Investigation of Creatine Levels in Glial Tumors Using MR Spectroscopy

Year 2024, , 262 - 270, 31.05.2024

Nadir Moustafa , Berrin Çavuşoğlu , Reşat Serhat Erbayraktar , Emel Ada

https://doi.org/10.30621/jbachs.1223385

Abstract

Purpose: The present study examines the efficacy of Creatine (Cr) levels in the determination of tumor grade on single-voxel (SV) and multi-voxel (MV) magnetic resonance spectroscopy (MRS) in patients with glial tumors.
Material and Methods: A retrospective review was made of 20 SV and 20 MV MRS PDF images of patients with a pathological diagnosis of glial tumor. Cr values and metabolite ratios were measured in the tumor and compared with those in the healthy symmetrical brain parenchyma of the contralateral hemisphere.
Results: A significant difference was noted in the (Cho+Cr)/NAA and Cho/NAA ratios on SV MRS between the high-grade tumors and the healthy contralateral hemisphere. On MV MRS, Cho/NAA ratios within the minimum and maximum Cr(h) voxels (Cho/NAAmin-Cr(h), Cho/NAAmax-Cr(h), respectively) were higher in high-grade tumors compared to healthy tissue. ROC analysis showed that the max-Cr(h) metabolite on MV MRS was successful in distinguishing low-grade tumors from high-grade tumors.
Conclusion: Using the minimum and maximum values of Cr as a reference can improve the overall diagnostic accuracy in the diagnosis and grading of glial tumors. Our findings showed that Cr tended to be low in high-grade tumors and further that the max-Cr(h) metabolite may help in the differentiation of glial tumors on MV MRS.

Keywords

Magnetic resonance imaging, spectroscopy, glial tumors, creatine

Investigation of Creatine Levels in Glial Tumors Using MR Spectroscopy

Abstract

Keywords

Magnetic resonance imaging, spectroscopy, glial tumors, creatine

References

• Catalaa I, Henry R, Dillon WP, et al. Perfusion, diffusion and spectroscopy values in newly diagnosed cerebral gliomas. NMR Biomed 2006;19(4):463-475.
• Allison GT, Fujiwara T. The relationship between EMG median frequency and low frequency band amplitude changes at different levels of muscle capacity. Clin Biomech 2002;17(6):464-469.
• Cai K, Tain RW, Zhou XJ, et al. Creatine CEST MRI for Differentiating Gliomas with Different Degrees of Aggressiveness. Mol Imaging Biol 2017;19(2):225-232.
• 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(10):1989-1998.
• Kleihues P, Burger PC, Scheithauer BW. The new WHO classification of brain tumours. Brain Pathol 1993;3(3):255-268.
• Daumas-Duport C, Tucker ML, Kolles H, et al. Oligodendrogliomas. Part II: A new grading system based on morphological and imaging criteria. J Neurooncol 1997;34(1):61-78.
• Bulik M, Jancalek R, Vanicek J, Skoch A, Mechl M. Potential of MR spectroscopy for assessment of glioma grading. Clinical Neurology and Neurosurgery 2013;115(2):146-153.
• 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(3):958-969.
• Likavcanová K, Dobrota D, Liptaj T, et al. In vitro study of astrocytic tumour metabolism by proton magnetic resonance spectroscopy. Gen Physiol Biophys 2005;24(3):327-335.
• Isobe T, Matsumura A, Anno I, et al. Quantification of cerebral metabolites in glioma patients with proton MR spectroscopy using T2 relaxation time correction. Mag Reson Imaging 2002;20(4):343-349.
• Tong Z, Yamaki T, Harada K, Houkin K. In vivo quantification of the metabolites in normal brain and brain tumors by proton MR spectroscopy using water as an internal standard. Magn Reson Imaging 2004;22(7):1017-1024.
• Yerli H, Ağildere AM, Ozen O, Geyik E, Atalay B, Elhan AH. Evaluation of cerebral glioma grade by using normal side creatine as an internal reference in multi-voxel 1H-MR spectroscopy. Diagn Interv Radiol 2007;13(1):3-9.
• Hattingen E, Raab P, Franz K, et al. Prognostic value of choline and creatin in WHO grade II gliomas. Diagnostic Neuroradiology 2008;50(9):759-767.
• Kinoshita Y, Kajiwarw H, Yokota A, Koga Y. Proton magnetic resonance spectroscopy of astrocytic tumors: an in vitro study. Neurol Med Chir (Tokyo) 1993;33(6):350-359.
• Hattingen E, Raab P, Franz K, Zanella FE, Lanfermann H, Pilatus U. Myo-inositol: a marker of reactive astrogliosis in glial tumors. NMR Biomed 2008;21(3):233-241.
• Xiaojuan L, Ying L, Pirzkall A, McKnight T, Nelson SJ. Analysis of the spatial characteristics of metabolic abnormalities in newly diagnosed glioma patients. Journal of magnetic resonanceimaging 2002;16(3):229-237.
• Saraf-Lavi E, Bowen BC, Pattany PM, Sklar EM, Murdoch JB, Petito CK. Proton MR spectroscopy of gliomatosis cerebri: case report of elevated myoinositol with normal choline levels. AJNR Am J Neuroradiol 2003;24(5):946-951.
• Hsu YY, Chang CN, Wie KJ, Lim KE, Hsu WC, Jung SM. Proton magnetic resonance spectroscopic imaging of cerebral gliomas: correlation of metabolite ratios with histopathologic grading. Chang Gung Med J 2004;27(6):399-407.