to 81.0%, and the threshold was 3.04. The AUC of rCho/Cr was maximum, which was 0.823, and the threshold and accuracy were 2.70 and 77.6%, respectively. There was significant difference between different grade gliomas in Ki-67 grading, and there was a positive correlation between Ki-67 grading and gliomas grading (r=0.741, P<0.05). Cho/NAA, Cho/Cr and rCho/Cr had positive correlation with Ki-67 grading (r were 0.313, 0.444 and 0.336, respectively, P<0.05).Conclusions: The relative level of choline is a great indicator that can indicate the state of gliomas cell proliferation and evaluate the level of malignant, it is helpful for classification of cerebral gliomas grading before operation.
[Keywords] Glioma；Magnetic resonance spectroscopy；Choline；Cell proliferation

SHI Da-fa Department of Radiology, the First Affiliated Hospital of China Medical University, Shenyang 110001, China

GUAN Li-ming* Department of Radiology, the First Affiliated Hospital of China Medical University, Shenyang 110001, China

QI Xi-xun Department of Radiology, the First Affiliated Hospital of China Medical University, Shenyang 110001, China

WEI Wei Department of Radiology, the First Affiliated Hospital of China Medical University, Shenyang 110001, China

WANG Yu-rui Department of Radiology, the First Affiliated Hospital of China Medical University, Shenyang 110001, China

REN Si-xie Department of Radiology, the First Affiliated Hospital of China Medical University, Shenyang 110001, China

TONG Zhi-yong Department of Neurosurgery, the First Affiliated Hospital of China Medical University, Shenyang 110001, China

LI Qing-chang Department of pathology, the First Affiliated Hospital of China Medical University, Shenyang 110001, China

*Correspondence to: Guan LM, E-mail: guanlm66@126.com

Conflicts of interest   None.

ACKNOWLEDGMENTS  This work was part of the General Program of National Natural Science Foundation of China No. 81101035
Received  2015-06-16
Accepted  2015-08-02
DOI: 10.3969/j.issn.1674-8034.2015.09.001
DOI:10.3969/j.issn.1674-8034.2015.09.001.

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