OZAN KARATAĞ, Gülden Yenice KARATAĞ, Ender UYSAL, S Meltem CAN, Mehmet ERTÜRK, Muzaffer BAŞAK

Can magnetic resonance spectroscopy adequately differentiate neoplastic from non-neoplastic and low-grade from high-grade lesions in brain masses?

Amaç: Bu çalışmanın amacı serebral lezyonların ayırıcı tanısında Manyetik Rezonans Spektroskopinin etkinliğini araştırmaktır. Yöntem: Serebral lezyonu olan 46 olgu Manyetik Rezonans Spektroskopi ile incelendi. Kolin, kreatin, N-asetil aspartat ve lipid-laktat pikleri değerlendirildi. Kırk altı olgunun 40'ına stereotaktik biopsi ya da operasyon uygulandı. Histopatolojik sonuçlar ile Manyetik Rezonans Spektroskopi sonuçları karşılaştırıldı. Bulgular: Lezyonların neoplastik/neoplastik olmayan ayrımında Kolin/N-asetil aspartat en yüksek duyarlılığa sahipti (%87.2) ve Kolin/Kreatin, Kolin/N-asetil aspartat, Kolin+Kreatin/N-asetil aspartat oranlarının özgüllük değerleri %100 olarak hesaplandı. Düşük/yüksek evre ayrımında Kolin/Kreatin en yüksek duyarlılığa sahipti (%95.7) ve Kolin/N-asetil aspartat, Kolin+Kreatin/N-asetil aspartat, lipid-laktat oranlarının özgüllüğü %100 olarak hesaplandı. Sonuç olarak Kolin/Kreatin oranının 2.2'den yüksek olması ve eşlik eden lipid-laktat pikinin neoplastik lezyonların düşük/yüksek evre ayrımında %100 (%82.2-100) duyarlılık ve %100 (%71.7-100) özgüllüğe sahip olduğu görüldü. Sonuç: Yüksek Kolin ve düşük N-asetil aspartat piklerinin lezyonların neoplastik/neoplastik olmayan ayrımında etkili olduğu görüldü. Neoplastik lezyonların yüksek/düşük evre ayrımında ise 2.2'den yüksek Kolin/Kreatin oranı ve eşlik eden lipid-laktat pikinin değerli bilgiler verdiği sonucuna varıldı.

Beyin kitlelerinde neoplastik / neoplastik olmayan ve yüksek evre / düşük evre ayrımında mr spektroskopinin yeri

Objective: The aim of this study was to evaluate the usefulness of Magnetic Resonance Spectroscopy in the differential diagnosis of brain lesions. Materials and Methods: Forty-six patients with cerebral lesions were examined by Magnetic Resonance Spectroscopy. Choline, creatine, N-acetyl aspartate and lipid-lactate peaks were evaluated. Forty of the 46 patients underwent stereotactic biopsy or surgery. Histopathological results were compared with the Magnetic Resonance Spectroscopy results. Results: The Choline / N- acetyl aspartate ratio had the highest sensitivity (87.2%) in neoplastic versus non-neoplastic differentiation and the specificities of the Choline / Creatine, Choline / N-acetyl aspartate and Choline+Creatine / N-acetyl aspartate ratios were found to be 100%. Choline / Creatine ratios showed the highest sensitivity (95.7%) in low-grade versus high-grade differentiation and specificities of Choline / N-acetyl aspartate, Choline+Creatine / N- acetyl aspartate ratios and lipid-lactate levels were found to be 100%. Consequently, a value of Choline / Creatine > 2.2 and an accompanying lipid-lactate peak differentiated neoplasms as low-grade versus high-grade with a sensitivity of 100% (82.2-100) and a specificity of 100% (71.7-100). Conclusion: The presence of elevated Choline and decreased N-acetyl aspartate levels are effective in the differetiation of neoplastic versus non-neoplastic lesions with high sensitivity and specificity. A proposed ratio of Choline / Creatine > 2.2 and an accompanying lipid-lactate peak provide valuable information in differentiating low-grade from high-grade lesions.

PDF

___

1) Dowling C, Bollen AW, Noworolski SM, et al. Preoperative proton MR spectroscopic imaging of brain tumors: correlation with histopathologic analysis of resection specimens specimens. AJNR Am J Neuroradiol 2001; 22: 604–612.
2) Hourani R, Brant LJ, Rizk T, Weingart JD, Barker PB, Horská A. Can proton MR spectroscopic and perfusion imaging differentiate between neoplastic and nonneoplastic brain lesions in adults? AJNR Am J Neuroradiol 2008; 29:366-372.
3) Stadlbauer A, Gruber S, Nimsky C, et al. Preoperative grading of gliomas by using metabolite quantification with high-spatial-resolution proton MR spectroscopic imaging. Radiology 2006; 238:958-969.
4) Bulakbasi N, Kocaoglu M, Ors F, Tayfun C, Ucoz T. Combination of single-voxel proton MR spectroscopy and apparent diffusion coefficient calculation in the evaluation of common brain tumors. AJNR Am J Neuroradiol 2003; 24:225-233.
5) Bernstein M, Parrent AG. Complications of CT-guided stereotactic biopsy of intra-axial brain lesions. J Neurosurg 1994; 81:165–168.
6) Field M, Witham TF, Flickinger JC, Kondziolka D, Lunsford LD. Comprehensive assessment of hemorrhage risks and outcomes after stereotactic brain biopsy. J Neurosurg 2001; 94:545–551.
7) Kreth FW, Muacevic A, Medele R, Bise K, Meyer T, Reulen HJ. The risk of haemorrhage after image guided stereotactic biopsy of intra-axial brain tumours: a prospective study. Acta Neurochir (Wien) 2001; 143: 539–545.
8) Sawin PD, Hitchon PW, Follett KA, Torner JC. Computed imaging-assisted stereotactic brain biopsy: a risk analysis of 225 consecutive cases. Surg Neurol 1998; 49:640–649.
9) Yu X, Liu Z, Tian Z, Li S, Huang H, et al. Stereotactic biopsy for intracranial space-occupying lesions: clinical analysis of 550 cases. Stereotact Funct Neurosurg 2000; 75:103–108.
10) Law M, Yang S, Wang H, et al. Glioma grading: sensitivity, specificity, and predictive values of perfusion MR imaging and proton MR spectroscopic imaging compared with conventional MR imaging. AJNR Am J Neuroradiol 2003; 24:1989-1998.
11) Al-Okaili RN, Krejza J, Woo JH, Wolf RL, O'Rourke DM, Judy KD, et al. Intraaxial brain masses: MR imagingbased diagnostic strategy—initial experience. Radiology 2007; 243:539–550.
12) García-Gómez JM, Luts J, Julià-Sapé M, et al. Multiproject-multicenter evaluation of automatic brain tumor classification by magnetic resonance spectroscopy. MAGMA 2009; 22:5-18.
13) Lin AP, Ross BD. Short-echo time proton MR spectroscopy in the presence of gadolinium. J Comput Assist Tomogr 2001; 25:705-712.
14) Murphy PS, Dzik-Jurasz AS, Leach MO, Rowland IJ. The effect of Gd-DTPA on T(1)-weighted choline signal in human brain tumours. Magn Reson Imaging 2002; 20:127-130.
15) Smith JK, Kwock L, Castillo M. Effects of contrast material on single-volume proton MR spectroscopy. AJNR Am J Neuroradiol 2000; 21:1084-1089.
16) Spampinato MV, Smith JK, Kwock L, et al. Cerebral blood volume measurements and proton MR spectroscopy in grading of oligodendroglial tumors. AJR Am J Roentgenol 2007; 188:204-212.
17) Bruhn H, Frahm J, Gyngell ML, et al. Noninvasive differentiation of tumors with use of localized H-1 MR spectroscopy in vivo: initial experience in patients with cerebral tumors. Radiology 1989; 172: 541–548.
18) Castillo M, Kwock L, Mukherji SK. Clinical applications of MR spectroscopy. AJNR Am J Neuroradiol 1996; 17:1–15.
19) Krouwer HG, Kim TA, Rand SD, et al. Single-voxel proton MR spectroscopy of nonneoplastic brain lesions suggestive of a neoplasm. AJNR Am J Neuroradiol 1998; 19:1695–1703.
20) Poptani H, Gupta RK, Roy R, Pandey R, Jain VK, Chhabra DK. Characterization of intracranial mass lesions with in vivo proton MR spectroscopy. AJNR Am J Neuroradiol 1995; 16:1593–1603.
21) Segebarth CM, Baleriaux DF, Luyten PR, den Hollander JA. Detection of metabolic heterogeneity of human intracranial tumors in vivo by H-1 NMR spectroscopic imaging. Magn Reson Med 1990; 13:62–76.
22) Rand SD, Prost R, Haughton V, et al. Accuracy of single-voxel proton MR spectroscopy in distinguishing neoplastic from nonneoplastic brain lesions. AJNR Am J Neuroradiol 1997; 18:1695–1704.
23) Demaerel P, Johannik K, van Hecke P, et al. Localized 1H NMR spectroscopy in fifty cases of newly diagnosed intracranial tumors. J Comput Assist Tomogr 1991; 15:67–76.
24) Herholz K, Heindel W, Luyten PR, et al. In vivo imaging of glucoseconsumption and lactate concentration in human gliomas. Ann Neurol 1992; 31:319–327.
25) Ott D, Hennig J, Ernst T. Human brain tumors: assessment with in vivo proton MR spectroscopy. Radiology 1993; 186:745–752.
26) Shimizu H, Kumabe T, Tominaga T, et al. Noninvasive evaluation of malignancy of brain tumors with proton MR spectroscopy. AJNR Am J Neuroradiol 1996; 17:737-747.
27) Kugel H, Heindel W, Ernestus R-I, Bunke J, du Mensil R, Friedmann G. Human brain tumors: spectral patterns detected with localized H-1 MR spectroscopy. Radiology 1992; 183:701–709.
28) Fulham MJ, Bizzi A, Dietz MJ, et al. Mapping of brain tumor metabolites with proton MR spectroscopic imaging: clinical relevance. Radiology 1992; 185:675-686.
29) Kinoshita Y, Kajiwara H, Yokota A, Koga Y. Proton magnetic resonance spectroscopy of brain tumors: an in vitro study. Neurosurgery 1994; 35:606–614.
30) Tien RD, Lai PH, Smith JS, Lazeyras F. Single-voxel proton brain spectroscopy exam (PROBE/SV) in patients with primary brain tumors. AJR Am J Roentgenol 1996; 167:201-209.
31) Meyerand ME, Pipas JM, Mamourian A, Tosteson TD, Dunn JF. Classification of biopsy-confirmed brain tumors using single-voxel MR spectroscopy. AJNR Am J Neuroradiol 1999; 20:117–123.
32) Moller-Hartmann W, Herminghaus S, Krings T, et al. Clinical application of proton magnetic resonance spectroscopy in the diagnosis of intracranial mass lesions. Neuroradiology 2002; 44:371–381.
33) Kimura T, Sako K, Gotoh T, Tanaka K, Tanaka T. In vivo singlevoxel proton MR spectroscopy in brain lesions with ring-like enhancement. NMR Biomed 2001; 14:339–349.
34) Poptani H, Gupta RK, Jain VK, Roy R, Pandey R. Cystic intracranial mass lesions: possible role of in vivo MR spectroscopy in its differential diagnosis. Magn Reson Imaging 1995; 13:1019-1029.
35) Luyten PR, Marien AJ, Heindel W, , et al. Metabolic imaging of patients with intracranial tumors: 1H MR spectroscopic imaging and PET. Radiology 1990; 176:791–799.
36) Martin AJ, Liu H, Hall WA, Truwit CL. Preliminary assessment of turbo spectroscopic imaging for targeting in brain biopsy. AJNR Am J Neuroradiol 2001; 22:959-968.
37) Bizzi A, Movsas B, Tedeschi G, et al. Response of non-Hodgkin lymphoma to radiation therapy: early and long-term assessment with H-1 MR spectroscopic imaging. Radiology 1995; 194:271-276.
38) Law M, Cha S, Knopp EA, Johnson G, Arnett J, Litt AW. High-grade gliomas and solitary metastases: differentiation by using perfusion and proton spectroscopic MR imaging. Radiology 2002; 222:715-721.
39) Bendszus M, Warmuth-Metz M, Klein R. MR spectroscopy in gliomatosis cerebri. Am J Neuroradiol 2000; 21:375–380.
40) Pyhtinen J. Proton MR spectroscopy in gliomatosis cerebri. Neuroradiology 2000; 42:612–615.
41) Uysal E, Erturk M, Yildirim H, et al. Multivoxel magnetic resonance spectroscopy in gliomatosis cerebri. Acta Radiol 2005; 46:621-624.
42) Garg M, Gupta RK, Husain M, et al. Brain abscesses: etiologic categorization with in vivo proton MR spectroscopy. Radiology 2004; 230:519-527.
43) Kim DG, Choe WJ, Chang KH, et al. In vivo proton magnetic resonance spectroscopy of central neurocytomas. Neurosurgery 2000; 46:329-334.
44) Lee DY, Chung CK, Hwang YS, et al. Dysembryoplastic neuroepithelial tumor: radiological findings (including PET, SPECT, and MRS) and surgical strategy. J Neurooncol 2000; 47:167–174.
45) Sener RN. Neuro-Behcet's disease: diffusion MR imaging and proton MR spectroscopy. AJNR Am J Neuroradiol 2003; 24:1612-1614.
46) Baysal T, Ozisik HI, Karlidag R, et al. Proton MRS in Behcet’s disease with and without neurological findings. Neuroradiol 2003; 45:860-864.
47) Appenzeller S, Li LM, Costallat LT, Cendes F. Neurometabolic changes in normal white matter may predict appearance of hyperintense lesions in systemic lupus erythematosus. Lupus 2007; 16:963-971.