Human cervical lymphadenopathy: evaluation with in vivo 1H-MRS at 1.5T

ChoK-Full of Potential: Choline Kinase in B Cell and T Cell Malignancies

Aberrant choline metabolism, characterized by an increase in total choline-containing compounds, phosphocholine and phosphatidylcholine (PC), is a metabolic hallmark of carcinogenesis and tumor progression. This aberration arises from alterations in metabolic enzymes that control PC biosynthesis and catabolism. Among these enzymes, choline kinase α (CHKα) exhibits the most frequent alterations and is commonly overexpressed in human cancers. CHKα catalyzes the phosphorylation of choline to generate phosphocholine, the first step in de novo PC biosynthesis. CHKα overexpression is associated with the malignant phenotype, metastatic capability and drug resistance in human cancers, and thus has been recognized as a robust biomarker and therapeutic target of cancer. Of clinical importance, increased choline metabolism and CHKα activity can be detected by non-invasive magnetic resonance spectroscopy (MRS) or positron emission tomography/computed tomography (PET/CT) imaging with radiolabeled choline analogs for diagnosis and treatment monitoring of cancer patients. Both choline-based MRS and PET/CT imaging have also been clinically applied for lymphoid malignancies, including non-Hodgkin lymphoma, multiple myeloma and central nervous system lymphoma. However, information on how choline kinase is dysregulated in lymphoid malignancies is very limited and has just begun to be unraveled. In this review, we provide an overview of the current understanding of choline kinase in B cell and T cell malignancies with the goal of promoting future investigation in this area.

Can magnetic resonance spectroscopy differentiate malignant and benign causes of lymphadenopathy? An in-vitro approach

Lymphadenopathy continues to be a common problem to radiologists and treating physicians because of the difficulty in confidently categorizing a node as being benign or malignant using standard diagnostic techniques. The goal of our research was to assess whether magnetic resonance (MR) spectroscopy contains the necessary information to allow differentiation of benign from malignant lymph nodes in an in-vitro approach using a modern pattern recognition method. Tissue samples from a tissue bank were analyzed on a nuclear magnetic resonance (NMR) spectrometer. A total of 69 samples were studied. The samples included a wide variety of malignant and benign etiologies. Using 45 samples, we initially created a model which was able to predict if a certain spectrum originates from benign or malignant lymph nodes using a pattern-recognition technique which takes into account the entire magnetic spectrum rather than single peaks alone. The remaining 24 samples were blindly loaded in the model to assess its performance. We obtained an excellent accuracy in differentiating benign and malignant lymphadenopathy using the model. It correctly differentiated as malignant or benign, in a blinded fashion, all of the malignant samples (13 of 13) and 10 out of the 11 benign samples. We thus showed that magnetic spectroscopy is able to differentiate benign from malignant causes of lymphadenopathy. Additional experiments were performed to verify that the differentiating abilities of our model were not due to differential tissue decay in between benign and malignant tissues. If future experiments demonstrate that a similar approach could be executed with standard MR imaging, this technique could be useful as a problem-solving tool when assessing lymphadenopathy in general. Alternatively, our in-vitro technique could also be useful to pathologists faced with indeterminate pathologies of the lymph nodes after validating our results with a larger sample size.

State of the art MRI in head and neck cancer

Head and neck cancer affects more than 11,000 new patients per year in the UK¹ and imaging has an important role in the diagnosis, treatment planning, and assessment, and post-treatment surveillance of these patients. The anatomical detail produced by magnetic resonance imaging (MRI) is ideally suited to staging and follow-up of primary tumours and cervical nodal metastases in the head and neck; however, anatomical images have limitations in cancer imaging and so increasingly functional-based MRI techniques, which provide molecular, metabolic, and physiological information, are being incorporated into MRI protocols. This article reviews the state of the art of these functional MRI techniques with emphasis on those that are most relevant to the current management of patients with head and neck cancer.

Preliminary study of diffusion-weighted imaging and magnetic resonance spectroscopy imaging in Kimura disease

In this study, we evaluated the value of diffusion-weighted imaging (DWI) and magnetic resonance (MR) spectroscopy imaging (MRSI) combined with computed tomography (CT) and conventional MR imaging (MRI) in the diagnosis of Kimura disease (KD). The clinical data and CT and MRI findings of 5 patients with KD proven by histopathologic examination were retrospectively reviewed. Diffusion-weighted imaging and MRSI were performed at 1.5 T in 3 patients with KD. Apparent diffusion coefficient (ADC) values and the choline/creatine ratio of the lesions were compared with those of the contralateral normal parotid glands. All imaging results were compared with histopathologic findings. The typical features of KD were subcutaneous lesions, continuously infiltrative parotid lesions with or without intraparotid lymphadenopathies, and reactive cervical lymphadenopathies on CT and conventional MRI. On DWI, the ADC values of all subcutaneous and infiltrative parotid lesions were higher compared to those of normal parotid glands, and the ADC values of reactive lymphadenopathies were lower compared to both. The choline/creatine levels of subcutaneous and infiltrative parotid lesions were slightly higher than those of normal parotid glands. In conclusion, DWI and MRSI offer valuable information that may be characteristic of KD, which can highly suggest the diagnosis of KD when combined with morphological imaging.

¹H magnetic resonance spectroscopy: a review of the current literature and its potential utility in veterinary oncology

Advanced imaging of veterinary cancer patients has evolved in recent years and modalities once limited to human medicine have now been described for diagnostic purposes in veterinary medicine (positron emission tomography/computed tomography, single-photon emission computed tomography, whole body magnetic resonance imaging). Magnetic resonance spectroscopy (MRS) is a non-invasive and non-ionizing technique that is well described in the human medical literature and is most frequently used to evaluate the metabolic activity of tissues with questionable malignant transformation. Differentiation of neoplastic tissue from surrounding normal tissue is dependent on variations in cellular metabolism. Positive identification of malignancy can be made when neoplastic alterations are occurring at the cellular level prior to gross anatomic changes. This improved, early detection of cancer occurrence (or recurrence) can improve patient survival and direct medical therapy. MRS techniques are largely underutilized in veterinary medicine, with current research predominantly limited to the brain (both evaluation of normal and diseased tissue). Given the clinical utility of MRS in humans, the technique may also be useful in the staging of cancer in veterinary medicine.

MR spectroscopy of head and neck cancer

The aim of this review is to discuss the technique and potential applications of magnetic resonance spectroscopy (MRS) in head and neck cancer. We illustrate the technical issues related to data acquisition, post processing and interpretation of MRS of head and neck lesions. MRS has been used for differentiation of squamous cell carcinoma from normal tissue. The main potential clinical application of proton MRS ((1)H-MRS) is monitoring patients with head and neck cancer undergoing therapy. Pretreatment prediction of response to therapy can be done with phosphorus MRS ((31)P-MRS). Although performance of MRS of head and neck is challenging, technological advances in both software and hardware has the potential to impact on the clinical management of patients with head and neck cancer.

The role of magnetic resonance imaging in oncology

Conventional diagnostic magnetic resonance imaging (MRI) techniques have focused on improving the spatial resolution and image acquisition speed (whole-body MRI) or on new contrast agents. Most advances in MRI go beyond morphologic study to obtain functional and structural information in vivo about different physiological processes of tumor microenvironment, such as oxygenation levels, cellular proliferation, or tumor vascularization through MRI analysis of some characteristics: angiogenesis (perfusion MRI), metabolism (MRI spectroscopy), cellularity (diffusion-weighted MRI), lymph node function, or hypoxia [blood-oxygen-level-dependent (BOLD) MRI]. We discuss the contributions of different MRI techniques than must be integrated in oncologic patients to substantially advance tumor detection and characterization risk stratification, prognosis, predicting and monitoring response to treatment, and development of new drugs.

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

PURPOSE

To determine if choline (cho) identified by proton magnetic resonance spectroscopy ((1)H-MRS) performed pretreatment and early in the course of treatment predicts clinicopathologic response of head and neck squamous cell carcinoma (HNSCC).

MATERIALS AND METHODS

In all, 60 patients with HNSCC scheduled to undergo concurrent chemoradiotherapy or radiotherapy alone were recruited. (1)H-MRS was performed pretreatment and early intratreatment (2 weeks after start of treatment). Cho:creatine and cho:water ratios at each timepoint and change in the ratios between the two timepoints were correlated with locoregional failure, distant metastases, overall survival, and cancer-related death. Statistical analysis was performed using logistic regression and chi-square and a P-value of < 0.05 was considered statistically significant.

RESULTS

Cho was identified in 47/49 successful pretreatment spectra and 42 of these 47 underwent successful (1)H-MRS early intratreatment, of which 21 showed persistent cho. Locoregional failure occurred in 15, distant metastases in 6, and death in 15 patients; the follow-up period in survivors ranged from 13-64 months (mean, 39 months). No statistically significant correlation was found between (1)H-MRS parameters and clinical endpoints.

CONCLUSION

The pretreatment cho and change in cho early during a course of treatment did not predict clinical outcome.

Malignant tumors and chronic infections in the masticator space: preliminary assessment with in vivo single-voxel 1H-MR spectroscopy

BACKGROUND AND PURPOSE

Differential diagnosis between malignant tumors and chronic infections in the masticator space remains challenging. The purpose of the study was to categorize various changes of both lesions by using single-voxel 1H-MR spectroscopy.

MATERIALS AND METHODS

Twenty-four masticator space lesions, 7 chronic infections, and 17 malignant tumors were assessed with 1H-MR spectroscopy before treatment procedures. The MR spectroscopic findings were compared with surgical and histopathologic results. Localization technique for 1H-MR spectroscopy was made by a point-resolved spectroscopy sequence at an echo time of 144 ms. Choline (Cho) signals (identified at 3.2 ppm) and Cho signal intensity-to-noise ratio (Cho/noise) were considered as evaluating criteria.

RESULTS

All the lesions were found with 3 1H-MR spectroscopic types: type 1, lesions without Cho signals (3 chronic infections); type 2, lesions with Cho signals and Cho/noise ratio <3 (4 chronic infections and 4 malignant tumors); and type 3, lesions with Cho signals and Cho/noise ratio >3 (13 malignant tumors). The mean +/- SD of the Cho/noise ratio between chronic infections and malignant tumors was 2.31 +/- 0.19 and 5.76 +/- 3.29 (P < .01), respectively.

CONCLUSION

In vivo single-voxel 1H-MR spectroscopy may be helpful in the assessment of masticator space lesions. Differences of Cho signals and Cho/noise ratios between malignant tumors and chronic infections provide valuable information in the differentiation of these 2 lesions.

Multimodality imaging of head and neck cancer

Imaging has an important role in staging, planning treatment and post-treatment follow up of patients with head and neck cancer. The most commonly utilized imaging modalities are discussed in relation to their relative indications, strengths and weaknesses. This is followed by a brief update on the advances in functional magnetic resonance imaging.

Clinical role of proton magnetic resonance spectroscopy in oncology: brain, breast, and prostate cancer

Standardised proton magnetic resonance spectroscopic imaging (MRSI) was initially developed for routine in-situ clinical assessment of human brain tumours, and its use was later extended for examination of prostate and breast cancers. MRSI coupled with both routine and functional MRI techniques provides more detailed information about a tumour's location and extent of its infiltration than any other modality alone. Information obtained by adding MRSI data to anatomical and functional MRI findings aid in clinical management decisions (such as watchful waiting vs immediate intervention). In this Review, we discuss the current status of proton MRSI, with emphasis on its clinical use to map the location and extent of tumour processes for spectroscopic image-guided biopsy procedures and to monitor treatment paradigms for brain, prostate, and breast cancer.