Proton magnetic resonance spectroscopy in the distinction of high-grade cerebral gliomas from single metastatic brain tumors

Server, Andrés; Josefsen, Roger; Kulle, Bettina; Mæhlen, Jan; Schellhorn, Till; Gadmar, Øystein B.; Kumar, Theresa; Haakonsen, Monika; Langberg, Carl W.; Nakstad, P

doi:10.3109/02841850903482901

Cited by 113 publications

(107 citation statements)

References 26 publications

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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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“…The potential of in vivo 1 H-MRS for differentiating intracerebral metastases from GBMs has been investigated in a number of studies [102,104]. Older studies [22,105] have reported that intratumoral 1 H-MRS, either on short or long TE, was unable to differentiate between metastases and GBMs, as they share common metabolic features.…”

Section: Cerebral Metastasismentioning

confidence: 99%

“…Cerebral metastases are a common complication of cancer and can affect 20% to 40% of patients [102] who suffer from primary tumors in lung, breast, skin or colon.…”

Section: Cerebral Metastasismentioning

confidence: 99%

Proton Magnetic Resonance Spectroscopy of the Central Nervous System

Kousi¹,

Tsougos²,

Eftychia³

2013

Novel Frontiers of Advanced Neuroimaging

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“…In addition, the gadopentetic acid enhancement may show a mass reinforcement, and the proton magnetic resonance spectroscopy may exhibit an elevation of choline and lactate peak. The fluorodeoxyglucose PET/CT scan may show single or multiple high metabolic signals that exhibit SUV elevation (10)(11)(12)(13)(14)(15)(16)(17)(18). In the present study, the MRI results differed from a typical PCNSL case: The lesion size was smaller and exhibited prominent surrounding edema, lateral ventricle compression and an evident occupied effect.…”

Section: Discussionmentioning

confidence: 99%

Primary diffuse large B-cell lymphoma of the central nervous system: A case report and literature review

Chen

et al. 2016

Oncology Letters

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Abstract. The present study reports the clinical diagnosis and management of a patient with primary diffuse large B-cell lymphoma (Bcl) of the central nervous system (CNS). Making an early diagnosis of primary diffuse large Bcl is challenging due to the variable and complicated clinical manifestations of the disease. The relevant literature was reviewed, and high-dose methotrexate, whole brain radiotherapy and highly active antiretroviral therapy was recommended for the patient. The present study elucidates the role of positron emission tomography-computed tomography scans for the diagnosis and management of primary diffuse large Bcl of the CNS, and demonstrates the importance of resection surgery in the management of the disease. Specifically, the present study proposes that resection surgery may be applied in the early stages of disease for patients with a single occupied lesion and increased intracranial pressure.

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Proton magnetic resonance spectroscopy in the distinction of high-grade cerebral gliomas from single metastatic brain tumors

Abstract: The results of this study demonstrate that MRS can differentiate high-grade gliomas from metastases, especially with peritumoral measurements, supporting the hypothesis that MRS can detect infiltration of tumor cells in the peritumoral edema.

Cited by 113 publications

References 26 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

Primary diffuse large B-cell lymphoma of the central nervous system: A case report and literature review

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