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Negendank WG , Sauter R , Brown TR , Evelhoch JL , Falini A , Gotsis ED , Heerschap A , Kamada K , Lee BCP , Mengeot MM , Moser E , PadavicShaller KA , Sanders JA , Spraggins TA , Stillman AE , Terwey B , Vogl TJ , Wicklow K , Zimmerman RA
Proton magnetic resonance spectroscopy in patients with glial tumors: A multicenter study
Journal of Neurosurgery. 1996 Mar;84(3) :449-458
PMID: ISI:A1996TW71300012   
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The authors represent a cooperative group of 15 institutions that examined the feasibility of using metabolic features observed in vivo with H-1-magnetic resonance (MR) spectroscopy to characterize brain tumors of the glial type. The institutions provided blinded, centralized MR spectroscopy data processing along with independent central review of MR spectroscopy voxel placement, composition and contamination by brain, histopathological typing using current World Health Organization criteria, and clinical data. Proton H-1-MR spectroscopy was performed using a spin-echo technique to obtain spectra from 8-cc voxels in the tumor and when feasible in the contralateral brain. Eighty-six cases were assessable, 41 of which had contralateral brain spectra. Glial tumors had significantly elevated intensities of choline signals, decreased intensities of creatine signals, and decreased intensities of N-acetylaspartate compared to brain. Choline signal intensities were highest in astrocytomas and anaplastic astrocytomas, and creatine signal intensities were lowest in glioblastomas. However, whether expressed relative to brain or as intratumoral ratios, these metabolic characteristics exhibited large variations within each subtype of glial turner. The resulting overlaps precluded diagnostic accuracy in the distinction of low- and high-grade tumors. Although the extent of contamination of the H-1-MR spectroscopy voxel by brain had a marked effect on metabolite concentrations and ratios, selection of cases with minimal contamination did not reduce these overlaps. Thus, each type and grade of tumor is a metabolically heterogeneous group. Lactate occurred infrequently and in all grades. Mobile lipids, on the other hand, occurred in 41% of high-grade tumors with higher mean amounts found in glioblastomas. This result, coupled with the recent demonstration that intratumoral mobile lipids correlate with microscopic tumor cell necrosis, leads to the hypothesis that mobile lipids observed in vivo in H-1-MR spectroscopy may correlate independently with prognosis of individual patients.
Times Cited: 99 English Article TW713 J NEUROSURG