Use of proton magnetic resonance spectroscopy of the brain to differentiate gliomatosis cerebri from low-grade glioma

2003 ◽  
Vol 98 (2) ◽  
pp. 269-276 ◽  
Author(s):  
Damien Galanaud ◽  
Olivier Chinot ◽  
François Nicoli ◽  
Sylviane Confort-Gouny ◽  
Yann Le Fur ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Mr Spectroscopy ◽  
Proton Magnetic Resonance ◽  
Cellular Proliferation ◽  
Gliomatosis Cerebri ◽  
Resonance Spectroscopy ◽  
Low Grade ◽  
Metabolic Pattern ◽  
Content Type ◽  
Fine Print

Object. Gliomatosis cerebri (GC), a rare entity characterized by a widespread infiltration of brain by tumor, lacks objective and quantitative diagnostic criteria. Single-voxel spectroscopy and chemical shift imaging (two-dimensional proton magnetic resonance [MR] spectroscopy) were performed using both short (20- or 22-msec) and long (135-msec) echo times in nine patients suffering from GC, nine patients with low-grade gliomas (LGGs), and 25 healthy volunteers to establish the precise metabolic pattern of this uncommon brain neoplasm. Methods. The gliomatosis infiltration was characterized by markedly elevated levels of creatine—phosphocreatine (Cr) and myo-inositol (Ins), a reduced level of N-acetyl aspartate (NAA), and a moderately elevated level of choline-containing compounds (Cho). This pattern differs strikingly from LGGs, which are characterized by elevated levels of Cho and Ins, markedly reduced levels of NAA, and low-to-normal Cr concentrations. Although the distinction between GC and LGG, based on histological and MR imaging criteria, is a matter of debate, MR spectroscopy produces valuable information for the differentiation between these two entities and, hence, the choice of therapeutic strategy. It also provides new insight into the pathophysiology of GC because elevated Cr and Ins levels may be related to proliferation of glial elements or, more probably, activation of normal glia. Elevated levels of Cho reflect cellular proliferation and reduced NAA corresponds to reversible neuronal injury and/or focal invasion by the tumor process. Conclusions. Owing to the unfavorable clinical outcome associated with GC compared with that associated with LGG, the findings of this study illustrate the diagnostic and prognostic value of proton MR spectroscopy in the characterization of infiltrating gliomas.

High-resolution 1H-magnetic resonance spectroscopy of pediatric posterior fossa tumors in vitro

1994 ◽  
Vol 81 (3) ◽  
pp. 443-448 ◽  
Author(s):  
Leslie N. Sutton ◽  
Suzanne L. Wehrli ◽  
Laura Gennarelli ◽  
Zhiyue Wang ◽  
Robert Zimmerman ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
High Resolution ◽  
Posterior Fossa ◽  
Mr Spectroscopy ◽  
Resonance Spectroscopy ◽  
Content Type ◽  
Primitive Neuroectodermal Tumors ◽  
Neuroectodermal Tumors ◽  
Fine Print

✓ High-resolution proton magnetic resonance (MR) spectroscopy was performed on perchlorate extracts of tumors (24 cases) or peritumoral vermis (five cases) obtained at surgery. Fifteen tumors were typical cerebellar astrocytomas and nine were posterior fossa primitive neuroectodermal tumors/medulloblastomas. Spectra obtained from the five samples of peritumoral vermis revealed a pattern of metabolites similar to that reported for cerebellar tissue, but concentrations of most metabolites were low, perhaps due to dilution from peritumoral edema. The astrocytomas were characterized by high levels of valine, alanine, and choline, an increase in the choline:N-acetylaspartate (NAA) ratio, and a shift from glutamate to glutamine. Elevations in lactate, pyruvate, and glucose were the result of ischemia during sampling. The primitive neuroectodermal tumors/medulloblastomas were distinguished from astrocytomas by a greater increase in the choline:NAA ratio, a smaller decrease in the glutamate:glutamine ratio, and a relative increase in glycine, taurine, and inositol levels. These metabolic patterns may be of value diagnostically as in vivo MR spectroscopy achieves higher resolution.

Assessment of cerebral S100B levels by proton magnetic resonance spectroscopy after lateral fluid-percussion injury in the rat

2005 ◽  
Vol 102 (6) ◽  
pp. 1115-1121 ◽  
Author(s):  
Andrea Kleindienst ◽  
Christos M. Tolias ◽  
Frank D. Corwin ◽  
Christian Müller ◽  
Anthony Marmarou ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Mr Spectroscopy ◽  
Proton Magnetic Resonance ◽  
Proton Mr Spectroscopy ◽  
Content Type ◽  
Serum S100b ◽  
Fluid Percussion ◽  
Fluid Percussion Injury ◽  
Lateral Fluid Percussion ◽  
Fine Print

Object. After traumatic brain injury (TBI), S100B protein is released by astrocytes. Furthermore, cerebrospinal fluid (CSF) and serum S100B levels have been correlated to outcome. Given that no data exist about the temporal profile of cerebral S100B levels following TBI and their correlation to serum levels, the authors examined whether proton magnetic resonance (MR) spectroscopy is capable of measuring S100B. Methods. Results of in vitro proton MR spectroscopy experiments (2.35-tesla magnet, 25 G/cm, point-resolved spatially localized spectroscopy) revealed an S100B-specific peak at 4.5 ppm and confirmed a positive correlation between different S100B concentrations (10 nM–1 µM) and the area under the curve (AUC) for the S100B peak (r = 0.991, p < 0.001). Thereafter, proton MR spectroscopy was performed in male Sprague—Dawley rats (7 × 5 × 5—mm voxel in each hemisphere, TR 3000 msec, TE 30 msec, 256 acquisitions). Exogenously increased CSF S100B levels (∼ 200 ng/ml) through the intraventricular infusion of S100B increased the AUC of the S100B peak from 0.06 ± 0.02 to 0.44 ± 0.06 (p < 0.05), whereas serum S100B levels remained normal. Two hours after lateral fluid-percussion injury, serum S100B levels increased to 0.61 ± 0.09 ng/ml (p < 0.01) and rapidly returned to normal levels, whereas the AUC of the S100B peak increased to 0.19 ± 0.04 at 2 hours postinjury and 0.41 ± 0.07 (p < 0.05) on Day 5 postinjury. Conclusions. Proton MR spectroscopy proves a strong correlation between the AUC of the S100B peak and S100B concentrations. Following experimental TBI, serum S100B levels increased for only a very short period, whereas cerebral S100B levels were increased up to Day 5 postinjury. Given that experimental data indicate that S100B is actively released following TBI, proton MR spectroscopy may represent a new tool to identify increased cerebral S100B levels in patients after injury, thus allowing its biological function to be better understood.

Serial proton magnetic resonance spectroscopy imaging of glioblastoma multiforme after brachytherapy

1997 ◽  
Vol 87 (4) ◽  
pp. 525-534 ◽  
Author(s):  
Lawrence L. Wald ◽  
Sarah J. Nelson ◽  
Mark R. Day ◽  
Susan E. Noworolski ◽  
Roland G. Henry ◽  
...  
Keyword(s):  
Glioblastoma Multiforme ◽  
Magnetic Resonance ◽  
Proton Magnetic Resonance ◽  
Proton Magnetic Resonance Spectroscopy ◽  
Radiation Necrosis ◽  
Resonance Spectroscopy ◽  
Recurrent Tumor ◽  
Imaging Data ◽  
Content Type ◽  
Fine Print

✓ The utility of three-dimensional (3-D) proton magnetic resonance spectroscopy (1H-MRS) imaging for detecting metabolic changes after brain tumor therapy was assessed in a serial study of 58 total examinations of 12 patients with glioblastoma multiforme (GBM) who received brachytherapy. Individual proton spectra from the 3-D array of spectra encompassing the lesion showed dramatic differences in spectral patterns indicative of radiation necrosis, recurrent or residual tumor, or normal brain. The 1H-MRS imaging data demonstrated significant differences between suspected residual or recurrent tumor and contrast-enhancing radiation-induced necrosis. Regions of abnormally high choline (Cho) levels, consistent with viable tumor, were detected beyond the regions of contrast enhancement for all 12 gliomas. Changes in the serial 1H-MRS imaging data were observed, reflecting an altered metabolism following treatment. These changes included the significant reduction in Cho levels after therapy, indicating the transformation of tumor to necrotic tissue. For patients who demonstrated subsequent clinical progression, an increase in Cho levels was observed in regions that previously appeared either normal or necrotic. Several patients showed regional variations in response to brachytherapy as evaluated by 1H-MRS imaging. This study demonstrates the potential of noninvasive 3-D 1H-MRS imaging to discriminate between the formation of contrast-enhancing radiation necrosis and residual or recurrent tumor following brachytherapy. This modality may also allow better definition of tumor extent prior to brachytherapy by detecting the presence of abnormal metabolite levels in nonenhancing regions of solid tumor.

Noninvasive evaluation of the malignant potential of intracranial meningiomas performed using proton magnetic resonance spectroscopy

1999 ◽  
Vol 91 (6) ◽  
pp. 928-934 ◽  
Author(s):  
Akihiko Shiino ◽  
Satoshi Nakasu ◽  
Masayuki Matsuda ◽  
Jyoji Handa ◽  
Shigehiro Morikawa ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Mr Spectroscopy ◽  
Tumor Grade ◽  
Resonance Spectroscopy ◽  
Proton Mr Spectroscopy ◽  
Content Type ◽  
The Mean ◽  
Benign Group ◽  
Fine Print ◽  
Mib 1

Object. Controversy exists about correlations between histological tumor grade and magnetic resonance (MR) spectroscopy data. The authors studied single-voxel proton MR spectroscopy as a noninvasive way to evaluate grade of malignancy in intracranial meningiomas.Methods. The authors compared the results of MR spectroscopy with those derived by the MIB-1 staining index (SI) in 29 meningiomas. Proton MR spectroscopy was performed using stimulated echo acquisition and volume-localized solvent-attenuated proton nuclear MR sequences before surgery or other therapy.Twenty-four tumors were histologically benign (13 meningothelial, three fibrous, four transitional, three angiomatous, and one chordoid); four were atypical (Grade II), and one was papillary (Grade III). The mean MIB-1 SI in the benign group was significantly lower than those in the other groups (p = 0.0041). The mean choline-containing compound (Cho)/creatine and phosphocreatine (Cr) ratios in the benign and nonbenign groups were 2.56 ± 1.26 and 7.85 ± 3.23, respectively (p = 0.0002). A significant linear correlation was observed between the Cho/Cr ratio and the MIB-1 SI (r0.05 = 0.74, p < 0.001). Necrosis was present histologically in four of the five meningiomas classified either as atypical or papillary. Magnetic resonance spectroscopy revealed a methylene signal in these meningiomas that was not detected in benign meningiomas. Of the five meningiomas in which only a lactate signal was observed, two were benign and the MIB-1 SI in these two benign meningiomas was higher than the mean value for the benign group. Alanine, detected in 12 of 30 meningiomas, did not correlate with either tumor grade or Cho/Cr ratio.Conclusions. Proton MR spectroscopy is a useful diagnostic method for determining the proliferative or malignant potential of meningiomas according to the Cho/Cr ratio. A lactate and/or methylene signal suggests a high-grade tumor.

Proton magnetic resonance spectroscopy imaging in the evaluation of patients undergoing gamma knife surgery for Grade IV glioma

2004 ◽  
Vol 101 (3) ◽  
pp. 467-475 ◽  
Author(s):  
Antoinette A. Chan ◽  
Aubrey Lau ◽  
Andrea Pirzkall ◽  
Susan M. Chang ◽  
Lynn J. Verhey ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Magnetic Resonance Spectroscopy ◽  
Gamma Knife ◽  
Proton Magnetic Resonance ◽  
Proton Magnetic Resonance Spectroscopy ◽  
Planning Process ◽  
Resonance Spectroscopy ◽  
Lesion Volume ◽  
Content Type ◽  
Fine Print

Object. The purpose of this study was to assess the differences in spatial extent and metabolic activity in a comparison of a radiosurgical target defined by conventional strategies that utilize the enhancing lesion and a metabolic lesion defined by proton magnetic resonance spectroscopy (MRS) imaging. The authors evaluated whether these differences manifest themselves in the clinical outcome of patients and assessed the value of incorporating 1H-MRS imaging—derived spatial information into the treatment planning process for gamma knife surgery (GKS). Methods. Twenty-six patients harboring Grade IV gliomas who had previously been treated with external-beam radiation therapy were evaluated by comparing the radiosurgically treated lesion volume with the volume of metabolically active tumor defined on 1H-MRS imaging. The cohort was evenly divided into two groups based on the percentage of overlap between the radiosurgical target and the metabolic lesion volumes. Patients with a percentage of overlap greater than 50% with respect to the metabolic lesion volume were classified as low risk and those with an overlap less than 50% were classified as high risk. Kaplan—Meier estimators were calculated using time to progression and survival as dependent variables. The metabolite levels within the metabolic lesion were significantly greater than those within the radiosurgical target (p ≤ 0.001). The median survival was 15.7 months for patients in the low-risk group and 10.4 months for those in the highrisk group. This difference was statistically significant (p < 0.01). Conclusions. Analysis of the results of this study indicates that patients undergoing GKS may benefit from the inclusion of 1H-MRS imaging in the treatment planning process.

Integration of biochemical images of a tumor into frameless stereotaxy achieved using a magnetic resonance imaging/magnetic resonance spectroscopy hybrid data set

2004 ◽  
Vol 101 (2) ◽  
pp. 287-294 ◽  
Author(s):  
Andreas Stadlbauer ◽  
Ewald Moser ◽  
Stephan Gruber ◽  
Christopher Nimsky ◽  
Rudolf Fahlbusch ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Mr Imaging ◽  
Mr Spectroscopy ◽  
Frameless Stereotaxy ◽  
Low Grade ◽  
Normal Brain ◽  
Tumor Infiltration ◽  
Data Set ◽  
Content Type ◽  
Fine Print

Object. It is often difficult to delineate the extent of invasion of high- and low-grade gliomas into normal brain tissue by using conventional T1- and T2-weighted magnetic resonance (MR) imaging. Knowledge of the relationship between the tumor infiltration zone and normal brain, however, is one of the prerequisites for performing as radical a tumor resection as possible. Proton MR spectroscopy allows noninvasive measurements of the concentrations and spatial distributions of brain metabolites and, therefore, may provide biochemical information in vivo, that is useful in distinguishing pathological from normal areas of the brain. The authors have developed a method to use the properties of MR spectroscopy to investigate intraoperatively pathological changes in the spatial distribution of choline (Cho)-containing compounds, total creatine, and N-acetylaspartate (NAA) in brain tumors with the aid of frameless stereotaxy. Methods. Maps of the Cho/NAA ratio were calculated and automatic segmentation of the tumors was performed. Spectroscopic images of the segmented tumor were matched to an anatomical three-dimensional (3D) MR imaging set by applying a fully automated mutual-information algorithm. The resulting 3D MR image can be used subsequently for neurosurgical planning, transfer to a frameless stereotactic system, and display in the navigation microscope during surgery leading to 1H-MR spectroscopy-guided navigation. Conclusions. This method may allow better intraoperative identification of tumor border zones based on metabolic changes due to tumor infiltration.

Characterization of astrocytomas, meningiomas, and pituitary adenomas by phosphorus magnetic resonance spectroscopy

1991 ◽  
Vol 74 (3) ◽  
pp. 447-453 ◽  
Author(s):  
Douglas L. Arnold ◽  
Joseph F. Emrich ◽  
Eric A. Shoubridge ◽  
Jean-Guy Villemure ◽  
William Feindel
Keyword(s):  
Magnetic Resonance ◽  
Pituitary Adenomas ◽  
Resonance Spectroscopy ◽  
Low Grade ◽  
Normal Brain ◽  
Tumor Type ◽  
Content Type ◽  
Tumor Types ◽  
Fine Print

✓ Phosphorus magnetic resonance (MR) spectroscopy allows noninvasive measurement of phosphate-containing compounds and pH within brain cells. The authors obtained localized phosphorus MR spectra from 10 normal brains, four low-grade astrocytomas, six glioblastomas, four meningiomas, and three pituitary adenomas and found differences in the spectra of each tumor type. Compared to normal brain, the spectra from low-grade astrocytomas showed a significant reduction of the phosphodiester (PDE) peak. Glioblastomas were characterized by a significant reduction of the PDE peak, elevation of the phosphomonoester (PME) peak, and a relatively alkaline intracellular pH. The spectra from meningiomas and pituitary adenomas were markedly different from the glial tumors. Meningiomas showed significant reductions in phosphocreatine, PDE, and inorganic phosphate, as well as a relatively alkaline pH. Pituitary adenomas resembled meningiomas, but had a much higher PME peak. Although the number of tumors studied was small, there appears to be a characteristic spectrum associated with these different tumor types. The present findings can be useful in the preoperative identification of these tumors and in furthering understanding of their growth and metabolism in vivo.

Histopathological validation of a three-dimensional magnetic resonance spectroscopy index as a predictor of tumor presence

2002 ◽  
Vol 97 (4) ◽  
pp. 794-802 ◽  
Author(s):  
Tracy R. McKnight ◽  
Mary H. von dem Bussche ◽  
Daniel B. Vigneron ◽  
Ying Lu ◽  
Mitchel S. Berger ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Mr Spectroscopy ◽  
Surgical Navigation ◽  
Three Dimensional ◽  
Correlation Study ◽  
Receiver Operating Curve ◽  
Resonance Spectroscopy ◽  
Hyperintense Lesion ◽  
Content Type ◽  
Fine Print

Object. Data obtained preoperatively from three-dimensional (3D)/proton magnetic resonance (MR) spectroscopy were compared with the results of histopathological assays of tissue biopsies obtained during surgery to verify the sensitivity and specificity of a choline-containing compound—N-acetylaspartate index (CNI) used to distinguish tumor from nontumorous tissue within T2 hyperintense and contrast-enhancing lesions of patients with untreated gliomas. The information gleaned from the biopsy correlation study was used to test the hypothesis that there is metabolically active tumor in nonenhancing regions of the T2-hyperintense lesion that can be detected using MR spectroscopy. Methods. Patients suspected of harboring a glioma underwent 3D MR spectroscopy during their preoperative MR imaging examination. Surgical navigation techniques were used to record the location of tissue biopsies collected during open resection of the tumor. A receiver operating curve analysis of the CNI and histological characteristics of specimens at each biopsy location was performed to determine the optimal threshold of the CNI required to separate tumor from nontumorous tissue. Histograms of the CNIs within enhancing and nonenhancing regions of lesions appearing on MR images were generated to determine the spatial distribution of CNIs consistent with tumor. Conclusions. Biopsy samples containing tumor were distinguished from those containing a mixture of normal, edematous, gliotic, and necrotic tissue with 90% sensitivity and 86% specificity by using a CNI threshold of 2.5. The CNIs of nontumorous specimens were significantly different from those of biopsy specimens containing Grade II (p < 0.03), Grade III (p < 0.005), and Grade IV (p < 0.01) tumors. On average, one third to one half of the T2-hyperintense lesion outside the contrast-enhancing lesion contained CNI greater than 2.5.

Persistent high lactate level as a sensitive MR spectroscopy indicator of completed infarction

1990 ◽  
Vol 72 (5) ◽  
pp. 763-766 ◽  
Author(s):  
Kiyohiro Houkin ◽  
Ingrid L. Kwee ◽  
Tsutomu Nakada
Keyword(s):  
Magnetic Resonance ◽  
Cerebral Infarction ◽  
Mr Spectroscopy ◽  
The Other ◽  
Proton Spectroscopy ◽  
Normal Pattern ◽  
Content Type ◽  
Lactate Levels ◽  
High Lactate ◽  
Fine Print

✓ Serial proton (1H) and phosphorus-31 (31P) magnetic resonance (MR) spectroscopy of cerebral infarction was performed in rats to assess the sensitivity of these techniques for use in clinical cerebral infarction. In this experimental chronic infarction model, 31P spectroscopy tended to return to a “normal” pattern within 24 hours after induction of infarction in spite of pathologically proven completed infarction and, therefore, appeared not to be sensitive enough for clinical application. On the other hand, proton spectroscopy invariably showed persistent high lactate levels and was capable of distinguishing completed infarction from reperfused recovered brain. Persistent high lactate levels appear to be a good MR spectroscopic indicator of completed infarction.

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