In vivo brain MR spectroscopy in gliomas: clinical and pre-clinical chances

Abstract

Purpose Gliomas, the most common primary brain tumours, have recently been re-classified incorporating molecular aspects with important clinical, prognostic, and predictive implications. Concurrently, the reprogramming of metabolism, altering intracellular and extracellular metabolites affecting gene expression, differentiation, and the tumour microenvironment, is increasingly being studied, and alterations in metabolic pathways are becoming hallmarks of cancer. Magnetic resonance spectroscopy (MRS) is a complementary, non-invasive technique capable of quantifying multiple metabolites. The aim of this review focuses on the methodology and analysis techniques in proton MRS (1H MRS), including a brief look at X-nuclei MRS, and on its perspectives for diagnostic and prognostic biomarkers in gliomas in both clinical practice and preclinical research. Methods PubMed literature research was performed cross-linking the following key words: glioma, MRS, brain, in-vivo, human, animal model, clinical, pre-clinical, techniques, sequences, 1H, X-nuclei, Artificial Intelligence (AI), hyperpolarization. Results We selected clinical works (n = 51), preclinical studies (n = 35) and AI MRS application papers (n = 15) published within the last two decades. The methodological papers (n = 62) were taken into account since the technique first description. Conclusions Given the development of treatments targeting specific cancer metabolic pathways, MRS could play a key role in allowing non-invasive assessment for patient diagnosis and stratification, predicting and monitoring treatment responses and prognosis. The characterization of gliomas through MRS will benefit of a wide synergy among scientists and clinicians of different specialties within the context of new translational competences. Head coils, MRI hardware and post-processing analysis progress, advances in research, experts’ consensus recommendations and specific professionalizing programs will make the technique increasingly trustworthy, responsive, accessible.

The STEMRI trial: Magnetic resonance spectroscopy imaging can define tumor areas enriched in glioblastoma stem-like cells

“…As recurrence is almost systematic, determining the tumor prognosis, the response to radio/chemotherapy, the site of recurrence, and the degree of tumor invasion are crucial challenges. For more than two decades, MRSI combined to conventional MRI has allowed a better understanding of GBM heterogeneity through the determination of some key metabolites at tumor and peritumoral levels ( 13 , 39 ). Specific metabolites [such as Chol, NAA, lactate (Lac), lipids, myoinositol (mIns)] or metabolite ratios [such as Cho/NAA, Cho/Cr (creatine) or Lac/NAA] have been shown to improve assessment of GBM diagnosis, progression, prognosis, and response to treatment, notably to RT.…”

The STEMRI trial: magnetic resonance spectroscopy imaging can define tumor areas enriched in glioblastoma-initiating cells

“…As recurrence is almost systematic, determining the tumor prognosis, the response to radio/chemotherapy, the site of recurrence and the degree of tumor invasion are crucial challenges. For more than two decades, MRSI combined to conventional MRI has allowed a better understanding of GB heterogeneity through the determination of some key metabolites at tumor and peritumoral levels (5,29). Indeed, specific metabolites (such as Chol, NAA, lactate (Lac), lipids, myoinositol (mIns)) or metabolite ratios (such as Cho/NAA, Cho/Cr (creatine) or Lac/NAA) have been 14 shown to improve assessment of GB diagnosis, progression, prognosis and response to treatment, notably to RT.…”

Utilidad de la Espectroscopía por Resonancia Magnética para la diferenciación de gliomas de alto y bajo grado.

“…Un voxel resulta en mayor señal, mientras la técnica de multivoxel cubre un área mayor y puede dar datos metabólicos de las diferentes áreas de una misma lesión y sus alrededores. 15 Esta técnica de resonancia no requiere inyección de contraste ni radiaciones ionizantes que son ventajas evidentes con respecto a otros métodos de estudio. 16 Los principales metabolitos observados con tiempos de eco largos que van de 135 a 280 ms (Figura 1), son el N-acetil-aspartato (NAA), colina (Cho), creatina (Cr), lactato y glicina (Gly).…”