脑膜瘤主要是良性的，但有些病例在手术后表现出复发性生长，并发生恶性转化，达到 WHO 2 级或 3 级。尽管遗传分析取得了进展，但代谢组学分析的进展仍然不太确定。在此，作者通过使用质子磁共振波谱 (1H-MRS) 无创性研究了 WHO 1 级脑膜瘤和 WHO 2 级或 3 级脑膜瘤之间的代谢活性差异，旨在术前评估恶性肿瘤。他们还回顾了文献以阐明脑膜瘤研究的这方面。 在琉球大学医院，作者重点关注了 2011 年至 2021 年间诊断为脑膜瘤的 93 名患者。纳入标准包括既往手术、脑膜瘤的病理诊断和术前 1H-MRS。第一组包括 71 名 WHO 1 级脑膜瘤患者，第二组包括 22 名患者，分别包括 19 名和 3 名 WHO 2 级和 3 级脑膜瘤患者。作者回顾性地对患者背景和肿瘤代谢物进行了比较分析。I组和II组在患者人口统计特征（年龄和性别）方面没有显着差异。第二组的肿瘤切除程度显着降低 (p < 0.01)，MIB-1 标记指数 (LI) 较高 (p < 0.05)，既往照射发生率较高 (p < 0.001)，肿瘤复发率增加 (p < 0.001) = 0.005）与第 I 组相比。根据 1H-MRS，除乳酸外，第 II 组的所有代谢物均显示出显着高于第 I 组的中位肌酸 (Cr) 比率：谷氨酰胺/Cr 为 8.46，谷氨酸/Cr 为 9.49，脂质/ Cr为11.36，胆碱/Cr为2.77。根据受试者工作特征（ROC）分析，谷氨酰胺在10种代谢物中曲线下面积最大，为0.765，区分I组和II组的截止值为5.76。病理分级为WHO 2级或3级脑膜瘤的病例、谷氨酰胺、谷氨酸、脂质、胆碱等代谢产物显着增加。这些变化与 MIB-1 LI 的升高相关。在第 II 组中，平均 MIB-1 LI 为 8.58，显着高于第 I 组，表明与病理恶性肿瘤有很强的相关性。因此，1H-MRS可能有助于无创地预测肿瘤代谢活动和肿瘤复发。此外，作者从 ROC 分析中得出结论，谷氨酰胺可能是脑膜瘤未来生长和早期手术益处的潜在指标。

Meningiomas are predominantly benign, but some cases exhibit recurrent growth after surgery and undergo malignant transformation to WHO grade 2 or grade 3. Despite progress in genetic analyses, advancements in metabolomic analysis remain less established. Herein, the authors investigated metabolic activity differences between WHO grade 1 meningiomas and WHO grade 2 or 3 meningiomas by noninvasively using proton magnetic resonance spectroscopy (1H-MRS), aiming to preoperatively estimate malignancy. They also reviewed the literature to elucidate this aspect of meningioma research.At Ryukyu University Hospital, the authors focused on 93 patients diagnosed with meningioma between 2011 and 2021. The inclusion criteria encompassed prior surgery, pathological diagnoses of meningioma, and preoperative 1H-MRS. Group I included 71 patients with WHO grade 1 meningioma and group II included 22 patients, comprising 19 and 3 with WHO grade 2 and 3 meningioma, respectively. The authors retrospectively conducted a comparative analysis of patient backgrounds and tumor metabolites.Group I and II did not differ significantly in terms of patient demographic characteristics (age and sex). Group II demonstrated a significantly lower extent of tumor resection (p < 0.01), higher MIB-1 labeling index (LI) (p < 0.05), higher incidence of prior irradiation (p < 0.001), and increased rate of tumor recurrence (p = 0.005) compared to group I. According to 1H-MRS, all metabolites, except lactate, displayed significantly higher median creatine (Cr) ratios in group II than group I: glutamine/Cr was 8.46, glutamate/Cr was 9.49, lipid/Cr was 11.36, and choline/Cr was 2.77. According to the receiver operating characteristic (ROC) analysis, glutamine had the largest area under the curve of 0.765 among 10 metabolites, and the cutoff value for distinguishing between group I and II was 5.76.In cases pathologically graded as WHO grade 2 or 3 meningiomas, metabolic products such as glutamine, glutamate, lipids, and choline increased significantly. These changes were correlated with elevation of the MIB-1 LI. In group II, the mean MIB-1 LI was 8.58, significantly higher than in group I, suggesting a strong association with pathological malignancy. Therefore, 1H-MRS may help to noninvasively predict tumor metabolic activity and tumor recurrence. Furthermore, the authors concluded from the ROC analysis that glutamine may be a potential indicator of future growth of meningioma and benefits of early surgery.