Mapping of brain tumor metabolites with proton MR spectroscopic imaging: clinical relevance.

Fulham, Michael; Bizzi, Alberto; Dietz, M. J.; Shih, H. H.-L.; Raman, Ramesh; Sobering, Geoffrey; Frank, Joseph A.; Dwyer, Andrew J.; Alger, J. R.; Chiro, Giovanni Di

doi:10.1148/radiology.185.3.1438744

Cited by 305 publications

(155 citation statements)

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“…The pro t o n s p e c t roscopy of astrocytomas shows a significant reduction in NAA due to loss of neuronal elements, and elevation of choline peak that may reflect incre ased membrane synthesis. The presence of lactate peak c o rrelates with higher degree of malignance commonly observed in GBM 13 .…”

Section: Discussionmentioning

confidence: 88%

Cerebellar glioblastoma multiforme in an adult

Mattos

Marenco

Campos

et al. 2006

Arq. Neuro-Psiquiatr.

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-Cerebellar glioblastoma multiforme (GBM) is a rare tumor. This is the third case published in Brazilian literature and, the last one has been described more than 15 years ago. The aggressive behavior of GBM prompts for fast treatment, which can be hampered by the fact that the diagnosis of GBM re q u i re s a high degree of suspicion. We describe a case of GBM in a 46 years old man. In conjunction, we pre s e n t a literature review including particular issues, clinical data, advances in imaging studies, pathological characteristics, treatment options and the behavior of such malignant tumor.KEY WORDS: high grade astrocytoma, cerebellar glioblastoma multiforme, posterior fossa glioma.Glioblastoma multiforme cerebelar primário em um adulto RESUMO -Glioblastoma multiforme (GBM) c e rebelar é um tumor raro. Apresentamos o terc e i ro caso re v i s ado em literatura neurológica brasileira, sendo o último descrito há mais de 15 anos. Devido a sua agre ssividade, o tratamento deve ser instituído rapidamente, porém certa indefinição quanto à conduta pode o c o rre r, pois o diagnóstico de GBM pode não ser lembrado. Apresentamos um caso de GBM c e rebelar em um homem de 46 anos. Também fazemos uma revisão a respeito de seu comportamento, quadro clínico e avanços quanto à investigação por imagem, aspectos histopatológicos, formas de tratamento e suas características peculiares.PA L AV R A S -C H AVE:a s t rocitoma de alto grau, glioblastoma multiforme cere b e l a r, glioma de fossa posterior.Glioblastoma multiforme (GBM) is the most common primary central nervous system (CNS) tumor in adults comprising approximately 50% of all primary intracranial tumors. Primary cerebellar GBM is a rare tumor in adults 1 -7 and accounts for 1% of all GBM 4 . The reason for its rarity is not completely understood 1 -3 , 5 . D i ff e rential diagnosis of GBM from other CNS lesions is an outstanding issue, especially in re g a rd to its diff e rentiation from other primary CNS tumors such as the anaplasic astrocytoma and from metastases 5 , 7 , 8 since the prognosis and outcome is diff e rent. For this reason, neuroimaging and ultimately the immunostainning assessment are important tools for planning the therapeutic course.We re p o rta case of an adult man with a cere b e llar GBM and a literature review concerning the clinical data, diagnosis including radiological and pathological aspects, treatment and its particular behavior is done. CASEA 46 years old man was admitted due to history of headache beginning 4 months before. Ve n t r i c l e -p e r i t o n e a l shunt was perf o rmed in another hospital due to acute h y d rocephalus 1 month after the initial symptoms. The patient developed progressive cerebellar signs with gait disturbance, nystagmus and clumsiness of the extremities, more intense on the left side, and vomiting. He was unable to walk and showed mild degree of confusional state at examination. A magnetic resonance imaging (MRI) revealed an infiltrative mass situated in the left hemisphere and para-

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Section: Discussionmentioning

confidence: 88%

Cerebellar glioblastoma multiforme in an adult

Mattos

Marenco

Campos

et al. 2006

Arq. Neuro-Psiquiatr.

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“…Mass lesions including brain cancer-There are 5 basic changes in the MRS signal associated with brain tumors; NAA is decreased, lactate is increased, lipid is increased, creatine plus phosphocreatine are decreased, and choline is increased (Danielsen and Ross, 1999). NAA is reduced or even absent from most brain tumor spectra, as well as from most space-occupying brain lesions, whether benign or malignant (Arnold et al, 1990b;Barker et al, 2006;Bruhn et al, 1989a;Danielsen and Ross, 1999;Fulham et al, 1992). The explanation for the lack of NAA signal lies in the cell lines of origin for almost all primary and secondary brain tumors, which do not express the biosynthetic enzyme for NAA, Asp-NAT (see section 2.1. below).…”

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

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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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“…Higher glucose utilization rates for lesions in which lactate is detected usually indicate high-grade gliomas. The various biochemical components provided strong evidence for the presence of tumor since increased choline and a lactate peak would not be expected in necrotic tissue [6] .…”

Section: Hmrs and Tumor Treatment Effectmentioning

confidence: 99%

Comments and controversies: Magnetic resonance spectroscopy and gliomas

Fan

2006

Cancer Imaging

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In vivo proton magnetic resonance spectroscopy (1HMRS) can substantially improve the non-invasive categorization of human brain tumors, especially for gliomas. It provides greater information concerning tumor activity and characterization of the tumor tissue than is possible with MRI techniques alone. Moreover, 1HMRS may ultimately prove to be a highly beneficial modality in the post-irradiation care of patients with brain gliomas. This paper reviews the current status of 1HMRS with the emphasis on its clinical utility in the diagnosis of active tumor processes of gliomas, and its use in planning surgical and radiation therapy interventions and monitoring tumor treatment paradigms.

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Mapping of brain tumor metabolites with proton MR spectroscopic imaging: clinical relevance.

Cited by 305 publications

References 0 publications

Cerebellar glioblastoma multiforme in an adult

Cerebellar glioblastoma multiforme in an adult

N-Acetylaspartate in the CNS: From neurodiagnostics to neurobiology

Comments and controversies: Magnetic resonance spectroscopy and gliomas

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