HASAN MURAT AYDIN, Aydın Nilay OKTAY, Serdar SİPAHİOĞLU, Elif ALTIN, Baki HEKİMOĞLU

The efficacy and value of proton MR spectroscopy in evaluating the brain tumours

Proton MR spektroskopinin beyin tümörlerinin değerlendirilmesindeki yararı ve değeri Amacımız beyin tümörlerini sınıflandırmada Proton MR Spektroskopinin (H-MRS) yararını saptamaktır. Multivok-sel imajlar (MV-MRS) intrakranial kitle lezyonu olan 33 hastada Philips 1.5 T Achieva MR ünitesinde alındı. Beyin tümörleri düşük-yüksek grade'li glial neoplazmlar, menengiomlar ve metastazlar olarak sınıflandırıldı. Cho/ NAA, Cho/Cr, Cho/MI oranları tüm tümör grupları için hesaplandı ve bu metabolit oranlarına göre istatiksel analiz yapıldı. İstatiksel analiz ile gruplar arasındaki fark saptanmaya ve sınıflandırılmaya^çalışıldı. Bu üç oranın hepsi GBM grubunda yüksekti.»^ofİ^A- Cho/MI oranları düşük gradeli neoplazmlarda dtîşuk, Cho/Cr oranı ise menegiomlarda düşüktü. Metaştazfard|î Cho rezonansında güçlü elevasyon mevcut olup^ aynı zamanda diğer üç oran da yüksek olarak saptanmıştır. Sonuç olarak MV-MRS değişik tiplerde beyin tümörlerinin saptanmasında ve glial neoplazmların evrelenmesinde %97 sensitivite ve %87,9 spesifisite ile önemli katkılar sağlayabilmektedir.

Proton MR spektroskopinin beyin tümörlerinin değerlendirilmesindeki yararı ve değeri

Our aim was to evaluate the usefulness of proton MR spectroscopy (H-MRS) in categorizing the brain tumours. Multivoxel imaging (MV-MRS) was performed to 33 patients with intra-cranial mass lesions at Philips 1.5 T Achieva MR unit. The brain tumours are classified to; low-high grade glial neoplasms, menengiomas and metastasis. Cho/NAA, Cho/Cr, Cho/MI ratios are calculated for all tumour groups and according to these metabolite ratios by using statistical analysis. We tried to show the differences between groups and tried to categorize them. All three ratios are highest in GBM group, Cho/NAA- Cho/MI ratios are lowest in low-grade gliomas, Cho/Cr ratio is lowest in menengiomas. Metastasis also have strong elevation of Cho resonances and all three ratios are also high in this group. As a conclusion, MV-MRS is a useful tool, provides important informations for the analysis of the brain tumours of different types and for grading glial neoplasms with 97% sensitivity and 87.9% specificity.

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1.Poptani H, Gupta R, Roy R, Pandey R, Jain VK, Chhabra DK. Characterization of Intracranial mass lesions with in vivo Proton MR Spectroscopy. AJNR 1995; 16: 1593-603.
2.Sibtain NA, Howe FA, Saunders DE. The clinical value of proton magnetic resonance spectroscopy in adult brain tumours. Clinical Radiology 2007;62: 109-19.
3.Hartmann W, Herminghaus S, Krings T, Marquardt G, Lanfermann H, Pilatus U, et al. Clinical application of proton magnetic resonance spectroscopy in the diagnosis of intracranial-mass lesions. Neuroradiology 2002;44: 371-81.
4.Kuesel AC, Sutherland GR, Halliday: W, Smith JC. H-MRS of high grade astrocytomas;mobile lipid accumulation in jiecrotic tissue.NMR Biomed 1994;7: 149-55.
5.Ross B, Michaelis T. Clinical application of magnetic resonance spectroscopy. Magn Reson Q 1994:10: 191-247.
6.Majos C, Alonso J, Aguilera C, Serrallonga M, Martin JP, Acebes JJ et al. Proton magnetic resonance of human brain tumours; Assessment of differences between tumour types and its applicability in brain tumour categorization. Eur Radiol 2003; 13: 582-91.
7.Nagar VA,Ye J, Xu M, Ng WH, Yeo TT, Ong PL, et al. Multi-voxel MR Spectroscopic Imaging-Distinguishing Intracranial Tumours from Non-neoplastic Diseases. Ann Acad Med Singapore 2007;36: 309-13.
8.Parmar H, Lim TC, Yin H, Chua V, Khin LW, Raidy T, et al. Multi-voxel MR Spectroscopic imaging of the brain: Utility in clinical setting-initial results. Eur J Radiol 2005;55: 401-8.
9.Magalhaes A, Godfrey W, Shen Y, Hu J, Smith Wl. Proton magnetic resonance Spectroscopy of brain Tumours correlated with pathology. Acad Radiol 2005;12: 51-7.
10.Callot V, Galanaud D, Le Fur Y, Gouny SC, Ranjeva JP, Cozzone PJ. H-MR spectroscopy of human brain tumours; A practical approach. European Journal of Radiology 2008;67; 268-74.
11.Papanagiotou P, Backens M, Grunwald IQ, Farmakis G, Politi M, Roth C, et al. MR-Spektroskopie bei Hirntumoren. Radiologe 2007;47: 520-9.
12.Herminghaus S, Dierks T, Pilatus U, Krings T, Horska A. Determination of histopathological tumour grade in neuro-epithelial brain tumours by using spectral pattern analysis of in vivo spectroscopic data. J Neurosurg 2003;98: 74-81
13.Venkatesh SK, Gupta RK, Pal L, Husain N, Husain M. Spectroscopic increase in choline signal, is a non-specific marker for differentiation of infective-inflammatory from neoplastic lesions of the brain. J Magn Reson Imaging 2001;14: 8-15.