非典型脑膜瘤和复发性脑膜瘤的代谢分析：质子磁共振光谱的比较分析

脑膜瘤主要是良性的，但是某些病例在手术后表现出复发性的生长，并经历了WHO 2级或3级3级的恶性转化。尽管遗传分析的进展，但代谢组分析的进步仍然较少。在此，作者研究了WHO 1级脑膜瘤与WHO 2或3级脑膜瘤之间的代谢活性差异，该元素使用质子磁共振光谱（1H-MRS），旨在术前估计恶性肿瘤。他们还回顾了文献，以阐明脑膜瘤研究的这一方面。在鲁京大学医院，作者重点介绍了2011年至2021年间诊断出患有脑膜瘤的93例患者。纳入标准涵盖了先前的手术，脑膜瘤的病理学诊断和术前1H-MR。 I组包括71名WHO 1级脑膜瘤和II组患者，其中包括22例患者，分别包括19和3级患者，分别为WHO 2和3级脑膜瘤。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和II组在患者人口特征（年龄和性别）方面没有显着差异。第二组证明肿瘤切除程度明显较低（P <0.01），MIB-1标记指数（LI）（p <0.05）（p <0.05），先前照射的发生率更高（P <0.001）（P <0.001），肿瘤复发率提高，根据1H-mrs，分类均高于lactabolites，均具有较高的分类率，均高于组，均高于II的组合（P = 0.005）。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。根据接收器的操作特征（ROC）分析，谷氨酰胺在10种代谢产物中的曲线下最大的面积为0.765，并且区分I组和II组的截止值为5.76。这些变化与MIB-1 LI的升高相关。在II组中，平均MIB-1 LI为8.58，明显高于I组，这表明与病理恶性肿瘤有着密切的关联。因此，1H-MR可能有助于非侵入性预测肿瘤代谢活性和肿瘤复发。此外，作者从ROC分析得出结论，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.