Comments and controversies: Magnetic resonance spectroscopy and gliomas

Fan, Guoguang

doi:10.1102/1470-7330.2006.0018

Cited by 23 publications

(23 citation statements)

References 7 publications

(8 reference statements)

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“…As prior studies have demonstrated tCho to decrease and NAA to stabilize or partially recover in primary CNS neoplasms after successful treatment, 16 suggesting a tumoricidal mechanism, we hypothesize that a therapeutic response to SIACI of bevacizumab would be associated with decreased tCho/NAA ratios. To our knowledge, the utility of MRS in recurrent GB status post bevacizumab treatment, and particularly in patients receiving novel dose intensification with SIACI of bevacizumab following transient blood-brain barrier disruption with mannitol, has not been investigated.…”

mentioning

confidence: 72%

Metabolic Response of Glioblastoma to Superselective Intra-Arterial Cerebral Infusion of Bevacizumab: A Proton MR Spectroscopic Imaging Study

Jeon

Kovanlikaya²,

Boockvar

et al. 2012

AJNR Am J Neuroradiol

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confidence: 72%

Metabolic Response of Glioblastoma to Superselective Intra-Arterial Cerebral Infusion of Bevacizumab: A Proton MR Spectroscopic Imaging Study

Jeon

Kovanlikaya²,

Boockvar

et al. 2012

AJNR Am J Neuroradiol

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“…This finding confirms the utility of proton MRS to differentiate tumors with different cellular populations. One of the most promising uses for MRS in neurooncology may be to follow the course of recovery after radiation therapy for glioma, permitting the differentiation of active glioma from radiation effects in the surrounding tissue (Fan, 2006). 1.1.5.…”

Section: Magnetic Resonance Spectroscopy and Imaging Of Naamentioning

confidence: 99%

N-Acetylaspartate in the CNS: From neurodiagnostics to neurobiology

Moffett

Ross

Arun

et al. 2007

Progress in Neurobiology

1,183

1,126

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The brain is unique among organs in many respects, including its mechanisms of lipid synthesis and energy production. The nervous system-specific metabolite N-acetylaspartate (NAA), which is synthesized from aspartate and acetyl-coenzyme A in neurons, appears to be a key link in these distinct biochemical features of CNS metabolism. During early postnatal CNS development, the expression of lipogenic enzymes in oligodendrocytes, including the NAA-degrading enzyme aspartoacylase (ASPA), is increased along with increased NAA production in neurons. NAA is transported from neurons to the cytoplasm of oligodendrocytes, where ASPA cleaves the acetate moiety for use in fatty acid and steroid synthesis. The fatty acids and steroids produced then go on to be used as building blocks for myelin lipid synthesis. Mutations in the gene for ASPA result in the fatal leukodystrophy Canavan disease, for which there is currently no effective treatment. Once postnatal myelination is completed, NAA may continue to be involved in myelin lipid turnover in adults, but it also appears to adopt other roles, including a bioenergetic role in neuronal mitochondria. NAA and ATP metabolism appear to be linked indirectly, whereby acetylation of aspartate may facilitate its removal from neuronal mitochondria, thus favoring conversion of glutamate to alpha ketoglutarate which can enter the tricarboxylic acid cycle for energy production. In its role as a mechanism for enhancing mitochondrial energy production from glutamate, NAA is in a key position to act as a magnetic resonance spectroscopy marker for neuronal health, viability and number. Evidence suggests that NAA is a direct precursor for the enzymatic synthesis of the neuron specific dipeptide N-acetylaspartylglutamate, the most concentrated neuropeptide in the human brain. Other proposed roles for NAA include neuronal osmoregulation and axon-glial signaling. We propose that NAA may also be involved in brain nitrogen balance. Further research will be required to more fully understand the biochemical functions served by NAA in CNS development and activity, and additional functions are likely to be discovered.

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“…Spectral patterns or specific metabolite intensities can be compared with traditional MRI to identify changes in spectra from adjacent voxels or to obtain a distribution pattern of a particular metabolite within the tumor. Standard brain proton MRS uses proton and measures choline (assessment of membrane turnover and proliferation), creatine (energy homeostasis), N -acetyl aspartate (glioneural structures) and lactate or lipids (necrosis) [26]. A direct correlation between choline and cellular proliferation has been shown [27–29].…”

Section: Novel Techniques In Mrimentioning

confidence: 99%

“…Detection of new choline accumulation may indicate residual or recurrent tumor after treatment. Necrotic areas are devoid of any spectroscopic activity and a decrease in the level of choline and modest increases in N -acetyl aspartate indicate decrease in tumor burden [26]. Even though multiple metabolites and their ratios have been studied, to date none have been demonstrated to have sufficient diagnostic specificity to differentiate active tumor from treatment effect.…”

Section: Novel Techniques In Mrimentioning

confidence: 99%

Emerging methods for disease monitoring in malignant gliomas

2013

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Summary MRI remains the backbone of measuring disease burden and treatment response in individuals with malignant gliomas. Traditional radiographic approaches, however, are largely limited to depicting anatomic changes and are not a direct measure of disease burden. For example, contrast enhancement is related to blood–brain barrier integrity rather than actual tumor size. Without accurate measures of disease, common clinical dilemmas include ‘pseudo-progression’ (e.g., after chemoradiation) or ‘pseudo-response’ (e.g., with steroid treatment and antiangiogenic agents), which can lead to delays in therapy, premature discontinuation of successful treatments and to unnecessary surgical procedures. This overview focuses on novel, minimally invasive approaches in the area of imaging and blood-based biomarkers that aim to more accurately determine disease status and response to treatment in malignant brain tumors.

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Comments and controversies: Magnetic resonance spectroscopy and gliomas

Cited by 23 publications

References 7 publications

Metabolic Response of Glioblastoma to Superselective Intra-Arterial Cerebral Infusion of Bevacizumab: A Proton MR Spectroscopic Imaging Study

Metabolic Response of Glioblastoma to Superselective Intra-Arterial Cerebral Infusion of Bevacizumab: A Proton MR Spectroscopic Imaging Study

N-Acetylaspartate in the CNS: From neurodiagnostics to neurobiology

Emerging methods for disease monitoring in malignant gliomas

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