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Cocuzzo D, Lin A, Stanwell P, Mountford C, Keshava N. In Vivo Brain Magnetic Resonance Spectroscopy: A Measurement of Biomarker Sensitivity to Post-Processing Algorithms. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE-JTEHM 2014; 2:2900117. [PMID: 29018629 PMCID: PMC5477797 DOI: 10.1109/jtehm.2014.2309333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Revised: 01/20/2014] [Accepted: 02/04/2014] [Indexed: 11/07/2022]
Abstract
Clinical translation of reported biomarkers requires reliable and consistent algorithms to derive biomarkers. However, the literature reports statistically significant differences between 1-D MRS measurements from control groups and subjects with disease states but frequently provides little information on the algorithms and parameters used to process the data. The sensitivity of in vivo brain magnetic resonance spectroscopy biomarkers is investigated with respect to parameter values for two key stages of post-acquisitional processing. Our effort is specifically motivated by the lack of consensus on approaches and parameter values for the two critical operations, water resonance removal, and baseline correction. The different stages of data processing also introduce varying levels of uncertainty and arbitrary selection of parameter values can significantly underutilize the intrinsic differences between two classes of signals. The sensitivity of biomarkers points to the need for a better understanding of how all stages of post-acquisitional processing affect biomarker discovery and ultimately, clinical translation. Our results also highlight the possibility of optimizing biomarker discovery by the careful selection of parameters that best reveal class differences. Using previously reported data and biomarkers, our results demonstrate that small changes in parameter values affect the statistical significance and corresponding effect size of biomarkers. Consequently, it is possible to increase the strength of biomarkers by selecting optimal parameter values in different spectral intervals. Our analyses with a previously reported data set demonstrate an increase in effect sizes for wavelet-based biomarkers of up to 36%, with increases in classification performance of up to 12%.
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Affiliation(s)
- Daniel Cocuzzo
- Department of Computer ScienceStanford UniversityPalo AltoCAUSA80523
| | - Alexander Lin
- Centre for Clinical SpectroscopyDepartment of RadiologyBrigham and Women's HospitalHarvard Medical SchoolBostonMAUSA02215
| | - Peter Stanwell
- School of Health SciencesUniversity of NewcastleCallaghanNSWAustralia2308
| | - Carolyn Mountford
- Centre for Clinical SpectroscopyDepartment of RadiologyBrigham and Women's HospitalHarvard Medical SchoolBostonMAUSA02215.,Centre for MR in HealthFaculty of HealthUniversity of NewcastleCallaghanNSWAustralia2308
| | - Nirmal Keshava
- Department of Research and Development InformationAstraZeneca PharmaceuticalsWalthamMAUSA02451
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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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Lima EC, Otaduy MCG, Tsunemi M, Pincerato R, Cardoso EF, Rosemberg S, Aguiar PH, Cerri GG, Leite CC. The effect of paramagnetic contrast in choline peak in patients with glioblastoma multiforme might not be significant. AJNR Am J Neuroradiol 2013; 34:80-4. [PMID: 22766678 DOI: 10.3174/ajnr.a3181] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE (1)H-MR spectroscopy is a useful tool in brain tumor evaluation. A critical point in obtaining representative spectra is the correct voxel positioning, which can be more accurate after Gd administration. Some experimental data suggested that Gd could cause Cho signal loss. Our aim was to evaluate the effect of Gd in the Cho peak area and width in patients with GBM. MATERIALS AND METHODS We performed multivoxel (1)H-MR spectroscopy before and after Gd administration in 18 patients with GBM. Quantification of Cho peak area and width in each voxel was completed, and the Cho mean and maximum values before and after Gd injection were calculated in the tumor and contralateral hemisphere. Choline peak area and width values obtained before and after contrast were compared, considering as separate entities enhancing and nonenhancing tumoral voxels and the contralateral hemisphere. RESULTS No statistically significant differences were found for the Cho peak area mean values in the tumoral voxels or contralaterally (P > .05). A tendency for an increase in the Cho peak width mean value was found in the tumoral enhancing voxels (P = .055). A statistically significant decrease was found for the mean value of the maximum Cho peak area in enhancing tumoral voxels (P = .020). No significant differences were found in the nonenhancing tumoral voxels or contralaterally (P > .05). CONCLUSIONS The injection of Gd before performing (1)H-MR spectroscopy might not significantly affect the Cho peak area in patients with GBM. The paramagnetic contrast seems to cause a different effect, depending on Gd enhancement.
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Affiliation(s)
- E C Lima
- Department of Radiology, University of Sao Paulo, Sao Paulo, Brazil.
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Xu L, Huang Y, Liu X, Liu B. Effects of contrast agent and outer volume saturation bands on water suppression and shimming of hepatic single-volume proton MR spectroscopy at 3.0T. ScientificWorldJournal 2012; 2012:804698. [PMID: 23213299 PMCID: PMC3508555 DOI: 10.1100/2012/804698] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2012] [Accepted: 10/04/2012] [Indexed: 11/17/2022] Open
Abstract
Purpose. To determine whether administration of gadolinium diethylenetriamine pentaacetic acid (Gd-DTPA) and whether placement of the outer volume saturation bands significantly affect shimming and water suppression on hepatic MR spectroscopic prescanning. Method. Region of interest (ROI) of 2 cm × 2 cm × 2 cm was carefully positioned in the region of the middle portion of the right hepatic lobe. 32 patients were examined before and after administration of Gd-DTPA with and without outer-volume saturation bands. Linewidths (Full-Width Half-Maximum (FWHM)) and water suppression were obtained. A paired t-test for comparison of means was used. Results. (1) The group with the outer volume saturation bands demonstrated slightly better water suppression effect than the group without outer volume saturation bands before administration. (2) The group with the outer volume saturation bands demonstrated better water suppression effect than the group without outer volume saturation bands after administration. (3) Both shimming and water suppression effectswere decreased on enhanced MR spectroscopic prescanning (all P < 0.05). Conclusions. Placement of the outer volume saturation bands is helpful to improve water suppression both before and after contrast agent administration. Gd-DTPA exerts a slightly adverse effect (a statistically significant but clinically unimportant) on magnetic resonance spectroscopic prescanning at 3T.
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Affiliation(s)
- Li Xu
- Department of Radiology, Guangdong Provincial Traditional Chinese Medicine Hospital and Postdoctoral Mobile Research Station of Guangzhou University of Traditional Chinese Medicine, 111 Da De Lu, Guangdong, Guangzhou 510120, China
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Kousi E, Tsougos I, Vasiou K, Theodorou K, Poultsidi A, Fezoulidis I, Kappas C. Magnetic resonance spectroscopy of the breast at 3T: pre- and post-contrast evaluation for breast lesion characterization. ScientificWorldJournal 2012; 2012:754380. [PMID: 22645448 PMCID: PMC3356737 DOI: 10.1100/2012/754380] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Accepted: 12/25/2011] [Indexed: 01/13/2023] Open
Abstract
PURPOSE To determine whether in vivo proton magnetic resonance spectroscopy at 3T can provide accurate breast lesion characterization, and to determine the effect of gadolinium on the resonance of tCho. METHODS Twenty-four positive-mammogram patients were examined on a 3T MR scanner. 1H-MRS was performed before and after gadolinium administration. tCho peak was qualitatively evaluated before and after contrast injection. RESULTS Fourteen out of 27 lesions proved to be malignant after histopathological diagnosis. Using 1H-MRS, before contrast injection, 6/14 confirmed malignancies and 11/13 benign lesions were correctly classified; while, after contrast injection, 11/14 confirmed malignancies and 12/13 benign processes were correctly classified. Post gadolinium 1H-MRS proved useful in picking up tCho signal, improving the overall accuracy, sensitivity, and specificity by 35%, 83%, and 9%, respectively. CONCLUSION 1H-MRS overall accuracy, sensitivity, and specificity in detecting breast lesion's malignancy were increased after gadolinium administration. It is prudent to perform 1H-MRS before contrast injection in large breast lesions to avoid choline underestimation. In cases of small or non-mass lesions, it is recommended to perform 1H-MRS after contrast injection for better voxel prescription to enable a reliable preoperative diagnosis.
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Affiliation(s)
- E Kousi
- Medical Physics Department, University of Thessaly, Biopolis, 41110 Larissa, Greece
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McIntyre DJO, Madhu B, Lee SH, Griffiths JR. Magnetic resonance spectroscopy of cancer metabolism and response to therapy. Radiat Res 2012; 177:398-435. [PMID: 22401303 DOI: 10.1667/rr2903.1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Magnetic resonance spectroscopy allows noninvasive in vivo measurements of biochemical information from living systems, ranging from cultured cells through experimental animals to humans. Studies of biopsies or extracts offer deeper insights by detecting more metabolites and resolving metabolites that cannot be distinguished in vivo. The pharmacokinetics of certain drugs, especially fluorinated drugs, can be directly measured in vivo. This review briefly describes these methods and their applications to cancer metabolism, including glycolysis, hypoxia, bioenergetics, tumor pH, and tumor responses to radiotherapy and chemotherapy.
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Affiliation(s)
- Dominick J O McIntyre
- Cancer Research UK, Cambridge Research Institute, Li Ka Shing Centre, Robinson Way, Cambridge CB2 0RE, UK.
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Xu L, Liang CH, Huang B, Tan SH, Cen D, Cui YH, Xiao YQ. Effects of contrast agent on water suppression and shimming of kidney single-volume proton MR spectroscopy at 3.0T. Acad Radiol 2010; 17:1462-7. [PMID: 20947387 DOI: 10.1016/j.acra.2010.07.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2010] [Revised: 07/14/2010] [Accepted: 07/15/2010] [Indexed: 12/28/2022]
Abstract
RATIONALE AND OBJECTIVES The aim of this study was to determine whether the administration of gadolinium diethylenetriamine penta-acetic acid (Gd-DTPA) significantly affects shimming and water suppression on kidney magnetic resonance spectroscopic prescanning and whether the impact of shimming and water suppression is changed with time after intravenous administration on a 3.0-T system. METHODS Forty patients (two patients were excluded from analysis because of motion) were examined before and after the administration of Gd-DTPA (the interval between the right and left kidneys was approximately 40 seconds). Regions of interest were carefully positioned in the region of the corresponding location of both kidneys separately. Line widths (full width at half maximum) and water suppression were obtained. A paired t test for comparison of means was used. In addition, repeat measurements with a shorter time interval (obtained 120-130 seconds after the injection) and a longer time interval (obtained 150-160 seconds after the injection) were performed in five patients in the same regions of interest of the right kidney. Sequential ¹H magnetic resonance spectroscopic prescanning in the same region of interest was performed in one patient. RESULTS The left kidney had slightly better shimming and water suppression effects than the right kidney after contrast agent administration (all P values < .01). The limiting resolution of both shimming and water suppression effects was decreased on enhanced images in both kidneys (all P values < .01). The longer time interval group had better shimming and water suppression effects than the shorter time interval group (all P values < .01). After the administration of Gd-DTPA in one patient, sequential values of shimming and water suppression in the right and left kidneys, respectively, were 13 Hz and 97% and 12 Hz and 97% prior to the examination, 34 Hz and 86% and 30 Hz and 88% at 5 minutes, 32 Hz and 89% and 27 Hz and 90% at 10 minutes, 28 Hz and 91% and 24 Hz and 91% at 15 minutes, and 24 Hz and 92% and 20 Hz and 92% at 25 minutes. CONCLUSIONS Gd-DTPA exerts adverse effects on water suppression and shimming, both of which show a trend of becoming well gradually with time extension after the injection of Gd-DTPA. This phenomenon limits the diagnostic use of kidney magnetic resonance spectroscopy performed immediately after contrast-enhanced magnetic resonance imaging.
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Tozaki M, Oyama Y, Fukuma E. Preliminary study of early response to neoadjuvant chemotherapy after the first cycle in breast cancer: comparison of 1H magnetic resonance spectroscopy with diffusion magnetic resonance imaging. Jpn J Radiol 2010; 28:101-9. [PMID: 20182844 DOI: 10.1007/s11604-009-0391-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2009] [Accepted: 10/07/2009] [Indexed: 12/20/2022]
Abstract
PURPOSE The aim of this study was to assess the efficacy of single-voxel (1)H magnetic resonance spectroscopy (MRS) at 1.5 T to evaluate early responses to neoadjuvant chemotherapy after the first treatment in breast cancer patients and to compare it to measurements of apparent diffusion coefficient (ADC) values derived from diffusion-weighted magnetic resonance imaging (MRI). MATERIALS AND METHODS Nine patients with breast cancer who were scheduled to receive neoadjuvant chemotherapy were recruited. MR examination after the first cycle was scheduled for a few days before the administration of the second dose. RESULTS Two patients were excluded from the study because their regimen was changed after the first cycle. MRS before chemotherapy demonstrated the presence of choline (Cho) at 3.22-3.23 ppm in six cases and at 3.27 ppm in one case. Diffusion-weighted MRI before chemotherapy demonstrated a localized high-signal lesion in all cases. The change of the integral value of Cho after the first cycle of chemotherapy showed a positive correlation with the change in lesion size (r = 0.91, P = 0.01), whereas no correlation was observed between the change of ADC values after the first cycle and the change in lesion size (r = 0.45, P = 0.32). CONCLUSION MRS after the first cycle may be more sensitive to diffusion-weighted MRI to predict the pathological response.
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Lenkinski RE, Wang X, Elian M, Goldberg SN. Interaction of gadolinium-based MR contrast agents with choline: implications for MR spectroscopy (MRS) of the breast. Magn Reson Med 2009; 61:1286-92. [PMID: 19365855 DOI: 10.1002/mrm.21937] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
It has been shown that magnetic resonance spectroscopy (MRS) can improve the specificity of the MR examination by the spectroscopic detection of choline (Cho). Commonly, the lesion is first visualized on postcontrast studies, and the MRS voxel is prescribed accordingly. The implicit assumption made in this approach is that the presence of gadolinium-based contrast agents will have a negligible effect on the MR spectra obtained from the lesion. In this work, we examined this assumption by determining the effects of six gadolinium-based contrast agents: Magnevist, Multihance, Omniscan, Optimark, ProHance, and Dotarem, on the Cho peak in phantoms and in a rat model for breast cancer. We found that only the three negatively-charged chelates: Magnevist, MultiHance, and Dotarem, broadened the Cho peak in phantoms and reduced the area of the Cho peak in vivo by an average of about 40%. The use of negatively-charged chelates may lead to an underestimation of the levels of Cho present in human breast cancers, since most studies use MRS postcontrast administration. Therefore, we recommend the use of the neutral chelates in MRI/MRS studies of the breast.
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Affiliation(s)
- Robert E Lenkinski
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02215, USA.
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Madhu B, Robinson SP, Howe FA, Griffiths JR. Effect of Gd-DTPA-BMA on choline signals of HT29 tumors detected by in vivo1H MRS. J Magn Reson Imaging 2008; 28:1201-8. [DOI: 10.1002/jmri.21577] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Truong MT, St Clair EG, Donahue BR, Rush SC, Miller DC, Formenti SC, Knopp EA, Han K, Golfinos JG. Results of Surgical Resection for Progression of Brain Metastases Previously Treatedby Gamma Knife Radiosurgery. Neurosurgery 2006; 59:86-97; discussion 86-97. [PMID: 16823304 DOI: 10.1227/01.neu.0000219858.80351.38] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To determine treatment outcome after surgical resection for progressive brain metastases after gamma knife radiosurgery (GKR) and to explore the role of dynamic contrast agent-enhanced perfusion magnetic resonance imaging (MRI) and proton spectroscopic MRI studies (MRS/P) in predicting pathological findings. METHODS Between 1997 and 2002, 32 patients underwent surgical resection for suspected progression of brain metastases from a cohort of 245 patients with brain metastases treated with GKR. Postradiosurgery MRI surveillance was performed at 6 and 12 weeks, and then every 12 weeks after GKR. In some cases, additional MRI scanning with spectroscopy or perfusion (MRS/P) was used to aid differentiation of radiation change from tumor progression. The decision to perform neurosurgical resection was based on MRI or clinical evidence of lesion progression among patients with a Karnofsky performance score of 60 or more and absent or stable systemic disease. RESULTS Thirteen percent (32 out of 245) of patients and 6% (38 out of 611) of lesions required surgical resection after GKR. The median time from GKR to surgical resection was 8.6 months (range, 1.7-27.1 mo). The 6-, 12-, and 24-month actuarial survival from time of GKR was 97, 78, and 47% for the resected patients and 65, 40, and 19% for the nonresected patients (P < 0.0001). The two-year survival rate of patients requiring two resections after GKR was 100% compared with 39% for patients undergoing one resection (P = 0.02). The median survival of resected patients was 27.2 months (range, 7.0-72.5 mo) from the diagnosis of brain metastases, 19.9 months (range, 5.0-60.7 mo) from GKR, and 8.9 months (range, 0.2-53.1 mo) from surgical resection. Tumor was found in 90% of resected specimens and necrosis alone in 10%. MRS/P studies were performed in 15 resected patients. Overall, MRS/P predicted tumor in 11 lesions, confirmed pathologically in nine lesions, and necrosis alone was found in two. The MRS/P predicted necrosis alone in three, whereas pathology revealed viable tumor in two and necrosis in one lesion. CONCLUSION Surgical intervention of progressive brain metastases after GKR in selected patients leads to a meaningful improvement in survival rates. Further studies are necessary to determine the role of MRS/P in the postradiosurgery surveillance of brain metastases.
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Affiliation(s)
- Minh T Truong
- Department of Radiation Oncology, Boston University School of Medicine, Boston, Massachusetts 02118, USA.
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Truong MT, St. Clair EG, Donahue BR, Rush SC, Miller DC, Formenti SC, Knopp EA, Han K, Golfinos JG. RESULTS OF SURGICAL RESECTION FOR PROGRESSION OF BRAIN METASTASES PREVIOUSLY TREATEDBY GAMMA KNIFE RADIOSURGERY. Neurosurgery 2006. [DOI: 10.1227/01.neu.0000243287.91167.a7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Fayed N, Morales H, Modrego PJ, Pina MA. Contrast/Noise ratio on conventional MRI and choline/creatine ratio on proton MRI spectroscopy accurately discriminate low-grade from high-grade cerebral gliomas. Acad Radiol 2006; 13:728-37. [PMID: 16679275 DOI: 10.1016/j.acra.2006.01.047] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2005] [Revised: 01/26/2006] [Accepted: 01/26/2006] [Indexed: 11/30/2022]
Abstract
RATIONALE AND OBJECTIVES Histopathology is the gold standard to establish the grade of brain tumors but biopsy and/or surgery are not always possible. The aim of this study is to determine whether histological grade of tumors may be predicted by means of conventional gadolinium-enhanced MRI and proton magnetic resonance spectroscopy (MRS). MATERIALS AND METHODS In this study, we included 35 consecutive patients with single brain tumors and final histopathological verification: 12 had low-grade glioma, 16 had high-grade glioma, and 7 had single metastasis. Initially, we carried out T1 and T2 MRI paying attention to the following features: border definition, mass effect, heterogeneity of signal, perilesional edeme, hemorrhage, necrosis, and corpus callosum invasion. Gadolinium-enhancement was evaluated with the contrast-to-noise ratio (CNR). Next, single-voxel proton MRS was carried out to measure the absolute values of metabolites (N-acetyl-aspartate, creatine, choline, and myo-inositol) and their ratios in the area of maximum contrast enhancement. RESULTS We found that gadolinium-enhancement measured with the CNR (CNR > 35.86) predicted malignancy at 82.6% sensitivity and 91.7% specificity (area under the curve, 0.88; 95% confidence interval [CI], 0.73-0.97). With regard to MRS a choline/creatine ratio higher than 1.56 predicted malignancy at 88.9% sensitivity and 91.7% specificity (area under the curve, 0.94; 95% CI, 0.78-0.99). When we combined the CNR value, the choline/creatine ratio, and the presence of lactates in a model of discriminant analysis the predictive power improved significantly with an area under the curve of 0.99% (95% CI, 0.87-1). However, the used techniques were unable to distinguish metastases from high-grade gliomas accurately. CONCLUSIONS The intensity of contrast enhancement measured with the CNR, the choline/creatine ratio, and the presence of lactate were the most powerful variables to predict malignancy in brain tumors. The CNR is a simple, objective, and useful tool in the initial assessment of gliomas and metastases.
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Affiliation(s)
- Nicolás Fayed
- Magnetic Resonance Unit, Clínica Quirón, Miguel Servet University Hospital, Zaragoza, Spain
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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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Lin A, Ross BD, Harris K, Wong W. Efficacy of proton magnetic resonance spectroscopy in neurological diagnosis and neurotherapeutic decision making. NeuroRx 2005; 2:197-214. [PMID: 15897945 PMCID: PMC1064986 DOI: 10.1602/neurorx.2.2.197] [Citation(s) in RCA: 122] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Anatomic and functional neuroimaging with magnetic resonance imaging (MRI) includes the technology more widely known as magnetic resonance spectroscopy (MRS). Now a routine automated "add-on" to all clinical magnetic resonance scanners, MRS, which assays regional neurochemical health and disease, is therefore the most accessible diagnostic tool for clinical management of neurometabolic disorders. Furthermore, the noninvasive nature of this technique makes it an ideal tool for therapeutic monitoring of disease and neurotherapeutic decision making. Among the more than 100 brain disorders that fall within this broad category, MRS contributes decisively to clinical decision making in a smaller but growing number. In this review, we will cover how MRS provides therapeutic impact in brain tumors, metabolic disorders such as adrenoleukodystrophy and Canavan's disease, Alzheimer's disease, hypoxia, secondary to trauma or ischemia, human immunodeficiency virus dementia and lesions, as well as systemic disease such as hepatic and renal failure. Together, these eight indications for MRS apply to a majority of all cases seen. This review, which examines the role of MRS in enhancing routine neurological practice and treatment concludes: 1) there is added value from MRS where MRI is positive; 2) there is unique decision-making information in MRS when MRI is negative; and 3) MRS usefully informs decision making in neurotherapeutics. Additional efficacy studies could extend the range of this capability.
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Affiliation(s)
- Alexander Lin
- Rudi Schulte Research Institute, Santa Barbara, California 93105, USA
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Abstract
MR Spectroscopy provides a means to characterize the metabolite profiles of tumoral and non-tumoral lesions in the brain. This article aims to provide tools to increase our sensitivity and specificity of neurodiagnosis, particularly in combination with other advanced MRI techniques such as perfusion MR imaging.
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Affiliation(s)
- Meng Law
- Department of Radiology, New York University Medical Center, New York, New York 10016, USA.
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Naganawa S, Nihashi T, Fukatsu H, Ishigaki T, Aoki I. Pre-surgical mapping of primary motor cortex by functional MRI at 3 T: effects of intravenous administration of Gd-DTPA. Eur Radiol 2003; 14:112-4. [PMID: 14600780 DOI: 10.1007/s00330-003-2147-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2003] [Revised: 06/13/2003] [Accepted: 09/26/2003] [Indexed: 11/30/2022]
Abstract
The functional magnetic resonance imaging (fMRI) is often performed at the end of a routine MRI examination during which, dependent on the clinical indication, contrast agent has been administered; however, the effects of Gd-DTPA injection on the results of blood oxygenation level dependent (BOLD)-fMRI remain unknown. The present study was conducted to investigate the effects of the intravenous administration of Gd-DTPA on the results of pre-surgical localization of the primary motor cortex by BOLD-fMRI at 3 T. Eight normal subjects were included in this study. After the anatomical scans, pre- and post-contrast fMRI scanning was performed. The number of significantly activated voxels and the mean percentage signal change were compared. The mean number of significantly activated voxels was 115.0+/-27.0 in pre-contrast runs and 90.8+/-27.1 in post-contrast runs (mean value of all 8 volunteers+/-standard deviation; p<0.05). The mean mean percentage signal change was 4.07+/-0.39 in pre-contrast runs and 3.86+/-1.91 in post-contrast runs ( p=0.16). Pre-surgical localization of the motor area by BOLD-fMRI should be performed before the administration of Gd contrast material.
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Affiliation(s)
- Shinji Naganawa
- Department of Radiology, Nagoya University School of Medicine, 65 Tsurumai-cho, Shouwa-ku, 466-8550, Nagoya, Japan.
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Howe FA, Opstad KS. 1H MR spectroscopy of brain tumours and masses. NMR IN BIOMEDICINE 2003; 16:123-131. [PMID: 12884355 DOI: 10.1002/nbm.822] [Citation(s) in RCA: 124] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Accurate diagnosis is essential for optimum management and treatment of patients with brain tumours. Proton magnetic resonance spectroscopy ((1)H MRS) provides information non-invasively on tumour biochemistry and has been shown to provide important additional information to that obtained by conventional radiology. We review the current status of (1)H MRS in classifying brain tumour type and grade, for monitoring response to therapy and progression to higher grade, and as a molecular imaging technique for determining tumour extent for treatment planning.
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Affiliation(s)
- Franklyn A Howe
- Cancer Research UK Biomedical Magnetic Resonance Research Group, Department of Basic Medical Sciences, St George's Hospital Medical School, London, UK.
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Herminghaus S, Dierks T, Pilatus U, Möller-Hartmann W, Wittsack J, Marquardt G, Labisch C, Lanfermann H, Schlote W, Zanella FE. Determination of histopathological tumor grade in neuroepithelial brain tumors by using spectral pattern analysis of in vivo spectroscopic data. J Neurosurg 2003; 98:74-81. [PMID: 12546355 DOI: 10.3171/jns.2003.98.1.0074] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT In this study, 1H magnetic resonance (MR) spectroscopy was prospectively tested as a reliable method for presurgical grading of neuroepithelial brain tumors. METHODS Using a database of tumor spectra obtained in patients with histologically confirmed diagnoses, 94 consecutive untreated patients were studied using single-voxel 1H spectroscopy (point-resolved spectroscopy; TE 135 msec, TE 135 msec, TR 1500 msec). A total of 90 tumor spectra obtained in patients with diagnostic 1H MR spectroscopy examinations were analyzed using commercially available software (MRUI/VARPRO) and classified using linear discriminant analysis as World Health Organization (WHO) Grade I/II, WHO Grade III, or WHO Grade IV lesions. In all cases, the classification results were matched with histopathological diagnoses that were made according to the WHO classification criteria after serial stereotactic biopsy procedures or open surgery. Histopathological studies revealed 30 Grade I/II tumors, 29 Grade III tumors, and 31 Grade IV tumors. The reliability of the histological diagnoses was validated considering a minimum postsurgical follow-up period of 12 months (range 12-37 months). Classifications based on spectroscopic data yielded 31 tumors in Grade I/II, 32 in Grade III, and 27 in Grade IV. Incorrect classifications included two Grade II tumors, one of which was identified as Grade III and one as Grade IV; two Grade III tumors identified as Grade II; two Grade III lesions identified as Grade IV; and six Grade IV tumors identified as Grade III. Furthermore, one glioblastoma (WHO Grade IV) was classified as WHO Grade I/II. This represents an overall success rate of 86%, and a 95% success rate in differentiating low-grade from high-grade tumors. CONCLUSIONS The authors conclude that in vivo 1H MR spectroscopy is a reliable technique for grading neuroepithelial brain tumors.
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Affiliation(s)
- Sebastian Herminghaus
- Department of Neurosurgery and Institute of Neuroradiology, Johann W. Goethe University, Frankfurt am Main, Germany.
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Leclerc X, Huisman TAGM, Sorensen AG. The potential of proton magnetic resonance spectroscopy ((1)H-MRS) in the diagnosis and management of patients with brain tumors. Curr Opin Oncol 2002; 14:292-8. [PMID: 11981274 DOI: 10.1097/00001622-200205000-00007] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Proton ((1)H) magnetic resonance spectroscopy (MRS) is a noninvasive method that can monitor the metabolic changes in most brain diseases. This technique is now available on current 1.5 Tesla magnetic resonance units and does not require sophisticated software or time-consuming post-processing techniques. Previous studies using single-voxel techniques showed the usefulness of MRS for the diagnosis of brain tumor despite some technical issues, including spatial resolution and volume coverage. Recent advances have been made through the use of multivoxel techniques and metabolite maps, which allow assessment of both the entire volume of the lesion and the surrounding normal-appearing brain tissue. Recent studies suggest the potential of this technique to guide biopsies, to define radiotherapy targets, and to monitor patients after treatment. Some persistent drawbacks, including measurement time and spectral resolution, will probably be overcome in the near future.
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Affiliation(s)
- Xavier Leclerc
- NMR Center, Massachusetts General Hospital and Harvard Medical School, Charlestown, Massachusetts 02129-2060, USA.
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