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Campion A, Iv M. Brain Tumor Imaging: Review of Conventional and Advanced Techniques. Semin Neurol 2023; 43:867-888. [PMID: 37963581 DOI: 10.1055/s-0043-1776765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
Approaches to central nervous system (CNS) tumor classification and evaluation have undergone multiple iterations over the past few decades, in large part due to our growing understanding of the influence of genetics on tumor behavior and our refinement of brain tumor imaging techniques. Computed tomography and magnetic resonance imaging (MRI) both play a critical role in the diagnosis and monitoring of brain tumors, although MRI has become especially important due to its superior soft tissue resolution. The purpose of this article will be to briefly review the fundamentals of conventional and advanced techniques used in brain tumor imaging. We will also highlight the applications of these imaging tools in the context of commonly encountered tumors based on the most recently updated 2021 World Health Organization (WHO) classification of CNS tumors framework.
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Affiliation(s)
- Andrew Campion
- Department of Radiology (Neuroradiology), Stanford University, Stanford, California
| | - Michael Iv
- Department of Radiology (Neuroradiology), Stanford University, Stanford, California
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2
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De Lucia F, Lefebvre Y, Lemort MP. Interest of routine MR spectroscopic techniques for differential diagnosis between radionecrosis and progression of brain tumor lesions. Eur J Radiol Open 2022; 9:100449. [DOI: 10.1016/j.ejro.2022.100449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 10/19/2022] [Accepted: 10/28/2022] [Indexed: 11/13/2022] Open
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Differentiating Glioblastomas from Solitary Brain Metastases: An Update on the Current Literature of Advanced Imaging Modalities. Cancers (Basel) 2021; 13:cancers13122960. [PMID: 34199151 PMCID: PMC8231515 DOI: 10.3390/cancers13122960] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 06/09/2021] [Accepted: 06/09/2021] [Indexed: 12/12/2022] Open
Abstract
Differentiating between glioblastomas and solitary brain metastases proves to be a challenging diagnosis for neuroradiologists, as both present with imaging patterns consisting of peritumoral hyperintensities with similar intratumoral texture on traditional magnetic resonance imaging sequences. Early diagnosis is paramount, as each pathology has completely different methods of clinical assessment. In the past decade, recent developments in advanced imaging modalities enabled providers to acquire a more accurate diagnosis earlier in the patient's clinical assessment, thus optimizing clinical outcome. Dynamic susceptibility contrast has been optimized for detecting relative cerebral blood flow and relative cerebral blood volume. Diffusion tensor imaging can be used to detect changes in mean diffusivity. Neurite orientation dispersion and density imaging is an innovative modality detecting changes in intracellular volume fraction, isotropic volume fraction, and extracellular volume fraction. Magnetic resonance spectroscopy is able to assist by providing a metabolic descriptor while detecting variable ratios of choline/N-acetylaspartate, choline/creatine, and N-acetylaspartate/creatine. Finally, radiomics and machine learning algorithms have been devised to assist in improving diagnostic accuracy while often utilizing more than one advanced imaging protocol per patient. In this review, we provide an update on all the current evidence regarding the identification and differentiation of glioblastomas from solitary brain metastases.
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Matsusue E, Inoue C, Tabuchi S, Yoshioka H, Nagao Y, Matsumoto K, Nakamura K, Fujii S. Utility of 3T single-voxel proton MR spectroscopy for differentiating intracranial meningiomas from intracranial enhanced mass lesions. Acta Radiol Open 2021; 10:20584601211009472. [PMID: 34211737 PMCID: PMC8215334 DOI: 10.1177/20584601211009472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 03/23/2021] [Indexed: 02/03/2023] Open
Abstract
Background Proton magnetic resonance spectroscopy (MRS) provides structural and
metabolic information that is useful for the diagnosis of meningiomas with
atypical radiological appearance. However, the metabolite that should be
prioritized for the diagnosis of meningiomas has not been established. Purpose To evaluate the differences between the metabolic peaks of meningiomas and
other intracranial enhanced mass lesions (non-meningiomas) using MR
spectroscopy in short echo time (TE) spectra and the most useful metabolic
peak for discriminating between the groups. Material and Methods The study involved 9 meningiomas, 22 non-meningiomas, intracranial enhancing
tumors and abscesses, and 15 normal controls. The ranking of the peak at
3.8 ppm, peak at 3.8 ppm/Creatine (Cr), β-γ Glutamine-Glutamate (bgGlx)/Cr,
N-acetyl compounds (NACs)/Cr, choline (Cho)/Cr, lipid and/or lactate
(Lip-Lac) at 1.3 ppm/Cr, and the presence of alanine (Ala) were derived. The
metabolic peaks were compared using the Mann-Whitney U test. ROC analysis
was used to determine the cut-off values for differentiating meningiomas
from non-meningiomas using statistically significant metabolic peaks. Results The ranking of the peak at 3.8 ppm among all the peaks, peak at 3.8 ppm/Cr,
bgGlx/Cr, Lip-Lac/Cr, and the presence of Ala discriminated meningiomas from
non-meningiomas with moderate to high accuracy. The highest accuracy was
96.9% at a threshold value of 3 for the rank of the peak at 3.8 ppm. Conclusion A distinct elevated peak at 3.8 ppm, ranked among the top three highest
peaks, allowed the detection of meningiomas.
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Affiliation(s)
- Eiji Matsusue
- Department of Radiology, Tottori Prefectural Central Hospital, Tottori, Japan
| | - Chie Inoue
- Department of Radiology, Tottori Prefectural Central Hospital, Tottori, Japan
| | - Sadaharu Tabuchi
- Department of Neurosurgery, Tottori Prefectural Central Hospital, Tottori, Japan
| | - Hiroki Yoshioka
- Department of Neurosurgery, Tottori Prefectural Central Hospital, Tottori, Japan
| | - Yuichiro Nagao
- Department of Neurosurgery, Tottori Prefectural Central Hospital, Tottori, Japan
| | - Kensuke Matsumoto
- Department of Radiology, Tottori Prefectural Central Hospital, Tottori, Japan
| | - Kazuhiko Nakamura
- Department of Radiology, Tottori Prefectural Central Hospital, Tottori, Japan
| | - Shinya Fujii
- Division of Radiology, Department of Multidisciplinary Internal Medicine, Tottori University, Tottori, Japan
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Ehsani S, Saatchian E, Sarikhani A, Montazerabadi A. 1H-MRS application in the evaluation of response to photo-thermal therapy using iron oxide-gold core-shell nanoparticles, an in vivo study. Photochem Photobiol Sci 2021; 20:245-254. [PMID: 33721249 DOI: 10.1007/s43630-021-00012-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 01/11/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Photo-thermal therapy (PTT) has been at the center of attention as a new method for cancer treatment in recent years. It is important to predict the response to treatment in the PTT procedure. Using magnetic resonance spectroscopy (MRS) can be considered a novel technique in evaluating changes in metabolites resulted from PTT. METHODS In the present project, we conducted an in vivo study to assess the efficacy of 1H-MRS as a noninvasive technique to evaluate the response to treatment in the early hours following PTT. The BALB/c mice subcutaneously bearing tumor cells (CT26 cell line) were scanned by 1H-MRS before and after PTT. Iron oxide-gold core-shell (Fe3O4@Au) as PTT agent was injected into intra-peritoneal at first and then irradiated by NIR laser. Single-voxel Point RESolved Spectroscopy (PRESS) sequence (TE = 144) was used, and metabolites alternations were evaluated by the non-parametric Wilcoxon test. Besides, Nanoparticle (NP) relaxometry was conducted for negative contrast agents' potentials. RESULTS MRS choline (Cho) peak dramatically reduced 24 h post-PTT (p = 0.01) and lipid peak as a marker for necrosis of tumor elevated (p = 0.01) just in group 3 (NPs injection + laser irradiation) 24 h after the procedure. CONCLUSION 1H-MRS showed its potential as a method in detecting the changes in metabolites and revealing the outcome accurately. Response to photo-thermal therapy evaluation was achievable only one day after PTT and proved by a 10-day follow-up of the tumor size. Iron oxide-gold core-shell can also be used as a negative contrast agent in MRI images during therapy.
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Affiliation(s)
- Sina Ehsani
- Department of Medical Physics, Medicine Faculty, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Erfan Saatchian
- Department of Medical Physics, Medicine Faculty, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Abolfazl Sarikhani
- Finetech in Medicine Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Montazerabadi
- Medical Physics Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
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Saatchian E, Ehsani S, Sarikhani A, Ghaznavi H, Montazerabadi A, Shakeri-Zadeh A. Monitoring of the choline/lipid ratio by 1H-MRS can be helpful for prediction and early detection of tumor response to nano-photo-thermal therapy. Lasers Med Sci 2021; 37:335-343. [PMID: 33523392 DOI: 10.1007/s10103-021-03256-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 01/19/2021] [Indexed: 12/12/2022]
Abstract
Nanotechnology-based photothermal therapy (NPTT) is a new emerging modality of cancer therapy. To have the right prediction and early detection of response to NPTT, it is necessary to get rapid feedback from a tumor treated by NPTT procedure and stay informed of what happens in the tumor site. We performed this study to find if proton magnetic resonance spectroscopy (1H-MRS) can be well responsive to such an imperative requirement. We considered various treatment groups including gold nanoparticles (AuNPs), laser, and the combination of AuNPs and laser (NPTT group). Therapeutic effects on CT26 colon tumor-bearing BALB/c mice were studied by looking at alterations that happened in 1H-MRS signals and tumor size after conducting treatment procedures. In MRS studies, the alterations of choline and lipid concentrations and their ratio were investigated. Having normalized the metabolite peak to water peak, we found a significant decrease in choline concentration post-NPTT (from (1.25 ± 0.05) × 10-3 to (0.43 ± 0.04) × 10-3), while the level of lipid concentration in the tumor was slightly increased (from (2.91 ± 0.23) × 10-3 to (3.52 ± 0.31) × 10-3). As a result, the choline/lipid ratio was significantly decreased post-NPTT (from 0.41 ± 0.11 to 0.11 ± 0.02). Such alterations appeared just 1 day after NPTT. Tumor shrinkage in all groups was studied and significant changes were significantly detectable on day 7 post-NPTT procedure. In conclusion, the study of choline/lipid ratio using 1H-MRS may help us estimate what happens in a tumor treated by the NPTT method. Such an in vivo assessment is interestingly feasible as soon as just 1 day post-NPTT. This would undoubtedly help the oncologists make a more precise decision about treatment planning strategies. Monitoring of the choline/lipid ratio by 1H-MRS can be helpful for prediction and early detection of response to nano-photo-thermal therapy.
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Affiliation(s)
- Erfan Saatchian
- Medical Physics Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sina Ehsani
- Medical Physics Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Abolfazl Sarikhani
- Finetech in Medicine Research Center, Iran University of Medical Science, Tehran, Iran
| | - Habib Ghaznavi
- Pharmacology Research Center, Zahedan University of Medical Sciences (ZaUMS), Zahedan, Iran.
| | - Alireza Montazerabadi
- Medical Physics Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Ali Shakeri-Zadeh
- Finetech in Medicine Research Center, Iran University of Medical Science, Tehran, Iran
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Dandıl E, Karaca S. Detection of pseudo brain tumors via stacked LSTM neural networks using MR spectroscopy signals. Biocybern Biomed Eng 2021. [DOI: 10.1016/j.bbe.2020.12.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Lee D, Riestenberg RA, Haskell-Mendoza A, Bloch O. Brain Metastasis Recurrence Versus Radiation Necrosis: Evaluation and Treatment. Neurosurg Clin N Am 2020; 31:575-587. [PMID: 32921353 DOI: 10.1016/j.nec.2020.06.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Radiation necrosis (RN) occurs in 5% to 25% of patients with brain metastases treated with stereotactic radiosurgery. RN must be distinguished from recurrent tumor to determine appropriate treatment. Stereotactic biopsy remains the gold standard for identifying RN. Initial treatment of RN often involves management of edema using corticosteroids, antiangiogenic therapies, and hyperbaric oxygen therapy. For refractory symptoms, surgical resection can be considered. Minimally invasive stereotactic laser ablation has the benefit of providing tissue diagnosis and treating RN or recurrent tumor with similar efficacy. Laser ablation should be considered for lesions in need of intervention where the diagnosis requires tissue confirmation.
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Affiliation(s)
- Dennis Lee
- Department of Neurological Surgery, University of California Davis, 4860 Y Street, Suite 3740, Sacramento, CA 95817, USA
| | - Robert A Riestenberg
- Department of Neurological Surgery, University of California Davis, 4860 Y Street, Suite 3740, Sacramento, CA 95817, USA
| | - Aden Haskell-Mendoza
- Department of Neurological Surgery, University of California Davis, 4860 Y Street, Suite 3740, Sacramento, CA 95817, USA
| | - Orin Bloch
- Department of Neurological Surgery, University of California, Davis School of Medicine, University of California Davis, 4860 Y Street, Suite 3740, Sacramento, CA 95817, USA.
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Margiewicz S, Cordova C, Chi AS, Jain R. State of the Art Treatment and Surveillance Imaging of Glioblastomas. Semin Roentgenol 2017; 53:23-36. [PMID: 29405952 DOI: 10.1053/j.ro.2017.11.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
| | - Christine Cordova
- Laura and Isaac Perlmutter Cancer Center, NYU School of Medicine, New York, NY
| | - Andrew S Chi
- Laura and Isaac Perlmutter Cancer Center, NYU School of Medicine, New York, NY
| | - Rajan Jain
- Department of Radiology, NYU School of Medicine, New York, NY; Department of Neurosurgery, NYU School of Medicine, New York, NY.
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Nagashima H, Sasayama T, Tanaka K, Kyotani K, Sato N, Maeyama M, Kohta M, Sakata J, Yamamoto Y, Hosoda K, Itoh T, Sasaki R, Kohmura E. Myo-inositol concentration in MR spectroscopy for differentiating high grade glioma from primary central nervous system lymphoma. J Neurooncol 2017; 136:317-326. [DOI: 10.1007/s11060-017-2655-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Accepted: 10/24/2017] [Indexed: 01/26/2023]
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Menoux I, Noël G, Namer I, Antoni D. TEP/tomodensitométrie et imagerie spectroscopique par résonance magnétique tridmensionnelle pour le diagnostic différentiel entre radionécrose cérébrale et rechute tumorale après irradiation en conditions stéréotaxiques de métastases cérébrales : place dans l’arbre décisionnel. Cancer Radiother 2017; 21:389-397. [DOI: 10.1016/j.canrad.2017.03.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 01/17/2017] [Accepted: 03/01/2017] [Indexed: 11/16/2022]
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12
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Toussaint M, Pinel S, Auger F, Durieux N, Thomassin M, Thomas E, Moussaron A, Meng D, Plénat F, Amouroux M, Bastogne T, Frochot C, Tillement O, Lux F, Barberi-Heyob M. Proton MR Spectroscopy and Diffusion MR Imaging Monitoring to Predict Tumor Response to Interstitial Photodynamic Therapy for Glioblastoma. Theranostics 2017; 7:436-451. [PMID: 28255341 PMCID: PMC5327359 DOI: 10.7150/thno.17218] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 10/12/2016] [Indexed: 01/31/2023] Open
Abstract
Despite recent progress in conventional therapeutic approaches, the vast majority of glioblastoma recur locally, indicating that a more aggressive local therapy is required. Interstitial photodynamic therapy (iPDT) appears as a very promising and complementary approach to conventional therapies. However, an optimal fractionation scheme for iPDT remains the indispensable requirement. To achieve that major goal, we suggested following iPDT tumor response by a non-invasive imaging monitoring. Nude rats bearing intracranial glioblastoma U87MG xenografts were treated by iPDT, just after intravenous injection of AGuIX® nanoparticles, encapsulating PDT and imaging agents. Magnetic Resonance Imaging (MRI) and Magnetic Resonance Spectroscopy (MRS) allowed us an original longitudinal follow-up of post-treatment effects to discriminate early predictive markers. We successfully used conventional MRI, T2 star (T2*), Diffusion Weighted Imaging (DWI) and MRS to extract relevant profiles on tissue cytoarchitectural alterations, local vascular disruption and metabolic information on brain tumor biology, achieving earlier assessment of tumor response. From one day post-iPDT, DWI and MRS allowed us to identify promising markers such as the Apparent Diffusion Coefficient (ADC) values, lipids, choline and myoInositol levels that led us to distinguish iPDT responders from non-responders. All these responses give us warning signs well before the tumor escapes and that the growth would be appreciated.
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Lu AY, Turban JL, Damisah EC, Li J, Alomari AK, Eid T, Vortmeyer AO, Chiang VL. Novel biomarker identification using metabolomic profiling to differentiate radiation necrosis and recurrent tumor following Gamma Knife radiosurgery. J Neurosurg 2016; 127:388-396. [PMID: 27885954 DOI: 10.3171/2016.8.jns161395] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Following an initial response of brain metastases to Gamma Knife radiosurgery, regrowth of the enhancing lesion as detected on MRI may represent either radiation necrosis (a treatment-related inflammatory change) or recurrent tumor. Differentiation of radiation necrosis from tumor is vital for management decision making but remains difficult by imaging alone. In this study, gas chromatography with time-of-flight mass spectrometry (GC-TOF) was used to identify differential metabolite profiles of the 2 tissue types obtained by surgical biopsy to find potential targets for noninvasive imaging. METHODS Specimens of pure radiation necrosis and pure tumor obtained from patient brain biopsies were flash-frozen and validated histologically. These formalin-free tissue samples were then analyzed using GC-TOF. The metabolite profiles of radiation necrosis and tumor samples were compared using multivariate and univariate statistical analysis. Statistical significance was defined as p ≤ 0.05. RESULTS For the metabolic profiling, GC-TOF was performed on 7 samples of radiation necrosis and 7 samples of tumor. Of the 141 metabolites identified, 17 (12.1%) were found to be statistically significantly different between comparison groups. Of these metabolites, 6 were increased in tumor, and 11 were increased in radiation necrosis. An unsupervised hierarchical clustering analysis found that tumor had elevated levels of metabolites associated with energy metabolism, whereas radiation necrosis had elevated levels of metabolites that were fatty acids and antioxidants/cofactors. CONCLUSIONS To the authors' knowledge, this is the first tissue-based metabolomics study of radiation necrosis and tumor. Radiation necrosis and recurrent tumor following Gamma Knife radiosurgery for brain metastases have unique metabolite profiles that may be targeted in the future to develop noninvasive metabolic imaging techniques.
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Affiliation(s)
| | | | | | | | | | - Tore Eid
- Laboratory Medicine, Yale School of Medicine, New Haven, Connecticut
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[Imaging methods used in the differential diagnosis between brain tumour relapse and radiation necrosis after stereotactic radiosurgery of brain metastases: Literature review]. Cancer Radiother 2016; 20:837-845. [PMID: 28270324 DOI: 10.1016/j.canrad.2016.07.098] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 06/22/2016] [Accepted: 07/01/2016] [Indexed: 11/20/2022]
Abstract
After stereotactic radiosurgery for a cerebral metastasis, one of the dreaded toxicities is radionecrosis. In the follow-up of these patients, it is impossible to distinguish radiation necrosis from tumour relapse either clinically or with MRI. In current practice, many imaging methods are designed such as special sequences of MRI (dynamic susceptibility contrast perfusion and susceptibility-weighted imaging, diffusion), proton magnetic resonance spectroscopy, positron emission tomography, or more seldom 201-thallium single-photon emission computerized tomography. This article is a required literature analysis in order to establish a decision tree with the analysis of retrospective and prospective data.
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Spectroscopic Characterization of Gliosarcomas—Do They Differ From Glioblastomas and Metastases? J Comput Assist Tomogr 2016; 40:815-9. [DOI: 10.1097/rct.0000000000000419] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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16
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Isobe T, Yamamoto T, Akutsu H, Shiigai M, Shibata Y, Takada K, Masumoto T, Anno I, Matsumura A. Preliminary study for differential diagnosis of intracranial tumors using in vivo quantitative proton MR spectroscopy with correction for T2 relaxation time. Radiography (Lond) 2015. [DOI: 10.1016/j.radi.2014.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Kimura T, Sugimura T, Fukuda S, Miyano M, Hashimoto M. Surgical indication of iNPH (idiopathic normal pressure hydrocephalus). Fluids Barriers CNS 2015. [PMCID: PMC4582361 DOI: 10.1186/2045-8118-12-s1-p25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
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1H-MRS is useful to reinforce the suspicion of primary central nervous system lymphoma prior to surgery. Eur Radiol 2014; 24:2895-905. [DOI: 10.1007/s00330-014-3308-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 06/04/2014] [Accepted: 07/02/2014] [Indexed: 10/25/2022]
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Muccio CF, Caranci F, D'Arco F, Cerase A, De Lipsis L, Esposito G, Tedeschi E, Andreula C. Magnetic resonance features of pyogenic brain abscesses and differential diagnosis using morphological and functional imaging studies: a pictorial essay. J Neuroradiol 2014; 41:153-67. [PMID: 24957685 DOI: 10.1016/j.neurad.2014.05.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 05/06/2014] [Accepted: 05/10/2014] [Indexed: 10/25/2022]
Abstract
The aim of this paper is to illustrate the potential of magnetic resonance imaging (MRI) in diagnosis, differential diagnosis, treatment planning and evaluation of therapy effectiveness of pyogenic brain abscesses, through the use of morphological (or conventional) and functional (or advanced) sequences. Conventional MRI study is useful for the identification of lesions, to determine the location and morphology and allows a correct hypothesis of nature in the most typical cases. However, the differential diagnosis from other brain lesions, such as non-pyogenic abscesses or necrotic tumors (high-grade gliomas and metastases) is often only possible through the use of functional sequences, as the measurement of diffusion with apparent diffusion coefficient (DWI-ADC), proton magnetic resonance spectroscopy ((1)H-MRS) and perfusion weighted imaging (PWI), which complement the morphological sequences and provide essential information on structural, metabolic and hemodynamic characteristics allowing greater neuroradiological confidence. Modern diagnostic MRI of pyogenic brain abscesses cannot be separated from knowledge, integration and proper use of the morphological and functional sequences.
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Affiliation(s)
- Carmine Franco Muccio
- Unit of Neuroradiology, Department of Neuroscience, Hospital "Gaetano Rummo", Benevento, Italy
| | - Ferdinando Caranci
- Unit of Neuroradiology, Department of Advanced Biomedical Sciences, University "Federico II", Naples, Italy
| | - Felice D'Arco
- Unit of Neuroradiology, Department of Advanced Biomedical Sciences, University "Federico II", Naples, Italy.
| | - Alfonso Cerase
- Unit of Neuroradiology, Department of Neuroscience, University "Santa Maria alle Scotte", Siena, Italy
| | - Luca De Lipsis
- Department of Critical Care Medicine, Hospital "Fatebenefratelli", Benevento, Italy
| | - Gennaro Esposito
- Unit of Neuroradiology, Department of Neuroscience, Hospital "Gaetano Rummo", Benevento, Italy
| | - Enrico Tedeschi
- Unit of Neuroradiology, Department of Advanced Biomedical Sciences, University "Federico II", Naples, Italy
| | - Cosma Andreula
- Unit of Radiology and Neuroradiology, Anthea Hospital, Bari, Italy
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Recurrent glioblastoma multiforme versus radiation injury: a multiparametric 3-T MR approach. Radiol Med 2014; 119:616-24. [PMID: 24408041 DOI: 10.1007/s11547-013-0371-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Accepted: 06/25/2013] [Indexed: 12/26/2022]
Abstract
OBJECTIVE The discrimination between recurrent glioma and radiation injury is often a challenge on conventional magnetic resonance imaging (MRI). We verified whether adding and combining proton MR spectroscopic imaging ((1)H-MRSI), diffusion-weighted imaging (DWI) and perfusion-weighted imaging (PWI) information at 3 Tesla facilitate such discrimination. MATERIALS AND METHODS Twenty-nine patients with histologically verified high-grade gliomas, who had undergone surgical resection and radiotherapy, and had developed new contrast-enhancing lesions close to the treated tumour, underwent MRI, (1)H-MRSI, DWI and PWI at regular time intervals. The metabolite ratios choline (Cho)/normal( n )Cho n , N-acetylaspartate (NAA)/NAA n , creatine (Cr)/Cr n , lactate/lipids (LL)/LL n , Cho/Cr n , NAA/Cr n , Cho/NAA, NAA/Cr and Cho/Cr were derived from (1)H-MRSI; the apparent diffusion coefficient (ADC) from DWI; and the relative cerebral blood volume (rCBV) from PWI. RESULTS In serial MRI, recurrent gliomas showed a progressive enlargement, and radiation injuries showed regression or no modification. Discriminant analysis showed that discrimination accuracy was 79.3 % when considering only the metabolite ratios (predictor, Cho/Cr n ), 86.2 % when considering ratios and ADC (predictors, Cho/Cr n and ADC), 89.7 % when considering ratios and rCBV (predictors, Cho/Cr n , Cho/Cr and rCBV), and 96.6 % when considering ratios, ADC and rCBV (predictors, Cho/Cho n , ADC and rCBV). CONCLUSIONS The multiparametric 3-T MR assessment based on (1)H-MRSI, DWI and PWI in addition to MRI is a useful tool to discriminate tumour recurrence/progression from radiation effects.
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Rezvanizadeh A, Firouznia K, Salehi-Sadaghiani M, Mohseni M, Gharaei D, Ghanaati H, Saligheh Rad H, Masoudnia M. The effects of voxel localization and time of echo on the diagnostic accuracy of cystic brain tumors in 3 tesla magnetic resonance spectroscopy. IRANIAN JOURNAL OF RADIOLOGY 2013; 9:195-201. [PMID: 23407767 PMCID: PMC3569551 DOI: 10.5812/iranjradiol.7510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Revised: 08/11/2012] [Accepted: 08/15/2012] [Indexed: 11/28/2022]
Abstract
Background Although magnetic resonance spectroscopy (MRS) has been shown as an effective diagnostic tool in distinguishing inflammation from neoplasm in cystic brain lesions, the optimum approach in selecting the portions of lesions in MRS and the possible effects of different times of echoes (TEs) remains unknown. Objectives To determine the most effective TE in diagnosing neoplastic lesions based on detecting choline (Cho), N acetyl aspartate (NAA) and creatinine (Cr). Moreover, the role of voxel localization on the diagnosis of the neoplastic nature of the lesions is assessed through comparing the abovementioned metabolite ratios in the rim and center of each lesion with the same TE. Patients and Methods In 16 patients with brain cystic tumors, MRS was performed at TEs of 30, 135 and 270 ms for detection of Cho, NAA and Cr metabolites using a 3 tesla MRI unit. The percentage of analyzed ratios greater than a cut-off point of 1.3 for Cho/Cr and 1.6 for Cho/NAA were calculated. Results Cho/Cr and Cho/NAA ratio means at all TEs were more at the central area in comparison with the periphery, although none of the differences were statistically significant. There was no statistically significant difference among the compared TEs. The percentages of ratios above the cut-off point at all TEs were more in the rim compared to the center and in the union of both compared to the rim or center. All the patients had at least one voxel with a Cho/Cr ratio of more than 1.3 when the voxel was chosen according to the hotspots shown in the chemical shift imaging map, regardless of their location at all examined TEs. Conclusions Selection of voxels with the guide of chemical shift imaging map yields to 100% diagnostic sensitivity. If not accessible, the use of the union of peripheral and central voxels enhances the sensitivity when compared to usage of peripheral or central voxels solely.
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Affiliation(s)
- Alireza Rezvanizadeh
- Department of Radiology, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Kavous Firouznia
- Department of Radiology, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran
- Corresponding author: Kavous Firouznia, Department of Radiology, Medical Imaging Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Tel.: +98-21-66581579, Fax: +98-21-66581578, E-mail:
| | | | - Meisam Mohseni
- Department of Neurosurgery, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Dona Gharaei
- Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Ghanaati
- Department of Radiology, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran
| | - Hamidreza Saligheh Rad
- Department of Medical Physics and Biomedical Engineering, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Majid Masoudnia
- Department of Radiology, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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Guo J, Yao C, Chen H, Zhuang D, Tang W, Ren G, Wang Y, Wu J, Huang F, Zhou L. The relationship between Cho/NAA and glioma metabolism: implementation for margin delineation of cerebral gliomas. Acta Neurochir (Wien) 2012; 154:1361-70; discussion 1370. [PMID: 22729482 PMCID: PMC3407558 DOI: 10.1007/s00701-012-1418-x] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Accepted: 06/05/2012] [Indexed: 11/28/2022]
Abstract
Background The marginal delineation of gliomas cannot be defined by conventional imaging due to their infiltrative growth pattern. Here we investigate the relationship between changes in glioma metabolism by proton magnetic resonance spectroscopic imaging (1H-MRSI) and histopathological findings in order to determine an optimal threshold value of choline/N-acetyl-aspartate (Cho/NAA) that can be used to define the extent of glioma spread. Method Eighteen patients with different grades of glioma were examined using 1H-MRSI. Needle biopsies were performed under the guidance of neuronavigation prior to craniotomy. Intraoperative magnetic resonance imaging (MRI) was performed to evaluate the accuracy of sampling. Haematoxylin and eosin, and immunohistochemical staining with IDH1, MIB-1, p53, CD34 and glial fibrillary acidic protein (GFAP) antibodies were performed on all samples. Logistic regression analysis was used to determine the relationship between Cho/NAA and MIB-1, p53, CD34, and the degree of tumour infiltration. The clinical threshold ratio distinguishing tumour tissue in high-grade (grades III and IV) glioma (HGG) and low-grade (grade II) glioma (LGG) was calculated. Results In HGG, higher Cho/NAA ratios were associated with a greater probability of higher MIB-1 counts, stronger CD34 expression, and tumour infiltration. Ratio threshold values of 0.5, 1.0, 1.5 and 2.0 appeared to predict the specimens containing the tumour with respective probabilities of 0.38, 0.60, 0.79, 0.90 in HGG and 0.16, 0.39, 0.67, 0.87 in LGG. Conclusions HGG and LGG exhibit different spectroscopic patterns. Using 1H-MRSI to guide the extent of resection has the potential to improve the clinical outcome of glioma surgery.
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Affiliation(s)
- Jun Guo
- Shanghai Medical College, Fudan University, Shanghai, 200040 China
| | - Chengjun Yao
- Glioma Surgery Division, Department of Neurologic Surgery, Huashan Hospital, Shanghai Medical College, Fudan University, No.12 Central Wulumuqi Road, Jing’an District, Shanghai, 200040 China
| | - Hong Chen
- Department of Neuropathology, Fudan University, Shanghai, 200040 China
| | - Dongxiao Zhuang
- Glioma Surgery Division, Department of Neurologic Surgery, Huashan Hospital, Shanghai Medical College, Fudan University, No.12 Central Wulumuqi Road, Jing’an District, Shanghai, 200040 China
| | - Weijun Tang
- Department of Radiology, Huashan Hospital, Shanghai, China
| | - Guang Ren
- Department of Radiology, Huashan Hospital, Shanghai, China
| | - Yin Wang
- Department of Neuropathology, Fudan University, Shanghai, 200040 China
| | - Jinsong Wu
- Glioma Surgery Division, Department of Neurologic Surgery, Huashan Hospital, Shanghai Medical College, Fudan University, No.12 Central Wulumuqi Road, Jing’an District, Shanghai, 200040 China
| | - Fengping Huang
- Glioma Surgery Division, Department of Neurologic Surgery, Huashan Hospital, Shanghai Medical College, Fudan University, No.12 Central Wulumuqi Road, Jing’an District, Shanghai, 200040 China
| | - Liangfu Zhou
- Glioma Surgery Division, Department of Neurologic Surgery, Huashan Hospital, Shanghai Medical College, Fudan University, No.12 Central Wulumuqi Road, Jing’an District, Shanghai, 200040 China
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Elmogy SA, Mousa AE, Elashry MS, Megahed AM. MR spectroscopy in post-treatment follow up of brain tumors. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2011. [DOI: 10.1016/j.ejrnm.2011.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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24
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Morita N, Harada M, Otsuka H, Melhem ER, Nishitani H. Clinical Application of MR Spectroscopy and Imaging of Brain Tumor. Magn Reson Med Sci 2011; 9:167-75. [PMID: 21187685 DOI: 10.2463/mrms.9.167] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Advanced imaging techniques, including diffusion tensor imaging (DTI), perfusion-weighted imaging (PWI), and magnetic resonance spectroscopy (MRS) can provide more information than that regarding anatomy. These techniques have been commonly used in the clinical field and recently been shown useful in diagnosing brain tumors, especially in cases difficult to specify using conventional imaging. Differentiation requires more than attention to each advanced image. Diagnostic accuracy improves by combining information from MRS with that from other sequences, such as maps of apparent diffusion coefficient (ADC) and fractional anisotropy (FA) generated from DTI and of cerebral blood volume (CBV) generated from PWI. We show clinical applications of advanced imaging techniques, combined MRS, for brain tumor.
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Affiliation(s)
- Naomi Morita
- Department of Radiology, Tokushima University Hospital.
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25
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Pyogenic abscess from Providencia stuartii mimicking necrotic tumour at perfusion-weighted imaging. Neurol Sci 2011; 32:919-23. [PMID: 21468679 DOI: 10.1007/s10072-011-0565-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2010] [Accepted: 03/19/2011] [Indexed: 10/18/2022]
Abstract
The purpose of this case report is to increase the knowledge about magnetic resonance spectrum of pyogenic abscesses of the brain. A 74-year-old woman presented with a left frontal lobe cystic mass, developed in the site of post-traumatic contusions after surgical evacuation of a subdural hematoma. MR imaging showed an ipsilateral mass lesion with a thin, regular rim of T1 high-intensity signal, T2 low-intensity signal, and gadolinium-enhancement. Diffusion-weighted imaging with measure of apparent diffusion coefficient value showed inhomogenous diffusion restriction in the lesion core. Perfusion-weighted imaging (PWI) demonstrated high relative cerebral blood volume (rCBV) in both the lesion wall and perilesional area, with a maximal rCBV ratio (rCBV of the lesion/rCBV of the normal contralateral white matter) of 5.65 and 0.58, respectively. As a result, surgery and pathology showed a pyogenic abscess. Cultures grew were Providencia stuartii species. In conclusion, a pyogenic brain abscess from P. stuartii may show high rCBV at PWI, thus mimicking a necrotic tumour.
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Huang BY, Kwock L, Castillo M, Smith JK. Association of choline levels and tumor perfusion in brain metastases assessed with proton MR spectroscopy and dynamic susceptibility contrast-enhanced perfusion weighted MRI. Technol Cancer Res Treat 2010; 9:327-37. [PMID: 20626199 DOI: 10.1177/153303461000900403] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
While malignant brain tumors typically show high choline concentrations and neovascularity, we have anecdotally noted that a substantial number of brain metastases from lung cancer demonstrate only mildly elevated choline resonances on proton MR spectroscopy ((1)H-MRS). The goals of this study were to determine whether lung cancer metastases are more likely to demonstrate low choline than other metastases and, in addition, to assess the relationship between choline and tissue perfusion in brain metastases. We performed a retrospective analysis of 66 patients with untreated brain metastases (40 NSCLC; 17 breast cancer; 9 melanoma) who underwent multivoxel 2D-CSI (1)H-MRS. Cho/Cr was compared between histologies using Mann-Whitney U tests. Lesions were dichotomized into low and high Cho/Cr groups, and differences in relative Cho/Cr between groups were assessed with Fisher's exact tests. 21 patients also underwent dynamic susceptibility MR perfusion weighted imaging (PWI). Normalized relative cerebral blood volume ratios (rCBV(norm)) were calculated, and strength of correlation between Cho/Cr and rCBV(norm) was assessed. Cho/Cr was significantly lower in lung cancer metastases compared to breast cancer metastases. Cho/Cr < 2.0 was observed in 37.5% of lung cancer metastases, 23.5% of breast cancer metastases, and 0% of melanoma metastases. Lung cancer metastases were significantly more likely to demonstrate low Cho/Cr than melanoma metastases (p = 0.04). There was a strong correlation between Cho/Cr and rCBV(norm) (p = 0.847, p < 0.001), and metastases in the high Cho/Cr group showed significantly higher rCBV(norm). These findings suggest that choline metabolism and tumor perfusion in brain metastases are interrelated, and we posit that this relationship may be due to the influence of the transcription factor HIF-1.
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Affiliation(s)
- B Y Huang
- Department of Radiolog, University of North Carolina, 101 Manning Drive, CB#7510 Chapel Hill, NC 27599-7510, USA.
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27
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N-Acetyl peak in MR spectra of intracranial metastatic mucinous adenocarcinomas. Magn Reson Imaging 2010; 28:1390-4. [PMID: 20797831 DOI: 10.1016/j.mri.2010.06.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2009] [Revised: 04/16/2010] [Accepted: 06/25/2010] [Indexed: 11/20/2022]
Abstract
Absence of N-acetylaspartate (NAA) is one important diagnostic criterion of MR spectroscopy (MRS) that may suggest that an intracranial mass lesion is a metastasis. We report two cases of histopathology-confirmed intracranial metastatic mucinous adenocarcinoma, which predominantly showed a large metabolite peak at 2.0 ppm, mimicking an NAA peak of normal brain tissue. This finding could be of help in the interpretation of MRS in cases of intracranial enhancing mass lesions, metastases or gliomas.
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28
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Sundgren PC, Cao Y. Brain irradiation: effects on normal brain parenchyma and radiation injury. Neuroimaging Clin N Am 2010; 19:657-68. [PMID: 19959011 DOI: 10.1016/j.nic.2009.08.014] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Radiation therapy is a major treatment modality for malignant and benign brain tumors. Concerns of radiation effects on the brain tissue and neurocognitive function and quality of life increase as survival of patients treated for brain tumors improves. In this article, the clinical and neurobehavioral symptoms and signs of radiation-induced brain injury, possible histopathology, and the potential of functional, metabolic, and molecular imaging as a biomarker for assessment and prediction of neurotoxicity after brain irradiation and imaging findings in radiation necrosis are discussed.
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Affiliation(s)
- Pia C Sundgren
- Diagnostic Centre for Imaging and Functional Medicine, Malmö University Hospital, University of Lund, SE-205 02 Malmö, Sweden.
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Abstract
Detecting a new area of contrast enhancement in or in the vicinity of a previously treated brain tumor always causes concern for both the patient and the physician. The question that immediately arises is whether this new lesion is recurrent tumor or a treatment effect. The differentiation of recurrent tumor or progressive tumor from radiation injury after radiation therapy is often a radiologic dilemma regardless the technique used, CT or MR imaging. The purpose of this article was to review the utility of one of the newer MR imaging techniques, MR spectroscopy, to distinguish recurrent tumor from radiation necrosis or radiation injury.
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Affiliation(s)
- P C Sundgren
- Division of Neuroradiology, Department of Radiology, University of Michigan Health Systems, 1500 E Medical Center Drive, Ann Arbor, MI 48109, USA.
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30
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Pruzincová L, Steno J, Srbecký M, Kalina P, Rychlý B, Boljesíková E, Chorváth M, Novotný M, Procka V, Makaiová I, Belan V. MR imaging of late radiation therapy- and chemotherapy-induced injury: a pictorial essay. Eur Radiol 2009; 19:2716-27. [PMID: 19471942 DOI: 10.1007/s00330-009-1449-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2008] [Revised: 03/19/2009] [Accepted: 03/27/2009] [Indexed: 11/29/2022]
Abstract
Radiation to the brain and adjuvant chemotherapy may produce late delayed changes from several months to years after treatment of intracranial malignancies with a reported prevalence of 5-24%. The pattern of treatment-related injury may vary from diffuse periventricular white matter lesions to focal or multifocal lesions. Differentiation of treatment-related injury from tumor progression/recurrence may be difficult with conventional MR imaging (MRI). With both disease processes, the characteristic but nonspecific imaging features are vasogenic edema, contrast enhancement, and mass effect. This pictorial essay presents MRI spectra of late therapy-induced injuries in the brain with a particular emphasis on radiation necrosis, the most common and severe form. Novel MRI techniques, such as diffusion-weighted imaging (DWI), proton MR spectroscopy (MRS), and perfusion MRI, improve the possibilities of better characterization of treatment-related changes. Advanced MRI techniques allow for the assessment of metabolism and physiology and may increase specificity for therapy-induced changes.
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Affiliation(s)
- L Pruzincová
- Department of Radiology, Derer's University Hospital, Bratislava, Slovakia.
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31
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Hosch W, Junghanss T, Stojkovic M, Brunetti E, Heye T, Kauffmann GW, Hull WE. Metabolic viability assessment of cystic echinococcosis using high-field 1H MRS of cyst contents. NMR IN BIOMEDICINE 2008; 21:734-754. [PMID: 18384178 DOI: 10.1002/nbm.1252] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Cystic echinococcosis is a worldwide disease caused by larval stages of the parasite Echinococcus granulosus (canine tapeworm). In clinical practice, staging of cyst development by ultrasonography (US) has allowed treatment options to be tailored to individual patient needs. However, the empirical correlation between cyst morphology and parasite viability is not always dependable and has, until now, required confirmation by invasive assessment of cyst content by light microscopy (LM), for example. Alternatively, high-field 1H MRS may be used to examine cyst fluid ex vivo and prepare detailed quantitative metabolite profiles, enabling a multivariate metabolomics approach to cyst staging. One-dimensional and two-dimensional 1H and 1H/13C MRS at 600 MHz (14.1 T) was used to analyze 50 cyst aspirates of various US and LM classes. MR parameters and concentrations relative to internal valine were determined for 44 metabolites and four substance classes. The high concentrations of succinate, fumarate, malate, acetate, alanine, and lactate found in earlier studies of viable cysts were confirmed, and additional metabolites such as myo-inositol, sorbitol, 1,5-anhydro-D-glucitol, betaine, and 2-hydroxyisovalerate were identified. Data analysis and cyst classification were performed using univariate (succinate), bivariate (succinate vs fumarate), and multivariate partial least squares discriminant analysis (PSL-DA) methods (with up to 48 metabolite variables). Metabolic classification of 23 viable and 18 nonviable cysts on the basis of succinate alone agreed with LM results. However, for seven samples, LM and MRS gave opposing results. Reclassification of these samples and two unclassified samples by PLS-DA prediction techniques led to a set of 50 samples that could be completely separated into viable and nonviable MRS classes with no overlap, using as few as nine variables: succinate, formate, malate, 2-hydroxyisovalerate, acetate, total protein content, 1,5-anhydro-D-glucitol, alanine, and betaine. Thus, future noninvasive in vivo applications of MRS would appear promising.
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Affiliation(s)
- Waldemar Hosch
- Department of Radiodiagnostics, University Hospital, Heidelberg, Germany
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Kapsalaki EZ, Gotsis ED, Fountas KN. The role of proton magnetic resonance spectroscopy in the diagnosis and categorization of cerebral abscesses. Neurosurg Focus 2008; 24:E7. [DOI: 10.3171/foc/2008/24/6/e7] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
✓ Despite recent advances in neuroimaging, differentiation between cerebral abscesses and necrotic tumors with ring-type contrast enhancement can be puzzling at times. The introduction of advanced imaging techniques, such as diffusion-weighted imaging, has contributed to the identification of cerebral abscesses. However, differentiation may be impossible with imaging only. In this review the authors evaluate the role of proton magnetic resonance (MR) spectroscopy in differentiating between cerebral abscesses and necrotic tumors and address the spectral characteristics of intracranial abscesses. A large number of metabolites not detected in the normal brain spectra may be detected and give valuable information regarding the nature of the abscesses. Proton MR spectroscopy is a safe, noninvasive diagnostic modality, which could significantly increase the accuracy and specificity of conventional MR imaging in differentiating between malignant tumors and cerebral abscesses and provide valuable information regarding the cause of an abscess, as well as, its response to the chosen treatment.
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Affiliation(s)
| | - Efstathios D. Gotsis
- 2Encephalos-Euromedica, Advanced Diagnostic and Research Institute, Athens, Greece
| | - Kostas N. Fountas
- 3Neurosurgery, University Hospital of Larissa, University of Thessaly, School of Medicine, Larissa, Greece; and
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Muccio CF, Esposito G, Bartolini A, Cerase A. Cerebral abscesses and necrotic cerebral tumours: differential diagnosis by perfusion-weighted magnetic resonance imaging. Radiol Med 2008; 113:747-57. [PMID: 18414811 DOI: 10.1007/s11547-008-0254-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2007] [Accepted: 07/12/2007] [Indexed: 11/28/2022]
Abstract
PURPOSE This study was undertaken to evaluate the usefulness of perfusion-weighted imaging (PWI) in the differential diagnosis of ring-enhancing cerebral lesions, including abscesses, high-grade gliomas and metastases. MATERIALS AND METHODS Nine cerebral abscesses (five pyogenic, four from Toxoplasma gondii), ten glioblastomas and five cerebral metastases in 19 patients were studied with gadolinium-enhanced magnetic resonance imaging, diffusion-weighted imaging (DWI) including calculation of mean apparent diffusion coefficient (ADC) of the lesion core, and PWI. At PWI, the mean of the maximum regional cerebral blood volume (rCBV) was calculated in the gadolinium-enhancing peripheral solid areas and compared with that of the contralateral normal-appearing white matter [ratio=rCBV (lesion)/rCBV (contralateral normal-appearing white matter)]. RESULTS DWI achieved the differential diagnosis in all cases except for the four Toxoplasma abscesses. At PWI, the mean ratio of the rCBV of the capsular portion was 0.72+/-0.08 (range 0.60-0.82) in the pyogenic abscesses, 0.84+/-0.07 (range 0.75-0.91) in the Toxoplasma abscesses, 4.45+/-1.5 (range 2.9-8.0) in the high-grade gliomas and 3.58+/-0.68 (range 3.28-4.27) in the metastases. CONCLUSIONS PWI seems to be useful in the differential diagnosis of ring-enhancing cerebral lesions. High rCBV values in the peripheral areas appear to indicate the possibility of a necrotic tumour, whereas low values tend to indicate an abscess.
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Affiliation(s)
- C F Muccio
- U.O. Neuroradiologia, Dipartimento di Neuroscienze, A.O. "G. Rummo", Via dell'Angelo 1, 82100 Benevento, Italy.
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(1)H MR spectroscopy of human brain tumours: a practical approach. Eur J Radiol 2008; 67:268-274. [PMID: 18406554 DOI: 10.1016/j.ejrad.2008.02.036] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2008] [Accepted: 02/29/2008] [Indexed: 10/22/2022]
Abstract
Magnetic resonance spectroscopy (MRS) is proposed in addition to magnetic resonance imaging (MRI) to help in the characterization of brain tumours by detecting metabolic alterations that may be indicative of the tumour class. MRS can be routinely performed on clinical magnets, within a reasonable acquisition time and if performed under adequate conditions, MRS is reproducible and thus can be used for longitudinal follow-up of treatment. MRS can also be performed in clinical practice to guide the neurosurgeon into the most aggressive part of the lesions or to avoid unnecessary surgery, which may furthermore decrease the risk of surgical morbidity.
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35
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Haque S, Law M, Abrey LE, Young RJ. Imaging of Lymphoma of the Central Nervous System, Spine, and Orbit. Radiol Clin North Am 2008; 46:339-61, ix. [DOI: 10.1016/j.rcl.2008.04.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Al-Okaili RN, Krejza J, Woo JH, Wolf RL, O'Rourke DM, Judy KD, Poptani H, Melhem ER. Intraaxial brain masses: MR imaging-based diagnostic strategy--initial experience. Radiology 2007; 243:539-50. [PMID: 17456876 DOI: 10.1148/radiol.2432060493] [Citation(s) in RCA: 178] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To develop and retrospectively determine the accuracy of a magnetic resonance (MR) imaging strategy to differentiate intraaxial brain masses, with histologic findings or clinical diagnosis as the reference standard. MATERIALS AND METHODS The study was HIPAA compliant and was approved by the institutional review board. A waiver of informed consent was obtained. A strategy was developed on the basis of conventional MR imaging, diffusion-weighted MR imaging, perfusion MR imaging, and proton MR spectroscopy to classify intraaxial masses as low-grade primary neoplasms, high-grade primary neoplasms, metastatic neoplasms, abscesses, lymphomas, tumefactive demyelinating lesions (TDLs), or encephalitis. The strategy was evaluated by using data from 111 patients (46 women, 65 men; mean age, 48.9 years) with imaging results available on a departmental picture archiving and communication system from a 5-year search period. Bayesian statistics of the strategy elements and three clinical tasks were calculated. RESULTS Search results identified 44 patients with high-grade and 14 with low-grade primary neoplasms, 24 with abscesses, 12 with lymphoma, 11 with TDLs, five with metastases, and one with encephalitis who had undergone conventional and advanced MR imaging. However, only 40 patients (25 women, 15 men; mean age, 45 years) had undergone all studies and had data to allow completion of the entire strategy. Accuracy, sensitivity, and specificity of the strategy, respectively, were 90%, 97%, and 67% for discrimination of neoplastic from nonneoplastic diseases, 90%, 88%, and 100% for discrimination of high-grade from low-grade neoplasms, and 85%, 84%, and 87% for discrimination of high-grade neoplasms and lymphoma from low-grade neoplasms and nonneoplastic diseases. CONCLUSION An integrated MR imaging-based strategy, which is accurate in differentiation of several intraaxial brain masses, was proposed.
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Affiliation(s)
- Riyadh N Al-Okaili
- Department of Radiology, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA
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37
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Galanaud D, Nicoli F, Confort-Gouny S, Le Fur Y, Ranjeva JP, Viola A, Girard N, Cozzone PJ. [Indications for cerebral MR proton spectroscopy in 2007]. Rev Neurol (Paris) 2007; 163:287-303. [PMID: 17404517 DOI: 10.1016/s0035-3787(07)90402-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Magnetic resonance spectroscopy (MRS) is being increasingly performed alongside the more conventional MRI sequences in the exploration of neurological disorders. It is however important to clearly differentiate its clinical applications aiming at improving the differential diagnosis or the prognostic evaluation of the patient, from the research protocols, when MRS can contribute to a better understanding of the pathophysiology of the disease or to the evaluation of new treatments. The most important applications in clinical practice are intracranial space occupying lesions (especially the positive diagnosis of intracranial abscesses and gliomatosis cerebri and the differential diagnosis between edema and tumor infiltration), alcoholic, hepatic, and HIV-related encephalopathies and the exploration of metabolic diseases. Among the research applications, MRS is widely used in multiple sclerosis, ischemia and brain injury, epilepsy and neuro degenerative diseases.
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Affiliation(s)
- D Galanaud
- Centre de Résonance Magnétique Biologique et Médicale (CRMBM), UMR CNRS 6612, Faculté de Médecine et Hôpital La Timone, Marseille, France
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Porto L, Hattingen E, Pilatus U, Kieslich M, Yan B, Schwabe D, Zanella FE, Lanfermann H. Proton magnetic resonance spectroscopy in childhood brainstem lesions. Childs Nerv Syst 2007; 23:305-14. [PMID: 16983570 DOI: 10.1007/s00381-006-0221-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2006] [Revised: 05/10/2006] [Indexed: 11/25/2022]
Abstract
BACKGROUND Diagnosis of brainstem lesions in children based on magnetic resonance imaging alone is a challenging problem. Magnetic resonance spectroscopy (MRS) is a noninvasive technique for spatial characterization of biochemical markers in tissues and gives information regarding cell membrane proliferation, neuronal damage, and energy metabolism. METHODS We measured the concentrations of biochemical markers in five children with brainstem lesions and evaluated their potential diagnostic significance. Images and spectra were acquired on a 1.5-T imager. The concentrations of N-acetylaspartate, tetramethylamines (e.g., choline), creatine, phosphocreatine, lactate, and lipids were measured within lesions located at the brainstem using Point-resolved spectroscopy sequences. RESULTS Diagnosis based on localized proton spectroscopy included brainstem glioma, brainstem encephalitis, demyelination, dysmyelination secondary to neurofibromatosis type 1 (NF 1), and possible infection or radiation necrosis. In all but one patient, diagnosis was confirmed by biopsy or by clinical follow-up. CONCLUSIONS This small sample of patients suggests that MRS is important in the differential diagnosis between proliferative and nonproliferative lesions in patients without neurofibromatosis. Unfortunately, in cases of NF 1, MRS can have a rather misdiagnosis role.
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Affiliation(s)
- L Porto
- Neuroradiology Department, Klinikum der Johann Wolfgang Goethe-Universität, Schleusenweg 2-16, 60528 Frankfurt am Main, Germany.
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39
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Harada K, Honmou O, Liu H, Bando M, Houkin K, Kocsis JD. Magnetic resonance lactate and lipid signals in rat brain after middle cerebral artery occlusion model. Brain Res 2006; 1134:206-13. [PMID: 17196558 PMCID: PMC2605392 DOI: 10.1016/j.brainres.2006.11.075] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2006] [Revised: 11/21/2006] [Accepted: 11/27/2006] [Indexed: 11/21/2022]
Abstract
Proton magnetic resonance spectroscopy (1-H MRS) has revealed changes of metabolites in acute cerebral infarction. Although the drastic changes of lactate and N-acetyl-aspartate have been reported to be useful indicators of the ischemic damage in both humans and experimental animals, lipid signals are also detected by the short echo time sequence 1-5 days after ischemia. The objective of this study was to find a novel technique to isolate lactate signals from lipid signals in the ischemic brain. First, MRS was used to study the lipid and lactate components of a spherical phantom in vitro, and parameters were established to separate these components in vitro. Then, MR measurements were obtained from the brains of middle cerebral artery occlusion rats. All MR measurements were performed using a 7-T (300 MHz), 18.3-cm-bore superconducting magnet (Oxford Magnet Technologies) interfaced to a Unity INOVA Imaging System (Varian Technologies). T2-weighted images were obtained from a 1.0-mm-thick coronal section using a 3-cm field of view. It is well known that lipid has a shorter and lactate a longer T2 relaxation time. These distinct magnetic characteristics allowed us to separate the lactate signal from the lipid signal. Thus, adjustment of the echo time is essential to analyze the metabolites in acute cerebral infarction, which may be useful in both the clinic and laboratory.
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Affiliation(s)
- Kuniaki Harada
- Department of Neurosurgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido 060-8543, Japan
| | - Osamu Honmou
- Department of Neurosurgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido 060-8543, Japan
- Department of Neurology and Center for Neuroscience and Regeneration Research, Yale University School of Medicine, New Haven, Connecticut 06516, USA
- Rehabilitation Research Center, VA Connecticut Healthcare System, West Haven, Connecticut 06516, USA
- Corresponding author: Department of Neurosurgery, Sapporo Medical University School of Medicine, South-1st, West-16th, Chuo-ku, Sapporo, Hokkaido 060-8543, Japan. Fax: +81 11 614 1662., E-mail address: (O. Honmou)
| | - He Liu
- Department of Neurosurgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido 060-8543, Japan
| | - Michio Bando
- Division of Radiology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido 060-8543, Japan
| | - Kiyohiro Houkin
- Department of Neurosurgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido 060-8543, Japan
| | - Jeffery D. Kocsis
- Department of Neurology and Center for Neuroscience and Regeneration Research, Yale University School of Medicine, New Haven, Connecticut 06516, USA
- Rehabilitation Research Center, VA Connecticut Healthcare System, West Haven, Connecticut 06516, USA
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Abstract
Establishing the diagnosis of a brain tumour is not always a straightforward process. Many non-neoplastic neurological diseases can mimic brain neoplasms on neuroimaging or on histological examination, including multiple sclerosis, stroke, pyogenic abscess, toxoplasmosis, tuberculosis, cysticercosis, fungal infections, syphilis, sarcoidosis, Behçet disease, radiation necrosis, venous thrombosis, and others. Conversely, several types of brain neoplasms, such as glioblastomas, low-grade gliomas, CNS lymphomas, and brain metastases, can present in the absence of typical tumefactive lesions, posing significant diagnostic challenges. In this Review, we discuss the process of accurately establishing the diagnosis of brain tumours, focusing on pitfalls commonly encountered in clinical practice. We also discuss the rational use and limitations of new diagnostic techniques, such as diffusion-weighted MRI, perfusion-weighted MRI, magnetic resonance spectroscopy, single-photon emission tomography, and positron emission tomography, as well as new tools for histological examination, such as immunohistochemistry and molecular genetics analysis.
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Affiliation(s)
- Antonio Mp Omuro
- AP-HP Hôpital Pitié-Salpêtrière, Service de Neurologie Mazarin, Universite Paris VI Pierre et Marie Curie, IFR 70, Unite Inserm U711, Paris, France.
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41
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Galanaud D, Nicoli F, Figarella-Branger D, Roche P, Confort-Gouny S, Le Fur Y, Cozzone PJ. Spectroscopie par résonance magnétique des tumeurs cérébrales. ACTA ACUST UNITED AC 2006; 87:822-32. [PMID: 16778750 DOI: 10.1016/s0221-0363(06)74090-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
MR spectroscopy (MRS) can complement MRI in the evaluation of intracranial tumors. Before treatment, MRS can contribute to the differential diagnosis between tumor and non tumoral lesion (especially intracranial abscesses), to assess the aggressiveness of a glial tumor or to determine its extension to better delineate the surgical removal or the target volume of radiotherapy. During treatment follow-up, MRS helps differentiate recurrent tumor from radionecrosis or physiological post-surgical contrast enhancement. The current studies are trying to determine if the indications of MRS, alone or in association with other MR sequences can further be extended in the study of brain tumors, in particular the follow-up of lesions undergoing chemo or radiotherapy.
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Affiliation(s)
- D Galanaud
- CRMBM CEMEREM UMR CRNS 6612, Faculté de Médecine, 27, boulevard Jean Moulin, 13005 Marseille.
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Kingsley PB, Shah TC, Woldenberg R. Identification of diffuse and focal brain lesions by clinical magnetic resonance spectroscopy. NMR IN BIOMEDICINE 2006; 19:435-62. [PMID: 16763970 DOI: 10.1002/nbm.1039] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
The purpose of this paper is to facilitate the comparison of magnetic resonance (MR) spectra acquired from unknown brain lesions with published spectra in order to help identify unknown lesions in clinical settings. The paper includes lists of references for published MR spectra of various brain diseases, including pyogenic abscesses, encephalitis (herpes simplex, Rasmussen's and subacute sclerosing panencephalitis), neurocysticercosis, tuberculoma, cysts (arachnoid, epidermoid and hydatid), acute disseminated encephalomyelitis (ADEM), adrenoleukodystrophy (ALD), Alexander disease, Canavan's disease, Krabbe disease (globoid cell leukodystrophy), Leigh's disease, megalencephalic leukoencephalopathy with cysts, metachromatic leukodystrophy (MLD), Pelizaeus-Merzbacher disease, Zellweger syndrome, HIV-associated lesions [cryptococcus, lymphoma, toxoplasmosis and progressive multifocal leukoencephalopathy (PML)], hydrocephalus and tuberous sclerosis. Each list includes information on the echo time(s) (TE) of the published spectra, whether a control spectrum is shown, whether the corresponding image and voxel position are shown and the patient ages if known. The references are listed in the approximate order of usefulness, based on spectral quality, number of spectra, range of echo times and whether the voxel positions are shown. Spectra of Zellweger syndrome, cryptococcal infection, toxoplasmosis and lymphoma are included, along with a spectrum showing propanediol (propylene glycol).
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Affiliation(s)
- Peter B Kingsley
- Department of Radiology, North Shore University Hospital, 300 Community Drive, Manhasset, NY 11030, USA.
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43
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Lin AP, Tran TT, Ross BD. Impact of evidence-based medicine on magnetic resonance spectroscopy. NMR IN BIOMEDICINE 2006; 19:476-83. [PMID: 16763969 DOI: 10.1002/nbm.1058] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Magnetic resonance spectroscopy (MRS) is a robust, non-invasive means of defining aspects of human neurochemistry. After more than two decades, it is clear that in addition to its scientific interest, MRS has diagnostic value in tumor diagnosis, prognosis, therapeutic outcome, dementia diagnosis and prognosis, multiple sclerosis, infections, trauma, development, stroke, perinatal ischemia, xenobiotics and inborn errors (as determined from a meta-analysis included in this paper). However, in many healthcare systems, a new radiological technique requires evidence-based medicine (EBM) before it is recommended for reimbursement. Much of the reason why MRS is thought to be non-reimbursable in the USA is due to recent announcements that this 15-year-old technique is still considered 'investigational' by these EBM assessments. An analysis is presented of the technology assessments that brought about this situation. Based on the conclusions of the EBM assessments, strategies are suggested that involve all entities responsible for spectroscopy including the scientists' role in ensuring the future for clinical spectroscopy.
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Affiliation(s)
- Alexander P Lin
- Rudi Schulte Research Institute, Santa Barbara, CA 93130, USA
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44
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Lin WC, Mahadevan-Jansen A, Johnson MD, Weil RJ, Toms SA. In vivo optical spectroscopy detects radiation damage in brain tissue. Neurosurgery 2006; 57:518-25; discussion 518-25. [PMID: 16145531 DOI: 10.1227/01.neu.0000170559.48166.ac] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Magnetic resonance imaging abnormalities in malignant brain tumors after irradiation may represent either recurrent tumor or radiation injury. Optical spectroscopy may represent a novel technique to identify radiation damage in brain tissues and to differentiate contrast-enhancing lesions from recurrent tumor. METHODS Fluorescence and diffuse reflectance spectra were acquired from 90 patients: 15 undergoing surgical resection for presumed recurrent tumor after radiation therapy, 15 with epilepsy and hippocampal sclerosis, and 60 with tumors who had not received irradiation. Optical spectra were acquired from 6 to 10 sites and were compared with a biopsy obtained from beneath the optical spectroscopy probe; the data then were classified by a neuropathologist blinded to the spectroscopy data. A probe for the intraoperative collection of diffuse reflectance and fluorescence spectra was used. RESULTS Thirteen of 15 patients (29 of 129 spectra) with previous irradiation showed a unique spectral feature characterized by a fluorescence peak centered at 500 nm (F500). All biopsy specimens showing histopathological signs of radiation injury had the F500 on their corresponding spectra (18 of 18). The F500 was identified in another 10% (11 of 111 spectra) of samples with previous irradiation but no histologically identifiable signs of radiation damage. The F500 was never seen in the normal temporal lobe of epilepsy patients with hippocampal sclerosis (0 of 105) and was seen in only 1.5% of tumor patients who did not undergo previous irradiation (6 of 433). CONCLUSION Optical spectroscopy detects radiation damage in brain tissues. The F500 spectral peak may allow accurate selection of tissues for biopsy in evaluating patients with new, contrast-enhancing lesions in the setting of previous irradiation.
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Affiliation(s)
- Wei-Chiang Lin
- Department of Biomedical Engineering, Florida International University, Miami, Florida, USA
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Abstract
Among the vast number of metabolites in living tissues, metabolites detectable by in vivo MR spectroscopy are limited to those present in high concentrations, and the actual number is only 10 to 20. None is disease-specific. Interpretation of MRS data, therefore, must be based on general knowledge of biochemical processes in association with pathological changes. Each spectrum is a window on the actual biochemical changes taking place within the living tissues, but the reality entails a wide and confusing variance. Continuous expansion of the knowledge may reduce the uncertainty of interpreting MRS data.
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Affiliation(s)
- Keiko Imamura
- Department of Radiology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki 216-8511, Japan.
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Yamasaki F, Takaba J, Ohtaki M, Abe N, Kajiwara Y, Saito T, Yoshioka H, Hama S, Akimitsu T, Sugiyama K, Arita K, Kurisu K. Detection and differentiation of lactate and lipids by single-voxel proton MR spectroscopy. Neurosurg Rev 2005; 28:267-77. [PMID: 16133454 DOI: 10.1007/s10143-005-0398-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2004] [Revised: 03/20/2005] [Accepted: 04/16/2005] [Indexed: 10/25/2022]
Abstract
The signals of lactate and lipids partially overlap in single-voxel proton MR spectroscopy (1HMRS), sometimes making them difficult to differentiate in clinical settings. Our aim in this study was to identify lactate and lipids by varying the echo time (TE). We expect that the accurate detection of lactate and lipids will have high diagnostic value in the diagnosis of brain tumors. Following our protocol, we obtained meaningful 1HMRS spectra from 213 patients, including 163 patients with brain tumors, between August 1999 and February 2004. 1HMRS was performed with a TE of 144 ms followed by a TE of 30 ms and/or a TE of 288 ms, if necessary. For the 213 patients, lactate level was "negative" in 47 patients, "positive" in 131 patients, and "strongly positive" in 35 patients. The lipid level was "negative" in 90 patients, "positive" in 56 patients, and "strongly positive" in 67 patients. Based on logistic discriminant analyses of neuro-epithelial tumor WHO grade and lactate and lipid levels, lactate and lipid levels were significant between WHO grades 2 and 3 (P=0.0239) and between grades 3 and 4 (P=0.0347). Lipids are a more significant factor for the discrimination between WHO grades 2 and 3 (P=0.0073) and between grades 3 and 4 (P=0.0048). With our method of varying the TE, it is possible accurately and efficiently to detect lactate and lipids in the brain. We found a significant correlation between lactate and lipid expression and WHO grade of neuro-epithelial tumors.
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Affiliation(s)
- Fumiyuki Yamasaki
- Department of Neurosurgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Hiroshima, 734-8551, Japan
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Matsumura A, Isobe T, Takano S, Kawamura H, Anno I. Non-invasive quantification of lactate by proton MR spectroscopy and its clinical applications. Clin Neurol Neurosurg 2005; 107:379-84. [PMID: 16023531 DOI: 10.1016/j.clineuro.2004.10.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2003] [Revised: 09/02/2004] [Accepted: 10/12/2004] [Indexed: 10/26/2022]
Abstract
Lactate is an important metabolite in clinical cases indicating the status of metabolic impairment. We applied a clinically relevant simple method for lactate quantification using magnetic resonance spectroscopy (MRS). We used two long in-phase echo time (TE=272,544 ms) to calculate T2 relaxation time and the absolute concentration of lactate. This method was optimized using phantom study and applied to clinical cases. This technique does not require complicated processing and could be applied in daily clinical practice. Moreover, this technique enables lactate quantification in cases (e.g. tumor) where lipid peak is overlapped with the lactate peak at short echo times.
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Affiliation(s)
- Akira Matsumura
- Department of Neurosurgery, Institute of Clinical Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba Science City, Ibaraki, 305-8575, Japan.
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Matsumura A, Isobe T, Anno I, Takano S, Kawamura H. Correlation between choline and MIB-1 index in human gliomas. A quantitative in proton MR spectroscopy study. J Clin Neurosci 2005; 12:416-20. [PMID: 15925772 DOI: 10.1016/j.jocn.2004.08.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2004] [Accepted: 08/03/2004] [Indexed: 11/26/2022]
Abstract
BACKGROUND Choline (Cho) containing compounds are usually evaluated using magnetic resonance spectroscopy (MRS) by relative ratios such as Cho/N-acetylaspartate (NAA) and Cho/creatine (Cre) ratios. To clarify the significance of Cho level in gliomas, we evaluated the quantified Cho level using MRS and compared it with the proliferation activity as determined by MIB-1 immunoreactivity in the histological specimen. METHODS There were seven benign and seven malignant gliomas. MRS was obtained using a single-voxel proton regional imaging of metabolites (PRIME) sequence with three different TE for T2 compensation. Quantified Cho level was compared with the number of MIB-1 immunopositive positive cells and cell density in surgical specimens. RESULT A positive correlation was observed between Cho and MIB-1 in benign gliomas, whereas there was a trend to an inverse correlation in malignant gliomas. This inverse correlation became a positive correlation when the necrotic area of the tumor (on the T1-weighted gadolinium enhanced images) was excluded from the voxel of interest (VOI) for MRS, but this correlation did not reach statistical significance. CONCLUSIONS The quantification data clarified the behavior of Cho in malignant gliomas. The quantification method has the advantage of limiting the influence of other metabolites on Cho determination. In particular, the levels of other commonly measured metabolites, including Cre, may also be altered in glioma, making ratios between metabolites misleading. Heterogeneity in the MRS VOI should be considered when evaluating the proliferative activity of malignant glioma by MRS.
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Affiliation(s)
- Akira Matsumura
- Department of Neurosurgery, Institute of Clinical Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.
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Abstract
Magnetic resonance imaging (MRI) is the neuroimaging method of choice for the noninvasive monitoring of patients with brain tumors due to the enormous amount of information it yields regarding the morphologic features of the lesion and surrounding parenchyma. Over the past decade, proton magnetic resonance spectroscopy (1H-MRS), which uses the same technology as MRI and can be performed during a routine clinical imaging examination, has been used to glean information about the metabolic status of the brain. Accurate interpretation of 1H-MRS data from individual patients requires an understanding of the various techniques for acquiring the data, the physiologic basis of the metabolic signatures obtained from different types of tumors, and the specificity of the technique. This review covers the basic physics of 1H-MRS, the spectral and physiological characteristics of the metabolites that are typically measured in various types of brain tumors, and the clinical utility of 1H-MRS with respect to diagnosis, therapeutic planning, and the assessment of response to treatment.
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