Alterations of Lactate (+lipid) Concentration in Brain Tumors with In Vivo Hydrogen Magnetic Resonance Spectroscopy During Radiotherapy

Tomoi, Masahiro; Kimura, Hirohiko; Yoshida, Masanori; Itoh, Satoshi; Kawamura, Yasutaka; Hayashi, Nobushige; Yamamoto, Kazutaka; Kubota, Toshihiko; Ishii, Yasushi

doi:10.1097/00004424-199705000-00006

Cited by 16 publications

(8 citation statements)

References 22 publications

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“…The limited number of cases in their series could be an explanation for this difference between our and their data. From a structural point of view, astrocytomas are characterized by an occasional increase in the amount of Lip referable to the increased cellularity of the tumor and the relative increase of the membranous structures [14,35,49]. Although Lip are fairly nonspecific and nonreproducible markers [14,28], a finding confirmed by our data in this series, further studies are needed for the better understanding of this metabolite and its role in the astrocytomas' biochemical profile.…”

Section: Discussionsupporting

confidence: 59%

“…In the future, new techniques such as three-dimensional chemical shift imaging as well as the technical ability to access quite small and discrete voxels suggest that continued progress should be possible using this modality. Indeed, even on a contemporary basis, MRS appears to be able to furnish useful information about the neoplastic aggressiveness of a particular lesion and may prove useful in evaluating the effectiveness of varying radio-therapeutic or chemotherapeutic treatment protocols [30,49] as well as in differentiating between local tumor recurrence and post-radiation necrosis, a very confounding and frequently encountered clinical dilemma [48,50]. Potentially, this noninvasive diagnostic modality could place a pre-operative histologic diagnosis of an intracranial tumor, which will be confirmed by the classical pathology examination and postoperatively will allow a real time analysis of the tumor's response to any adjunctive therapy.…”

Section: Discussionmentioning

confidence: 99%

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Noninvasive Histologic Grading of Solid Astrocytomas Using Proton Magnetic Resonance Spectroscopy

Fountas

Kapsalaki

Vogel

et al. 2004

Stereotact Funct Neurosurg

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Background: Proton magnetic resonance spectroscopy (¹H MRS) constitutes a promising modality to assess intracranial pathology. We present our experience using this method in grading solid brain astrocytomas. Material and Methods: Using a 1.5-Tesla MRI unit, 71 patients with the radiographic diagnosis of astrocytoma were examined. Water-suppressed single-voxel ¹H MRS was employed in all of our patients. The concentrations of choline (Cho), N-acetyl-aspartate (NAA), phosphocreatine-creatine (Pcr-Cr), myo-inositol (MI), lactate (Lac), lipids (Lip) as well as the metabolite ratios of Cho/Pcr-Cr, NAA/PCr-Cr and NAA/Cho were calculated. An appropriate surgical biopsy was performed. Standard pathology examination was employed in a double-blinded fashion. Results: An increased concentration of Cho and decreased concentrations of Pcr-Cr and NAA were detected. The concentrations of Lac, Lip and MI varied inconsistently, even among tumors of the same histologic grade. The Cho/Pcr-Cr ratio was calculated. This ratio was found to be 2.15 ± 0.26 in 27 patients with astrocytomas grade I and II, 2.78 ± 0.09 in 18 patients with grade III, and 5.40 ± 0.16 in 26 patients with grade IV. Discussion: The increased concentration of Cho is due to the increased cellularity and a relatively increased number of membranous structures in highly malignant tumors. In abnormal anaerobic metabolic tumor states there is relatively less phosphorylization of creatine. By using the Cho/Pcr-Cr ratio the concomitant effects of structural and metabolic alteration can thereby be emphasized for diagnostic advantage. Conclusion: The Cho/Pcr-Cr is a very important and statistically significant marker (p = 0.043) determining the degree of intracranial astrocytoma malignancy.

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Section: Discussionsupporting

confidence: 59%

Section: Discussionmentioning

confidence: 99%

Noninvasive Histologic Grading of Solid Astrocytomas Using Proton Magnetic Resonance Spectroscopy

Fountas

Kapsalaki

Vogel

et al. 2004

Stereotact Funct Neurosurg

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“…larity of the tumor and the relative increase in the membranous structures [17,21,33]. Although lipids are fairly non-specific and non-reproducible markers [10], further studies are needed for the better understanding of this metabolite and its role in the biochemical profile of the tumor.…”

Section: Discussionmentioning

confidence: 99%

“…Magnetic resonance spectroscopic (MRS) analysis offers many potential advantages in real-time analysis of intracranial neoplasms [19,22,24,31,33,34]. Recent evidence suggests that this maturing diagnostic modality with its ability to differentiate neoplastic cell types and their metabolic characteristics, as well as their malignant propensity, may assume an increasingly important role in everyday clinical practice [2,4,6,9,13,16,21,30,37,38].…”

Section: Introductionmentioning

confidence: 99%

In vivo Proton Magnetic Resonance Spectroscopy of Brain Tumors

Fountas¹,

Kapsalaki²,

Gotsis³

et al. 2000

Stereotact Funct Neurosurg

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The ability of magnetic resonance spectroscopy (MRS) to differentiate neoplastic brain cells and their metabolic and structural characteristics is evaluated. We examined 120 patients with brain tumors using a 1.5-tesla MRI unit and MRS. The peak areas of N-acetyl-aspartate (NAA), phosphocreatine-creatine (Pcr-Cr), choline-containing compounds (Cho), lactate, lipids, myoinositol, amino acids and the ratios of NAA/Pcr-Cr, NAA/Cho and Cho/Pcr-Cr were calculated by a standard integral algorithm. In normal brain tissue, the following metabolites were identified: NAA at 2.0 ppm, Pcr-Cr at 3.0 ppm and Cho at 3.2 ppm. The different concentrations of the metabolites examined and their role in the biochemical profile of different types of tumors are discussed. The confidence interval of the MRS versus pathology was between 0.9 and 0.954, while it was between 0.52 and 0.631 for MRI versus pathology. The Cho/Pcr-Cr ratio is a very important malignancy marker for histologic tumor grading of astrocytomas. The greater this ratio, the higher the grade of the astrocytoma. NAA/Pcr-Cr together with Cho/Pcr-Cr help specify the presence or absence of a neoplasm. Proton MRS is a useful and promising diagnostic modality not only in diagnosing but also in grading solid brain tumors.

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“…It has been shown that shrinkage of malignant cerebral lymphomas during irradiation is associated with a decrease of Cho and Lac and an increase in NAA, which precede reduction of the lesion volume [12][13][14] . Serial investigations of gliomas during and after chemotherapy 15,16 , radiotherapy 13,17-21 , brachytherapy 22 and SRS 23,24 consistently demonstrated that tumor shrinkage or stabilization of its growth is typically accompanied by a decrease of Cho content.…”

Section: Discussionmentioning

confidence: 99%

Dynamics of Metabolic Changes in Intracranial Metastases and Distant Normal-Appearing Brain Tissue after Stereotactic Radiosurgery: A Serial Proton Magnetic Resonance Spectroscopy Study

et al. 2009

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The present study evaluated the dynamics of metabolic changes in intracranial metastases and distant normal-appearing brain after stereotactic radiosurgery (SRS). Forty neoplasms were evaluated with single-voxel proton magnetic resonance spectroscopy ((1)H-MRS) both before and after treatment. From one to six examinations (median, 3) were done in each individual case during follow-up. At the time of each investigation additional (1)H-MRS was obtained from the normal-appearing brain distant from the radiosurgical target. Investigated metabolites included N-acetylaspartate (NAA), choline-containing compounds (Cho), creatine (Cr), and mobile lipids (Lip). Within the first month after SRS responded tumors showed a statistically significant increase in NAA/Cho ratio, and decrease of Cho content and Lip-to-normal brain Cr (nCr) ratio. By contrast, statistically significant metabolic alterations were not detected in stabilized tumors. Statistically significant volumetric and metabolic changes were not marked between three and 12 months after treatment in non-progressing lesions. Alternatively, decrease of NAA/Cho ratio, NAA content and Cr content, and increase in Lip/nCr ratio and Cho content were evident in progressive neoplasms, and subtle metabolic alterations could be revealed even before the increase in the lesion volume. Metabolic characteristics of normal-appearing brain distant from the radiosurgical target did not show statistically significant changes within the first year after treatment. In conclusion, additional use of serial (1)H-MRS during follow-up after SRS for intracranial metastases permits detailed evaluation of the metabolic tumor response and may be potentially helpful for early prediction of recurrence.

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Alterations of Lactate (+lipid) Concentration in Brain Tumors with In Vivo Hydrogen Magnetic Resonance Spectroscopy During Radiotherapy

Abstract: Assessment of r-Lac(+lip) may adjunctively contribute to the early prediction of the radiotherapeutic effect on brain tumors.

Cited by 16 publications

References 22 publications

Noninvasive Histologic Grading of Solid Astrocytomas Using Proton Magnetic Resonance Spectroscopy

Noninvasive Histologic Grading of Solid Astrocytomas Using Proton Magnetic Resonance Spectroscopy

In vivo Proton Magnetic Resonance Spectroscopy of Brain Tumors

Dynamics of Metabolic Changes in Intracranial Metastases and Distant Normal-Appearing Brain Tissue after Stereotactic Radiosurgery: A Serial Proton Magnetic Resonance Spectroscopy Study

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