Abstract：
OBJECTIVE: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.
摘要：
目的：脑膜瘤主要是良性的，但一些病例在手术后表现出复发性生长,并经历了WHO2级或3级的恶性转化。尽管基因分析取得了进展，代谢组学分析的进展还不太成熟。在这里，作者使用质子磁共振波谱（1H-MRS）非侵入性研究了WHO1级脑膜瘤与WHO2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一方面。
方法：在琉球大学医院，作者重点研究了2011年至2021年间诊断为脑膜瘤的93例患者.纳入标准包括先前的手术，脑膜瘤的病理诊断，术前1H-MRS。第一组包括71例WHO1级脑膜瘤患者，第二组包括22例患者，包括19和3，患有WHO2级和3级脑膜瘤，分别。作者对患者背景和肿瘤代谢物进行了回顾性分析。
结果：I组和II组在患者人口统计学特征（年龄和性别）方面没有显著差异。II组显示肿瘤切除程度明显较低（p<0.01），较高的MIB-1标记指数（LI）（p<0.05），较高的先前照射发生率(p<0.001)，与I组相比，肿瘤复发率增加（p=0.005）。根据1H-MRS，所有代谢物，除了乳酸,II组的中位数肌酸（Cr）比率明显高于I组：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。根据接收机工作特性(ROC)分析,在10种代谢物中，谷氨酰胺的曲线下面积最大，为0.765，区分I组和II组的截断值为5.76。
结论：在病理分级为WHO2级或3级脑膜瘤的病例中，代谢产物，如谷氨酰胺，谷氨酸,脂质，胆碱显著增加。这些变化与MIB-1LI的升高相关。在第二组中，平均MIB-1LI为8.58，显著高于I组，提示与病理性恶性肿瘤有很强的关联。因此,1H-MRS可能有助于无创预测肿瘤代谢活性和肿瘤复发。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获益的潜在指标.
方法：在琉球大学医院，作者重点研究了2011年至2021年间诊断为脑膜瘤的93例患者.纳入标准包括先前的手术，脑膜瘤的病理诊断，术前1H-MRS。第一组包括71例WHO1级脑膜瘤患者，第二组包括22例患者，包括19和3，患有WHO2级和3级脑膜瘤，分别。作者对患者背景和肿瘤代谢物进行了回顾性分析。
结果：I组和II组在患者人口统计学特征（年龄和性别）方面没有显著差异。II组显示肿瘤切除程度明显较低（p<0.01），较高的MIB-1标记指数（LI）（p<0.05），较高的先前照射发生率(p<0.001)，与I组相比，肿瘤复发率增加（p=0.005）。根据1H-MRS，所有代谢物，除了乳酸,II组的中位数肌酸（Cr）比率明显高于I组：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。根据接收机工作特性(ROC)分析,在10种代谢物中，谷氨酰胺的曲线下面积最大，为0.765，区分I组和II组的截断值为5.76。
结论：在病理分级为WHO2级或3级脑膜瘤的病例中，代谢产物，如谷氨酰胺，谷氨酸,脂质，胆碱显著增加。这些变化与MIB-1LI的升高相关。在第二组中，平均MIB-1LI为8.58，显著高于I组，提示与病理性恶性肿瘤有很强的关联。因此,1H-MRS可能有助于无创预测肿瘤代谢活性和肿瘤复发。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获益的潜在指标.
