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Blüml S, Margol AS, Sposto R, Kennedy RJ, Robison NJ, Vali M, Hung LT, Muthugounder S, Finlay JL, Erdreich-Epstein A, Gilles FH, Judkins AR, Krieger MD, Dhall G, Nelson MD, Asgharzadeh S. Molecular subgroups of medulloblastoma identification using noninvasive magnetic resonance spectroscopy. Neuro Oncol 2015; 18:126-31. [PMID: 26254476 DOI: 10.1093/neuonc/nov097] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Accepted: 05/17/2015] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Medulloblastomas in children can be categorized into 4 molecular subgroups with differing clinical characteristics, such that subgroup determination aids in prognostication and risk-adaptive treatment strategies. Magnetic resonance spectroscopy (MRS) is a widely available, noninvasive tool that is used to determine the metabolic characteristics of tumors and provide diagnostic information without the need for tumor tissue. In this study, we investigated the hypothesis that metabolite concentrations measured by MRS would differ between molecular subgroups of medulloblastoma and allow accurate subgroup determination. METHODS MRS was used to measure metabolites in medulloblastomas across molecular subgroups (SHH = 12, Groups 3/4 = 17, WNT = 1). Levels of 14 metabolites were analyzed to determine those that were the most discriminant for medulloblastoma subgroups in order to construct a multivariable classifier for distinguishing between combined Group 3/4 and SHH tumors. RESULTS Medulloblastomas across molecular subgroups revealed distinct spectral features. Group 3 and Group 4 tumors demonstrated metabolic profiles with readily detectable taurine, lower levels of lipids, and high levels of creatine. SHH tumors showed prominent choline and lipid with low levels of creatine and little or no evidence of taurine. A 5-metabolite subgroup classifier inclusive of creatine, myo-inositol, taurine, aspartate, and lipid 13a was developed that could discriminate between Group 3/4 and SHH medulloblastomas with excellent accuracy (cross-validated area under the curve [AUC] = 0.88). CONCLUSIONS The data show that medulloblastomas of Group 3/4 differ metabolically as measured using MRS when compared with SHH molecular subgroups. MRS is a useful and accurate tool to determine medulloblastoma molecular subgroups.
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Affiliation(s)
- Stefan Blüml
- Children's Hospital Los Angeles and The Saban Research Institute, Los Angeles, California (S.B., A.S.M., R.S., R.J.K., N.J.R., M.V., L.T.H., S.M., A.E-E., F.H.G., A.R.J., M.D.K., G.D., M.D.N., S.A.); Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, California (S.B., M.D.N.); Rudi Schulte Research Institute, Santa Barbara, California (S.B., M.D.N.); Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California (R.S.); Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio (J.L.F.); Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, California (A.E-E., F.H.G., A.R.J., S.A.); Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, California (M.D.K.); Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California (A.S.M., N.J.R., A.E-E., G.D., S.A.)
| | - Ashley S Margol
- Children's Hospital Los Angeles and The Saban Research Institute, Los Angeles, California (S.B., A.S.M., R.S., R.J.K., N.J.R., M.V., L.T.H., S.M., A.E-E., F.H.G., A.R.J., M.D.K., G.D., M.D.N., S.A.); Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, California (S.B., M.D.N.); Rudi Schulte Research Institute, Santa Barbara, California (S.B., M.D.N.); Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California (R.S.); Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio (J.L.F.); Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, California (A.E-E., F.H.G., A.R.J., S.A.); Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, California (M.D.K.); Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California (A.S.M., N.J.R., A.E-E., G.D., S.A.)
| | - Richard Sposto
- Children's Hospital Los Angeles and The Saban Research Institute, Los Angeles, California (S.B., A.S.M., R.S., R.J.K., N.J.R., M.V., L.T.H., S.M., A.E-E., F.H.G., A.R.J., M.D.K., G.D., M.D.N., S.A.); Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, California (S.B., M.D.N.); Rudi Schulte Research Institute, Santa Barbara, California (S.B., M.D.N.); Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California (R.S.); Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio (J.L.F.); Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, California (A.E-E., F.H.G., A.R.J., S.A.); Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, California (M.D.K.); Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California (A.S.M., N.J.R., A.E-E., G.D., S.A.)
| | - Rebekah J Kennedy
- Children's Hospital Los Angeles and The Saban Research Institute, Los Angeles, California (S.B., A.S.M., R.S., R.J.K., N.J.R., M.V., L.T.H., S.M., A.E-E., F.H.G., A.R.J., M.D.K., G.D., M.D.N., S.A.); Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, California (S.B., M.D.N.); Rudi Schulte Research Institute, Santa Barbara, California (S.B., M.D.N.); Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California (R.S.); Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio (J.L.F.); Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, California (A.E-E., F.H.G., A.R.J., S.A.); Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, California (M.D.K.); Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California (A.S.M., N.J.R., A.E-E., G.D., S.A.)
| | - Nathan J Robison
- Children's Hospital Los Angeles and The Saban Research Institute, Los Angeles, California (S.B., A.S.M., R.S., R.J.K., N.J.R., M.V., L.T.H., S.M., A.E-E., F.H.G., A.R.J., M.D.K., G.D., M.D.N., S.A.); Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, California (S.B., M.D.N.); Rudi Schulte Research Institute, Santa Barbara, California (S.B., M.D.N.); Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California (R.S.); Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio (J.L.F.); Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, California (A.E-E., F.H.G., A.R.J., S.A.); Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, California (M.D.K.); Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California (A.S.M., N.J.R., A.E-E., G.D., S.A.)
| | - Marzieh Vali
- Children's Hospital Los Angeles and The Saban Research Institute, Los Angeles, California (S.B., A.S.M., R.S., R.J.K., N.J.R., M.V., L.T.H., S.M., A.E-E., F.H.G., A.R.J., M.D.K., G.D., M.D.N., S.A.); Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, California (S.B., M.D.N.); Rudi Schulte Research Institute, Santa Barbara, California (S.B., M.D.N.); Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California (R.S.); Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio (J.L.F.); Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, California (A.E-E., F.H.G., A.R.J., S.A.); Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, California (M.D.K.); Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California (A.S.M., N.J.R., A.E-E., G.D., S.A.)
| | - Long T Hung
- Children's Hospital Los Angeles and The Saban Research Institute, Los Angeles, California (S.B., A.S.M., R.S., R.J.K., N.J.R., M.V., L.T.H., S.M., A.E-E., F.H.G., A.R.J., M.D.K., G.D., M.D.N., S.A.); Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, California (S.B., M.D.N.); Rudi Schulte Research Institute, Santa Barbara, California (S.B., M.D.N.); Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California (R.S.); Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio (J.L.F.); Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, California (A.E-E., F.H.G., A.R.J., S.A.); Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, California (M.D.K.); Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California (A.S.M., N.J.R., A.E-E., G.D., S.A.)
| | - Sakunthala Muthugounder
- Children's Hospital Los Angeles and The Saban Research Institute, Los Angeles, California (S.B., A.S.M., R.S., R.J.K., N.J.R., M.V., L.T.H., S.M., A.E-E., F.H.G., A.R.J., M.D.K., G.D., M.D.N., S.A.); Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, California (S.B., M.D.N.); Rudi Schulte Research Institute, Santa Barbara, California (S.B., M.D.N.); Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California (R.S.); Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio (J.L.F.); Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, California (A.E-E., F.H.G., A.R.J., S.A.); Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, California (M.D.K.); Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California (A.S.M., N.J.R., A.E-E., G.D., S.A.)
| | - Jonathan L Finlay
- Children's Hospital Los Angeles and The Saban Research Institute, Los Angeles, California (S.B., A.S.M., R.S., R.J.K., N.J.R., M.V., L.T.H., S.M., A.E-E., F.H.G., A.R.J., M.D.K., G.D., M.D.N., S.A.); Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, California (S.B., M.D.N.); Rudi Schulte Research Institute, Santa Barbara, California (S.B., M.D.N.); Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California (R.S.); Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio (J.L.F.); Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, California (A.E-E., F.H.G., A.R.J., S.A.); Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, California (M.D.K.); Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California (A.S.M., N.J.R., A.E-E., G.D., S.A.)
| | - Anat Erdreich-Epstein
- Children's Hospital Los Angeles and The Saban Research Institute, Los Angeles, California (S.B., A.S.M., R.S., R.J.K., N.J.R., M.V., L.T.H., S.M., A.E-E., F.H.G., A.R.J., M.D.K., G.D., M.D.N., S.A.); Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, California (S.B., M.D.N.); Rudi Schulte Research Institute, Santa Barbara, California (S.B., M.D.N.); Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California (R.S.); Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio (J.L.F.); Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, California (A.E-E., F.H.G., A.R.J., S.A.); Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, California (M.D.K.); Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California (A.S.M., N.J.R., A.E-E., G.D., S.A.)
| | - Floyd H Gilles
- Children's Hospital Los Angeles and The Saban Research Institute, Los Angeles, California (S.B., A.S.M., R.S., R.J.K., N.J.R., M.V., L.T.H., S.M., A.E-E., F.H.G., A.R.J., M.D.K., G.D., M.D.N., S.A.); Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, California (S.B., M.D.N.); Rudi Schulte Research Institute, Santa Barbara, California (S.B., M.D.N.); Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California (R.S.); Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio (J.L.F.); Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, California (A.E-E., F.H.G., A.R.J., S.A.); Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, California (M.D.K.); Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California (A.S.M., N.J.R., A.E-E., G.D., S.A.)
| | - Alexander R Judkins
- Children's Hospital Los Angeles and The Saban Research Institute, Los Angeles, California (S.B., A.S.M., R.S., R.J.K., N.J.R., M.V., L.T.H., S.M., A.E-E., F.H.G., A.R.J., M.D.K., G.D., M.D.N., S.A.); Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, California (S.B., M.D.N.); Rudi Schulte Research Institute, Santa Barbara, California (S.B., M.D.N.); Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California (R.S.); Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio (J.L.F.); Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, California (A.E-E., F.H.G., A.R.J., S.A.); Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, California (M.D.K.); Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California (A.S.M., N.J.R., A.E-E., G.D., S.A.)
| | - Mark D Krieger
- Children's Hospital Los Angeles and The Saban Research Institute, Los Angeles, California (S.B., A.S.M., R.S., R.J.K., N.J.R., M.V., L.T.H., S.M., A.E-E., F.H.G., A.R.J., M.D.K., G.D., M.D.N., S.A.); Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, California (S.B., M.D.N.); Rudi Schulte Research Institute, Santa Barbara, California (S.B., M.D.N.); Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California (R.S.); Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio (J.L.F.); Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, California (A.E-E., F.H.G., A.R.J., S.A.); Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, California (M.D.K.); Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California (A.S.M., N.J.R., A.E-E., G.D., S.A.)
| | - Girish Dhall
- Children's Hospital Los Angeles and The Saban Research Institute, Los Angeles, California (S.B., A.S.M., R.S., R.J.K., N.J.R., M.V., L.T.H., S.M., A.E-E., F.H.G., A.R.J., M.D.K., G.D., M.D.N., S.A.); Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, California (S.B., M.D.N.); Rudi Schulte Research Institute, Santa Barbara, California (S.B., M.D.N.); Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California (R.S.); Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio (J.L.F.); Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, California (A.E-E., F.H.G., A.R.J., S.A.); Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, California (M.D.K.); Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California (A.S.M., N.J.R., A.E-E., G.D., S.A.)
| | - Marvin D Nelson
- Children's Hospital Los Angeles and The Saban Research Institute, Los Angeles, California (S.B., A.S.M., R.S., R.J.K., N.J.R., M.V., L.T.H., S.M., A.E-E., F.H.G., A.R.J., M.D.K., G.D., M.D.N., S.A.); Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, California (S.B., M.D.N.); Rudi Schulte Research Institute, Santa Barbara, California (S.B., M.D.N.); Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California (R.S.); Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio (J.L.F.); Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, California (A.E-E., F.H.G., A.R.J., S.A.); Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, California (M.D.K.); Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California (A.S.M., N.J.R., A.E-E., G.D., S.A.)
| | - Shahab Asgharzadeh
- Children's Hospital Los Angeles and The Saban Research Institute, Los Angeles, California (S.B., A.S.M., R.S., R.J.K., N.J.R., M.V., L.T.H., S.M., A.E-E., F.H.G., A.R.J., M.D.K., G.D., M.D.N., S.A.); Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, California (S.B., M.D.N.); Rudi Schulte Research Institute, Santa Barbara, California (S.B., M.D.N.); Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California (R.S.); Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio (J.L.F.); Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, California (A.E-E., F.H.G., A.R.J., S.A.); Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, California (M.D.K.); Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California (A.S.M., N.J.R., A.E-E., G.D., S.A.)
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