In vivo proton MR spectroscopy of primary tumours, nodal and recurrent disease of the extracranial head and neck

Abstract

Benign and malignant neoplasms as well as metastatic lymph nodes of 39 patients were examined using localized single voxel magnetic resonance spectroscopy (MRS) [repetition time (TR) 1500, echo time (TE) 135) at 1.5 T. New techniques with simultaneous correction of motion artefacts during the acquisition, three-dimensional saturation pulses, respiratory triggering and smaller volume of interest (VOI) size, were applied. Ratios of peak areas under the choline (Cho) and creatine (Cr) resonances were estimated in all cases and compared with those from samples of normal tissue. Ninety one spectra were acquired in 39 patients, 63 of which were suitable for further evaluation. The smallest VOI was 0.40 cm(3). The Cho/Cr ratios in all malignant neoplasms (mean: 5.2, range: 1.7-17.8) were significantly elevated relative to those in the normal muscle structures (mean: 0.9, range: 0.2-1.4), while those in the benign neoplasms were elevated (mean: 24.4, range: 1.4-59.7) with respect to those in the malignant ones. The average Cho/Cr ratio in the metastatic lymph nodes was significantly higher (mean: 4.8, range: 3.3-5.6) than that for benign lymphoid hyperplasia (mean: 2.2, range: 1.0-3.0). MRS measurements were able to differentiate recurrent disease from post-therapeutic tissue changes in 11 out of 13 patients.

Malignant Tumors and Chronic Infections in the Masticator Space: Preliminary Assessment with In Vivo Single-Voxel1H-MR Spectroscopy

“…The height of Cho peaks shown on in vivo single-voxel 1 H-MR spectroscopic images is believed to be related to increased cellular membrane phospholipid biosynthesis and is, therefore, considered as an active marker for cellular proliferation. 16 A number of studies with in vivo 1 H-MR spectroscopy have shown that Cho signals could be reliably found in most malignant tumors of the extracranial head and neck, such as squamous cell carcinomas, [6][7][8][11][12][13]17 salivary carcinomas, 9,12 and extracranial malignant lymphomas. 11,18 Soft-tissue and bone sarcomas (outside the head and neck) marked with Cho signals have also been reported.…”

“…[6][7][8][9][10][11][12][13]17 However, some studies found that the Cho/Cr ratio could only be measured in half or less of extracranial head and neck neoplasms. [8][9][10][11] In our series, the peaks of Cr metabolites could only be identified in approximately 25% of masticator space lesions.…”

“…5 With rapid development and improvement of hardware and software, in vivo point-resolved MR spectroscopy ( 1 H-MR spectroscopy) has started to be used in the evaluation of extracranial head and neck lesions of the tongue, [6][7] nasopharynx, 8 parotid gland, 9 thyroid, 10 and metastatic lymph nodes of the neck. [6][7][8][10][11][12] In addition, the technology was used to detect recurrences of malignant tumors and to monitor treated or untreated tumors. 5,[11][12][13] However, to our knowledge, the 1 H-MR spectroscopic appearance of chronic infections and malignant tumors in the masticator space has not been reported.…”

“…[6][7][8][10][11][12] In addition, the technology was used to detect recurrences of malignant tumors and to monitor treated or untreated tumors. 5,[11][12][13] However, to our knowledge, the 1 H-MR spectroscopic appearance of chronic infections and malignant tumors in the masticator space has not been reported.…”

Pretreatment and early intratreatment prediction of clinicopathologic response of head and neck cancer to chemoradiotherapy using 1H‐MRS

“…Cho containing compounds are identified in vivo as a spectral peak at 3.2 ppm using proton magnetic resonance spectroscopy ( I H-MRS), which is a technique that can be added easily to the routine magnetic resonance imaging (MRI) examination. Cho has been identified in a range of head and neck cancers including HNSCC (1)(2)(3)(4)(5)(6)(7)(8), where pretreatment cho levels correlate with histological grading (7) and posttreatment cho levels with the presence of residual/ recurrent cancer after surgery or chemoradiotherapy (8). Changes in cho ratios from pretreatment to posttreatment also have been reported.…”