Correlation between Choline Level Measured by Proton MR Spectroscopy and Ki-67 Labeling Index in Gliomas
Hiroaki Shimizu
,a,
Toshihiro Kumabea,
Reizo Shiranea and
Takashi Yoshimotoa
a From the Department of Neurosurgery, Kohnan Hospital (H.S.); and the Department of Neurosurgery, Tohoku University School of Medicine (T.K., R.S., T.Y.), Sendai, Japan.
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FIG 1. A–C, Relationships between the Ki-67 labeling index and the Cho value (A), the Cho/Cr ratio (B), and the Cho/NAA ratio (C). Open circles indicate that the spectroscopic voxel is homogeneous on MR images with absent, faint, or homogeneous enhancement by contrast material. Closed circles indicate that the spectroscopic voxel is heterogeneous on MR images before or after contrast administration (cases 17–24, Table). There is a strong linear relationship between the Ki-67 labeling index and the Cho value, indicated by open circles (y = 1.24 + 0.34 * x, r = .81, P < .0001). There is a weak correlation between the Ki-67 labeling index and the Cho/Cr or Cho/NAA ratio, indicated by open circles (y = 1.22 + 0.15 * x, r = .58, P < .02 and y = 0.65 + 0.23 * x, r = .60, P < .02, respectively). Extreme data for the Cho/NAA ratio from cases 6, 13, and 25 are not shown in the graph.
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FIG 2. Case 11: A typical case in which the spectroscopic voxel is homogeneous without contrast enhancement.
A, Contrast-enhanced T1-weighted MR image shows the spectroscopic voxel (square) filled with unenhanced homogeneous tumor.
B, Proton spectrum obtained from the region indicated in A shows a Cho value of 2.06.
C, Photomicrograph of the resected tumor indicates anaplastic astrocytoma (grade 3) (hematoxylin-eosin, original magnification x100).
D, Photomicrograph of Ki-67 staining of the same tumor specimen shows a Ki-67 labeling index of 3.10% (original magnification x100).
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FIG 3. A and B, T1-weighted MR images of case 8 (A) and case 25 (B) in which the spectroscopic voxel is homogeneous and only faintly enhanced. The voxels for MR spectroscopy are indicated by squares. These contrast-enhanced images were obtained after spectroscopic examinations, and the location of the voxels was superimposed afterward. Note that in case 25, the tumor outside the voxel is heterogeneous
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FIG 4. Case 18: A typical case in which the spectroscopic voxel is heterogeneous on MR images before and after contrast agent administration.
A, T1-weighted MR image shows the spectroscopic voxel (square) filled with heterogeneous tumor, including intratumoral hemorrhage appearing as a hyperintense area.
B, Contrast-enhanced T1-weighted MR image shows heterogeneous enhancement within the voxel.
C, Proton spectrum obtained from the region indicated in A shows a Cho value of 5.21.
D, Photomicrograph of the resected tumor indicates glioblastoma multiforme (grade 4) (hematoxylin-eosin, original magnification x100).
E, Photomicrograph of Ki-67 staining of the same tumor specimen shows a Ki-67 labeling index of 50.20% (original magnification x100).
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FIG 5. A and B, Contrast-enhanced T1-weighted MR images of case 19 (A) and case 22 (B) in which the spectroscopic voxel appearance is heterogeneous. The voxels for MR spectroscopy are indicated by squares. These contrast-enhanced images were obtained after spectroscopic examination, and the location of the voxels was superimposed afterward
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