ORIGINAL PAPER/ARTYKUŕ ORYGINALNY
Magnetic resonance spectroscopy in intracranial tumours of glial originSpektroskopia rezonansu magnetycznego w wewnątrzczaszkowych nowotworach pochodzenia glejowego

https://doi.org/10.5114/ninp.2013.32999Get rights and content

Abstract

Background and purpose

To determine in vivo magnetic resonance spectroscopy (MRS) characteristics of intracranial glial tumours and to assess MRS reliability in glioma grading and discrimination between different histopathological types of tumours.

Material and methods

Analysis of spectra of 26 patients with glioblastomas, 6 with fibrillary astrocytomas, 4 with anaplastic astrocytomas, 2 with pilocytic astrocytoma, 3 with oligodendrogliomas, 3 with anaplastic oligodendrogliomas and 17 control spectra taken from healthy hemispheres.

Results

All tumours’ metabolite ratios, except for Cho/Cr in fibrillary astrocytomas (p = 0.06), were statistically signiflcantly different from the control. The tumours showed decreased Naa and Cr contents and a high Cho signal. The Lac-Lip signal was high in grade III astrocytomas and glioblastomas. Reports that Cho/Cr ratio increases with glioma's grade whereas Naa/Cr decreases were not confirmed. Anaplastic astrocytomas compared to grade II astrocytomas had a statistically significantly greater ml/Cr ratio (p = 0.02). In pilocytic astrocytomas the Naa/Cr value (2.58 ± 0.39) was greater, whilst the Cho/Naa ratio was lower (2.14 ± 0.64) than in the other astrocytomas. The specific feature of oligodendrogliomas was the presence of glutamate/glutamine peak Glx. However, this peak was absent in two out of three anaplastic oligodendrogliomas. Characteristically, the latter tumours had a high Lac-Lip signal.

Conclusions

MRS in vivo cannot be used as a reliable method for glioma grading. The method is useful in discrimination between WHO grade I and WHO grade II astrocytomas as well as oligodendrogliomas from other gliomas.

Streszczenie

Wstęp i cel pracy

Ustalenie charakterystyki spektroskopii magnetycznego rezonansu jądrowego (magnetic resonance spectroscopy – MRS) u chorych z nowotworami wewnątrzczaszkowymi pochodzenia glejowego oraz ocena przydatności tego badania w diagnostyce różnicowej typów histologicznych glejaków.

Materiał i metody

Przeprowadzono analizę widm MRS nowotworów u 26 chorych z glejakami wielopostaciowymi, 6 z gwiaździakami włókienkowymi, 4 z gwiaździakami anaplastycznymi, 2 z włosowatokomórkowymi, 3 ze skąpodrzewiakami, 3 ze skąpodrzewiakami anaplastycznymi oraz 17 widm kontrolnych pochodzących ze zdrowych półkul mózgu.

Wyniki

Wszystkie wskaźniki metaboliczne w przypadkach nowotworów, z wyjątkiem Cho/Cr w gwiaździakach włókienkowych (p = 0,06), różniły się znamiennie od tych w grupie kontrolnej. Nowotwory wykazywały zmniejszoną zawartość Naa i Cr oraz wysoki sygnał Cho. Sygnał Lac-Lip był wysoki w gwiaździakach III stopnia wg WHO i glejakach wielopostaciowych. Nie udało się potwierdzić doniesień, że wskaźnik Cho/Cr rośnie, a wskaźnik Naa/Cr maleje wraz ze wzrostem stopnia złośliwości glejaka. Gwiaździaki anaplastyczne wykazywały znamiennie wyższy wskaźnik ml/Cr (p = 0,02) w porównaniu z gwiaździakami II stopnia wg WHO. W gwiaździakach włosowatokomórkowych wartość Naa/Cr (2,58 ± 0,39) była większa, a Cho/Naa mniejsza (2,14 ± 0,64) niż w innych gwiaździakach. Skąpodrzewiaki charakteryzowała obecność szczytu glutaminianu/glutaminy (Glx), którego jednak nie obserwowano w 2 spośród 3 przypadków skąpodrzewiaków anaplastycznych. Dla tych ostatnich symptomatyczna była obecność silnego sygnału Lac-Lip.

Wnioski

Badanie MRS in vivo nie jest niezawodną metodą różnicującą glejaki wewnątrzczaszkowe. Wydaje się użyteczne w diagnostyce różnicowej gwiaździaków I i II stopnia wg WHO oraz w odróżnianiu skąpodrzewiaków od pozostałych glejaków.

Introduction

The progress of magnetic resonance imaging (MRI) has considerably facilitated diagnosis of brain tumours. One of its particular applications is magnetic resonance spectroscopy in vivo (MRS). To date, a number of reports have presented a correlation between MRS spectra and neuropathology of brain tumours [1, 2, 3, 4, 5, 6, 7]. This method proved to be helpful in in vivo grading of gliomas [8, 9, 10, 11], discrimination between lymphomas and gliomas [12, 13], metastases and gliomas [14], as well as neoplasms and non-neoplastic lesions [15, 16]. It appears that MRS may add to the diagnostic accuracy of MRI [17], having also certain prognostic value in patients with malignant gliomas [18, 19].

The aim of this study was to determine in vivo MRS characteristics in patients operated on at the Department of Neurosurgery, Medical University of Lodz, Poland and to compare these data with reports available in the literature, as well as to assess MRS reliability in glioma grading and discrimination between different histopathological types of tumours.

Section snippets

Material and methods

The study involved 89 patients with brain tumours who underwent neurosurgery at the Department of Neurosurgery of the Medical University in Lodz. There were 38 men and 51 females aged from 19 to 75. The study evaluated only patients with medium and large tumours i.e. the cases in which the investigator was able to set a voxel volume from 1 to 8 cubic centimetres. All patients gave informed consent to the study. The study protocol has been accepted by the University Bioethical Committee for

Results

Glioblastoma (WHO grade IV) was diagnosed in 26 patients: 14 males and 12 females aged 20 to 70 (mean age, 54 years). In the long TE sequence (Fig. 2), in 11 cases the MRS spectrum showed a high Cho signal, low peaks of Cr and Naa and a high Lac-Lip signal. In 5 other spectra, the only difference was that the Lac-Lip signals were much lower and in the other 7 there was a negative Lac signal. In 2 cases, there were low peaks of Cho, Cr and Naa together with a high Lac-Lip signal. Finally, one

Discussion

MRS of gliomas shows decreased contents of Naa [25, 26, 27, 28] since neurons are superseded by the neoplasm cells. For the same reason, a decreased level of Cr is observed [26, 28, 29]. Furthermore, astrocytomas show high Cho contents [28, 30, 31, 32] due to increased synthesis of cellular membranes inside the tumour.

In our patients with diffuse gliomas those features were apparent in all types of tumours. The only exception was the Cho/Cr ratio in fibrillary astrocytomas since it was not

Conclusions

At present, it seems that in vivo MR spectroscopy cannot be used as a reliable method for glioma grading. Nevertheless, it is useful in discrimination between WHO grade I and WHO grade II astrocytomas as well as oligodendrogliomas and other gliomas.

Disclosure

Authors report no conflict of interest.

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    Copyright © 2013 Polish Society of Neurology and the Polish Association of Neurosurgeons. Published by Elsevier Urban & Partner Sp. z o.o. All rights reserved.