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<article article-type="research-article" dtd-version="1.3" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xml:lang="ru"><front><journal-meta><journal-id journal-id-type="publisher-id">vmireaviz</journal-id><journal-title-group><journal-title xml:lang="ru">Вестник медицинского института «РЕАВИЗ». Реабилитация, Врач и Здоровье</journal-title><trans-title-group xml:lang="en"><trans-title>Bulletin of the Medical Institute "REAVIZ" (REHABILITATION, DOCTOR AND HEALTH)</trans-title></trans-title-group></journal-title-group><issn pub-type="ppub">2226-762X</issn><issn pub-type="epub">2782-1579</issn><publisher><publisher-name>РЕАВИЗ</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.20340/vmi-rvz.2025.4.MIM.3</article-id><article-id custom-type="elpub" pub-id-type="custom">vmireaviz-1310</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="ru"><subject>Медицинская визуализация</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="en"><subject>Medical Imaging</subject></subj-group></article-categories><title-group><article-title>Протонная магнитно-резонансная спектроскопия (¹H-magnetic resonance spectroscopy) в оценке метаболических изменений перифокальной зоны при глиомах высокой степени злокачественности (обзор литературы)</article-title><trans-title-group xml:lang="en"><trans-title>Proton magnetic resonance spectroscopy (1h-magnetic resonance spectroscopy) in assessing metabolic changes in the perifocal zone in high-grade gliomas (literature review)</trans-title></trans-title-group></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0001-5439-4189</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Сидорина</surname><given-names>А. С.</given-names></name><name name-style="western" xml:lang="en"><surname>Sidorina</surname><given-names>A. S.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Сидорина Анастасия Сергеевна, Врач-рентгенолог отделения магнитно-резонансной томографии, аспирант кафедры лучевой диагностики и медицинской визуализации с клиникой института медицинского образования Вклад автора: научное обоснование, методология, верификация данных, анализ данных, анализ литературных источников.</p><p>ул. Аккуратова, д. 2, г. Санкт-Петербург, 197341</p></bio><bio xml:lang="en"><p>Anastasiya S. Sidorina, Radiologist at the Department of Magnetic Resonance Imaging, postgraduate student at the Department of Radiation Diagnostics and Medical Imaging at the Clinic of the of the Institute of Medical Education Author’s contribution: scientific justification, methodology, data verification, data analysis, analysis of literary sources.</p><p>Akkuratova St., 2. St. Petersburg, 197341</p></bio><email xlink:type="simple">anastasia-sidorinaa@yandex.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0009-0000-5601-7862</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Просалова</surname><given-names>Н. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Prosalova</surname><given-names>N. V.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Просалова Наталия Валерьевна, Врач рентгенолог отделения лучевой диагностики Вклад автора: научное обоснование, методология, верификация данных, анализ данных, анализ литературных источников.</p><p>Ленинградская ул., д. 68А, пос. Песочный, Санкт-Петербург, 197758</p></bio><bio xml:lang="en"><p>Nataliya V. Prosalova, Radiologist at the Department of Radiation Diagnostics Author's contribution: scientific substantiation, methodology, data verification, data analysis, analysis of literary sources.</p><p>Leningradskaya St., 68A, village Pesochny, St. Petersburg, 197758</p></bio><email xlink:type="simple">prosalova98@inbox.ru</email><xref ref-type="aff" rid="aff-2"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0009-0007-3646-4439</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Дорохова</surname><given-names>Д. Д.</given-names></name><name name-style="western" xml:lang="en"><surname>Dorokhova</surname><given-names>D. D.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Дорохова Дария Дмитриевна, Ординатор кафедры лучевой диагностики и медицинской визуализации с клиникой института медицинского образования Вклад автора: сбор и обработка материала, написание и редактирование текста.</p><p>ул. Аккуратова, д. 2, г. Санкт-Петербург, 197341</p></bio><bio xml:lang="en"><p>Daria D. Dorokhova, Resident of the Department of Radiation Diagnostics and Medical Imaging with the clinic of the Institute of Medical Education Author's contribution: collecting and processing material, writing and editing text.</p><p>Akkuratova St., 2. St. Petersburg, 197341</p></bio><email xlink:type="simple">dariadorokhowa@yandex.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0003-1545-8877</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Прокудин</surname><given-names>М. Ю.</given-names></name><name name-style="western" xml:lang="en"><surname>Prokudin</surname><given-names>M. Yu.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Прокудин Михаил Юрьевич, Канд. мед. наук, ассистент кафедры нервных болезней Вклад автора: сбор и обработка материала, написание и редактирование текста.</p><p>ул. Академика Лебедева, д. 6, Санкт-Петербург, 194044</p></bio><bio xml:lang="en"><p>Mikhail Yu. Prokudin, Cand. Sci. (Med.), Assistant Professor at the Department of Nervous Diseases Author's contribution: collecting and processing material, writing and editing text.</p><p>Academician Lebedev St., 6, lit. Zh, St. Petersburg, 194044</p></bio><email xlink:type="simple">prmihail@mail.ru</email><xref ref-type="aff" rid="aff-3"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-8459-2466</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Мартынов</surname><given-names>Б. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Martynov</surname><given-names>B. V.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Мартынов Борис Владимирович, Д-р мед. наук, доцент, заведующий отделением, врач-нейрохирург кафедры нейрохирургии Вклад автора: сбор и обработка материала, написание и редактирование текста.</p><p>ул. Академика Лебедева, д. 6, Санкт-Петербург, 194044</p></bio><bio xml:lang="en"><p>Boris V. Martynov, Dr. Sci. (Med.), Docent, Neurosurgeon at the Department of Neurosurgery Author's contribution: collecting and processing material, writing and editing text.</p><p>Academician Lebedev St., 6, lit. Zh, St. Petersburg, 194044</p></bio><email xlink:type="simple">omartynova2005@rambler.ru</email><xref ref-type="aff" rid="aff-3"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0001-5226-1104</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Рыжков</surname><given-names>А. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Ryzhkov</surname><given-names>A. V.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Рыжков Антон Владимирович, Врач рентгенолог высшей категории, заведующий отделением магнитно-резонансной томографии Вклад автора: сбор и обработка материала, написание и редактирование текста.</p><p>ул. Аккуратова, д. 2, г. Санкт-Петербург, 197341</p></bio><bio xml:lang="en"><p>Anton V. Ryzhkov, Radiologist of the highest category, Head of the Magnetic Resonance Imaging Department Author's contribution: collecting and processing material, writing and editing text.</p><p>Akkuratova St., 2. St. Petersburg, 197341</p></bio><email xlink:type="simple">pr@almazovcentre.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-1611-5000</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Труфанов</surname><given-names>Г. Е.</given-names></name><name name-style="western" xml:lang="en"><surname>Trufanov</surname><given-names>G. E.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Труфанов Геннадий Евгеньевич, Д-р мед. наук, профессор, заведующий кафедрой лучевой диагностики и медицинской визуализации с клиникой института медицинского образования Вклад автора: концепция исследования, научное редактирование статьи.</p><p>ул. Аккуратова, д. 2, г. Санкт-Петербург, 197341</p></bio><bio xml:lang="en"><p>Gennadiy E. Trufanov, Dr. Sci. (Med.), Professor of the Department of Radiology Diagnostics and Medical Imaging with the clinic of the Institute Author's contribution: research concept, scientific editing of the article.</p><p>Akkuratova St., 2. St. Petersburg, 197341</p></bio><email xlink:type="simple">trufanovge@mail.ru</email><xref ref-type="aff" rid="aff-1"/></contrib></contrib-group><aff-alternatives id="aff-1"><aff xml:lang="ru"><institution>Национальный медицинский исследовательский центр имени В.А. Алмазова</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Almazov National Research Medical Center</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-2"><aff xml:lang="ru"><institution>Санкт-Петербургский клинический научно-практический центр специализированных видов медицинской помощи (онкологический) имени Н.П. Напалкова</institution><country>Россия</country></aff><aff xml:lang="en"><institution>St. Petersburg Clinical Scientific and Practical Center of specialized types of medical care (oncological) named after N.P. Napalkov</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-3"><aff xml:lang="ru"><institution>Военно-медицинская академия имени С.М. Кирова</institution><country>Россия</country></aff><aff xml:lang="en"><institution>S.M. Kirov Military Medical Academy</institution><country>Russian Federation</country></aff></aff-alternatives><pub-date pub-type="collection"><year>2025</year></pub-date><pub-date pub-type="epub"><day>28</day><month>10</month><year>2025</year></pub-date><volume>15</volume><issue>4</issue><fpage>255</fpage><lpage>263</lpage><permissions><copyright-statement>Copyright &amp;#x00A9; Сидорина А.С., Просалова Н.В., Дорохова Д.Д., Прокудин М.Ю., Мартынов Б.В., Рыжков А.В., Труфанов Г.Е., 2025</copyright-statement><copyright-year>2025</copyright-year><copyright-holder xml:lang="ru">Сидорина А.С., Просалова Н.В., Дорохова Д.Д., Прокудин М.Ю., Мартынов Б.В., Рыжков А.В., Труфанов Г.Е.</copyright-holder><copyright-holder xml:lang="en">Sidorina A.S., Prosalova N.V., Dorokhova D.D., Prokudin M.Y., Martynov B.V., Ryzhkov A.V., Trufanov G.E.</copyright-holder><license xml:lang="ru" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>Данная работа распространяется под лицензией Creative Commons Attribution 4.0.</license-p></license><license xml:lang="en" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>This work is licensed under a Creative Commons Attribution 4.0 License.</license-p></license></permissions><self-uri xlink:href="https://vestnik.reaviz.ru/jour/article/view/1310">https://vestnik.reaviz.ru/jour/article/view/1310</self-uri><abstract><p>Актуальность. Глиомы высокой степени злокачественности характеризуются инфильтративным ростом с возможным наличием опухолевых клеток в перифокальной зоне, что создаёт трудности в определении истинных границ опухоли при использовании стандартных методов МРТ-диагностики. Цель исследования: представить обзор современных публикаций о применении протонной магнитно-резонансной спектроскопии (¹H-MRS) в оценке метаболических изменений перифокальной зоны при глиомах высокой степени злокачественности. Материалы и методы. Проведен систематический анализ публикаций в базах данных PubMed, Scopus, eLibrary и Google Scholar за период 2015–2024 гг. с использованием ключевых слов: "¹H-MRS", "high-grade glioma", "glioblastoma", "peritumoral zone", "metabolic changes". Результаты. Протонная МР-спектроскопия позволяет выявлять метаболические нарушения в перифокальной зоне глиом, включая повышение уровня холина (Cho), снижение N-ацетиласпартата (NAA) и появление лактата (Lac). Наиболее значимыми прогностическими маркерами являются повышенные соотношения Cho/NAA &gt;1,99 и Cho/Cr &gt;1,73, которые коррелируют с ранним рецидивом опухоли и наличием инфильтрирующих опухолевых клеток в зонах, не усиливающихся контрастом. Заключение. Интеграция ¹H-MRS в клинический протокол оценки глиом высокой степени злокачественности повышает точность диагностики, улучшает планирование хирургического вмешательства и лучевой терапии, а также позволяет оптимизировать персонализированные подходы к лечению пациентов.</p></abstract><trans-abstract xml:lang="en"><p>Background. High-grade gliomas are characterized by infiltrative growth with possible presence of tumor cells in the perifocal zone, which creates difficulties in determining the true tumor boundaries when using standard MRI diagnostic methods. Objective: To present a review of current publications on the application of proton magnetic resonance spectroscopy (¹H-MRS) in assessing metabolic changes in the perifocal zone in high-grade gliomas. Materials and methods. A systematic analysis of publications in PubMed, Scopus, eLibrary and Google Scholar databases for the period 2015-2024 was conducted using keywords: "¹H-MRS", "high-grade glioma", "glioblastoma", "peritumoral zone", "metabolic changes". Results. Proton MR spectroscopy allows detection of metabolic disorders in the perifocal zone of gliomas, including increased choline (Cho) levels, decreased N-acetylaspartate (NAA) and appearance of lactate (Lac). The most significant prognostic markers are elevated Cho/NAA ratios &gt;1.99 and Cho/Cr ratios &gt;1.73, which correlate with early tumor recurrence and presence of infiltrating tumor cells in noncontrast enhancing zones. Conclusion. Integration of ¹H-MRS into the clinical protocol for evaluating high-grade gliomas improves diagnostic accuracy, enhances surgical and radiation therapy planning, and allows optimization of personalized treatment approaches for patients</p></trans-abstract><kwd-group xml:lang="ru"><kwd>глиомы высокой степени злокачественности [D018303]</kwd><kwd>протонная МР-спектроскопия [D009682]</kwd><kwd>метаболические маркеры [D015415]</kwd><kwd>перифокальная зона [нет точного MeSH-кода]</kwd><kwd>глиобластома [D005909]</kwd><kwd>холин [D002794]</kwd><kwd>N-ацетиласпартат [D019807]</kwd><kwd>креатин [D003401]</kwd><kwd>лактат [D019344]</kwd></kwd-group><kwd-group xml:lang="en"><kwd>high-grade gliomas [D018303]</kwd><kwd>proton MR spectroscopy [D009682]</kwd><kwd>metabolic markers [D015415]</kwd><kwd>perifocal zone [нет точного MeSH-кода]</kwd><kwd>glioblastoma [D005909]</kwd><kwd>choline [D002794]</kwd><kwd>N-acetylaspartate [D019807]</kwd><kwd>creatine [D003401]</kwd><kwd>lactate [D019344]</kwd></kwd-group></article-meta></front><back><ref-list><title>References</title><ref id="cit1"><label>1</label><citation-alternatives><mixed-citation xml:lang="ru">Louis D.N., Perry A., Wesseling P., Brat D.J., Cree I.A., Figarella-Branger D. et al. 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