Metabolic Findings on 3T 1H-MR Spectroscopy in Peritumoral Brain Edema

Ricci, R.; Bacci, A.; Tugnoli, Vitaliano; Battaglia, Simone; Maffei, Monica; Agati, R.; Leonardi, Marco

doi:10.3174/ajnr.a0564

Cited by 59 publications

(46 citation statements)

References 39 publications

(43 reference statements)

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“…Studies focusing on peritumoral brain tissue have demonstrated that even glioma infiltration within normal-appearing brain parenchyma can be detected with MRS. 19,23,24,27 Based on these studies, we hypothe- Fig. 1.…”

Section: Discussionmentioning

confidence: 99%

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Intraoperative magnetic resonance spectroscopy for identification of residual tumor during low-grade glioma surgery

Pamir

Özduman²,

Yıldız

et al. 2013

JNS

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M axiMal safe resection is currently the most effective form of therapy for hemispheric LGGs and patients benefit from the extent of resection. 1,7,16,20 Intraoperative MRI has been used with success in LGG surgery, and the technique has been shown to both increase the extent of resection 2,[10][11][12]21,22,25 and significantly decrease recurrence and death rate in patients with LGGs. 2During LGG surgery, ioMRI can detect residual tumor tissue that cannot be identified by visual inspection or intraoperative ultrasonography. 8,15,25 The tumor mass is defined as the T2-hyperintense area and the extent of resection is based on comparison of intraoperatively acquired T2-weighted images with preoperative ones. However, especially after resection of large LGGs with mass effect, intraoperative images may show T2-hyperintense areas at the resection border, and a differential diagnosis between tumoral and nontumoral tissue may be difficult.15 The difficulty lies in that both tumor and nontumoral changes such as infarction, edema, or iatrogenic contusion or other surgically induced changes can appear similarly as T2 hyperintensities on MRI. This is a potential limiting factor for an optimum resection in certain Object. The authors had previously shown that 3-T intraoperative MRI (ioMRI) detects residual tumor tissue during low-grade glioma and that it helps to increase the extent of resection. In a proportion of their cases, however, the ioMRI disclosed T2-hyperintense areas at the tumor resection border after the initial resection attempt and prompted a differential diagnosis between residual tumor and nontumoral changes. To guide this differential diagnosis the authors used intraoperative long-TE single-voxel proton MR spectroscopy (ioMRS) and tested the correlation of these findings with findings from pathological examination of resected tissue.Methods. Patients who were undergoing surgery for hemispheric or insular WHO Grade II gliomas and were found to have T2 changes around the resection cavity at the initial ioMRI were prospectively examined with ioMRS and biopsies were taken from corresponding localizations. In 14 consecutive patients, the ioMRS diagnosis in 20 voxels of interest was tested against the histopathological diagnosis. Intraoperative diffusion-weighted imaging (ioDWI) was also performed, as a part of the routine imaging, to rule out surgically induced changes, which could also appear as T2 hyperintensity.Results. Presence of tumor was documented in 14 (70%) of the 20 T2-hyperintense areas by histopathological examination. The sensitivity of ioMRS for identifying residual tumor was 85.7%, the specificity was 100%, the positive predictive value was 100%, and the negative predictive value was 75%. The specificity of ioDWI for surgically induced changes was high (100%), but the sensitivity was only 60%.Conclusions. This is the first clinical series to indicate that ioMRS can be used to differentiate residual tumor from nontumoral changes around the resection cavity, with high sensitivity and specificity. ...

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Section: Discussionmentioning

confidence: 99%

“…18,19,23 We measured the Cho/Cr ratio at the VOI and a comparable voxel in the contralateral hemisphere (internal control) and used a 20% increase as our criterion for a tumoral spectrum. The sensitivity of this paradigm (tested against the gold standard of tissue diagnosis) was 85.7% in this study.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative magnetic resonance spectroscopy for identification of residual tumor during low-grade glioma surgery

Pamir

Özduman²,

Yıldız

et al. 2013

JNS

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“…Increased levels of Glx complex are markers of epileptogenic processes [31] and low levels of Glx have been observed in Alzheimer Dementia and patients with chronic Schizophrenia [32]. Glx complex increment, has been also observed in the peritumoral brain edema correlated with neuronal loss and demyelination [33]. As reported by Malhorta et al, Glx might be used as an in vivo index of inflammation since they observed elevated Glx levels in acute MS plaques but not in chronic ones [34].…”

Section: Neurospectroscopy Biochemical Features and Their Clinical Simentioning

confidence: 98%

“…Delayed acquisition (e.g. TE > 80 ms) removes the macromolecules due to their shorter T2 relaxation times (∼30 msec), at the expense of loss of information of many scalar-coupled resonances [21] which have been suggested valuable for tumor and stroke characterization [4,21,22,24,25,33].…”

Section: Post Processing Techniquesmentioning

confidence: 99%

Proton Magnetic Resonance Spectroscopy of the Central Nervous System

Kousi¹,

Tsougos²,

Eftychia³

2013

Novel Frontiers of Advanced Neuroimaging

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“…Magnetic Resonance Imaging (MRI) and localized single voxel in vivo 1 H-MRS were performed with a 3 Tesla wholebody scanner (General Electric Medical Systems, Milwaukee, WI) on two patients affected by cerebral lesion, following the routine standard clinical protocol previously described (15). After MRI and in vivo MRS the patients underwent surgery and two adjacent samples were obtained.…”

Section: Methodsmentioning

confidence: 99%

Identification of mobile lipids in human cancer tissues by ex vivo diffusion edited HR-MAS MRS

et al. 2009

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Magnetic Resonance Spectroscopy visible mobilelipids are considered important markers in the diagnosis ofhuman cancer and are thought to be closely involved in variousaspects of tumour transformation, such as cell proliferation,necrosis, apoptosis, hypoxia and drug resistance. A methodallowing the straightforward identification of the lipid classescontributing to the mobile lipids in human malignant tissuesis highly advisable. Ex vivo High Resolution Magic AngleSpinning Magnetic Resonance Spectroscopy was done directlyon human cerebral, renal and colorectal malignant tissuespecimens. A diffusion edited sequence, based on stimulatedecho and bipolar gradient pulses, was used to characterizemolecules with low diffusion rates, arising from mobile lipidcomponents. Cholesterol, triglycerides and phosphatidylcholineare simultaneously detected and all contribute to the mobilelipid resonances present in malignant glioma and clear cellrenal carcinoma tissue specimens spectra. On the contrary,papillary cell renal carcinoma spectrum is predominated byphosphatidylcholine resonances and that of colorectal adenocarcinoma is characterized by signals arising from triglycerides. Ex vivo diffusion edited High Resolution Magic AngleSpinning Magnetic Resonance Spectroscopy, done on intacttissue, is a powerful analytical tool to obtain a simple andimmediate identification of mobile lipid components. This can offer a significant contribution to better understanding their involvement in cancer tissues. Furthermore, ex vivo high resolution spectroscopic measurements allow to improve the interpretation of in vivo Magnetic Resonance spectra, increasing its clinical potentiality

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Metabolic Findings on 3T 1H-MR Spectroscopy in Peritumoral Brain Edema

Cited by 59 publications

References 39 publications

Intraoperative magnetic resonance spectroscopy for identification of residual tumor during low-grade glioma surgery

Intraoperative magnetic resonance spectroscopy for identification of residual tumor during low-grade glioma surgery

Proton Magnetic Resonance Spectroscopy of the Central Nervous System

Identification of mobile lipids in human cancer tissues by ex vivo diffusion edited HR-MAS MRS

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