目的 探讨脑胶质瘤瘤体与瘤周 水肿区的相关代谢物磁共振表观弥散系 数(ADC)值及氢质子磁共振波谱(1 H-MRS) 物比值与p53基因突变表达的相关性及 其应用价值。方法 2011年9月至2015年 12月收集脑胶质瘤病人30例，术前均行 常规MR扫描、1 H-MRS及DWI扫描，术后对 瘤体及瘤周组织进行p53基因突变表达的 检测；对比分析瘤体及瘤周感兴趣区主 要代谢产物N-乙酰天门冬氨酸(NAA)、胆 碱(Cho)、肌酸(Cr)比值及ADC值与相应 肿瘤组织p53基因突变表达的相关性。结 果 (1)胶质瘤瘤体及瘤周Cho/NAA比值与 p53基因突变表达呈正相关(r=0.621， P=0.012；r=0.421，P=0.022)；胶质瘤瘤 体Cho/Cr比值与p53基因突变表达呈正相 关(r=0.901，P=0.019)；(2)胶质瘤瘤周 水肿区Cho/Cr比值与p53基因突变表达不 相关(P=0.431)；瘤体及瘤周NAA/Cr比值 与p53基因突变表达均不相关(P=0.912， P=0.742)。(3)胶质瘤瘤体ADC值与p53 基因突变表达呈负相关(r=-0.792， P=0.014)；瘤周ADC值与p53基因突变表 达表达不相关(P=0.291)。结论 DWI检查 及氢质子磁共振波谱(1 H-MRS)检查均可以 准确反应脑胶质瘤p53基因突变表达的情 况，其中Cho/NAA比值的诊断价值最高， 应用这些指标可以准确的评价胶质瘤恶性 基因突变表达的生物学行为。

Objective To investigate the correlation of 1 H-MRS, ADC value with mutation of p53 gene in brain gliomas and peritumoral edema region, which could improve application values. Methods Between September 2011 and December 2015, the MR scanning, 1 H-MRS, and DWI were conventionally performed before the operations in 30 patients with gliomas diagnosed by the postoperative pathological examination. Postoperative mutation of p53 gene was detected in parenchyma region. N-acetyl aspartic acid (NAA), choline (Cho), creatine (Cr), which were main metabolic products in the glioma parenchyma and peritumoral edema region, The correlativity of Cho/NAA、 Cho/Cr、NAA/Cr and ADC with P53 expression in tumor was analyzed. Results (1) The Cho/NAA ratio was positively correlated with the mutation of p53 gene in brain gliomas and peritumoral edema region (r=0.621, P=0.012, r=0.421, P=0.022), the Cho/ Cr ratio was positively correlated with the mutation of p53 gene in brain gliomas(r=0.901, P=0.019). (2)The Cho/Cr ratio was not correlated with the mutation of p53 gene in peritumoral edema region(P=0.431). The NAA/Cr ratio was not correlated with the mutation of p53 gene (P=0.912,P=0.742) in brain gliomas and peritumoral edema region. (3)The ADC values was negatively correlated with mutation of p53 gene(r=-0.792, P=0.014). The ADC values was not correlated with mutation of p53 gene(P=0.291) in peritumoral edema region. Conclusion DWI examination and 1 H-MRS can effectively show the mutation of p53 gene in the glioma, especially Cho/NAA ratio is highest, these indicators could exactly evaluate mutation of p53 gene forglioma.