BEYİN KİTLELERİNDE NEOPLASTİK / NEOPLASTİK OLMAYAN VE YÜKSEK EVRE / DÜŞÜK EVRE AYRIMINDA MR SPEKTROSKOPİNİN YERİ

Year 2010, Volume: 23 Issue: 3, 326 - 338, 28.04.2015

Ozan Karatağ Gülden Yenice Karatağ Ender Uysal S. Can Mehmet Ertürk Muzaffer Başak

Abstract

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, Nasetil 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.

Anahtar Kelimeler: Beyin neoplazmları, Manyetik rezonans görüntüleme, Manyetik rezonans spektroskopi, Stereotaktik biyopsi

Keywords

-

References

• 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.
• 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.
• 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.
• 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.
• Bernstein M, Parrent AG. Complications of CT-guided
• stereotactic biopsy of intra-axial brain lesions. J
• Neurosurg 1994; 81:165–168.
• 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.
• 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:
• –545.
• Sawin PD, Hitchon PW, Follett KA, Torner JC.
• Computed imaging-assisted stereotactic brain biopsy: a
• risk analysis of 225 consecutive cases. Surg Neurol
• ; 49:640–649.
• 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;
• :103–108.
• 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.
• 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.
• 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.
• Lin AP, Ross BD. Short-echo time proton MR
• spectroscopy in the presence of gadolinium. J Comput
• Assist Tomogr 2001; 25:705-712.
• 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;
• :127-130.
• Smith JK, Kwock L, Castillo M. Effects of contrast
• material on single-volume proton MR spectroscopy.
• AJNR Am J Neuroradiol 2000; 21:1084-1089.
• 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.
• 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.
• Castillo M, Kwock L, Mukherji SK. Clinical
• applications of MR spectroscopy. AJNR Am J
• Neuroradiol 1996; 17:1–15.
• 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
• ; 19:1695–1703.
• 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.
• 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.
• 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.
• Demaerel P, Johannik K, van Hecke P, et al. Localized
• H NMR spectroscopy in fifty cases of newly diagnosed
• intracranial tumors. J Comput Assist Tomogr 1991;
• :67–76.
• Herholz K, Heindel W, Luyten PR, et al. In vivo
• imaging of glucoseconsumption and lactate
• concentration in human gliomas. Ann Neurol 1992;
• :319–327.
• Ott D, Hennig J, Ernst T. Human brain tumors:
• assessment with in vivo proton MR spectroscopy.
• Radiology 1993; 186:745–752.
• Shimizu H, Kumabe T, Tominaga T, et al. Noninvasive
• evaluation of malignancy of brain tumors with proton
• MR spectroscopy. AJNR Am J Neuroradiol 1996;
• :737-747.
• 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.
• Fulham MJ, Bizzi A, Dietz MJ, et al. Mapping of brain
• tumor metabolites with proton MR spectroscopic
• imaging: clinical relevance. Radiology 1992; 185:675-
• -
• -
• Marmara Medical Journal 2010;23(3); 326-338
• Ozan Karatağ, et al.
• Can magnetic resonance spectroscopy adequately differentiate neoplastic from non-neoplastic and low-grade from highgrade
• lesions in brain masses?
• Kinoshita Y, Kajiwara H, Yokota A, Koga Y. Proton
• magnetic resonance spectroscopy of brain tumors: an in
• vitro study. Neurosurgery 1994; 35:606–614.
• 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.
• 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.
• 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.
• 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;
• :339–349.
• 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.
• Luyten PR, Marien AJ, Heindel W, , et al. Metabolic
• imaging of patients with intracranial tumors: 1H MR
• spectroscopic imaging and PET. Radiology 1990;
• :791–799.
• 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-
• -
• Bizzi A, Movsas B, Tedeschi G, et al. Response of nonHodgkin
• lymphoma to radiation therapy: early and longterm
• assessment with H-1 MR spectroscopic imaging.
• Radiology 1995; 194:271-276.
• 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-
• -
• Bendszus M, Warmuth-Metz M, Klein R. MR
• spectroscopy in gliomatosis cerebri. Am J Neuroradiol
• ; 21:375–380.
• Pyhtinen J. Proton MR spectroscopy in gliomatosis
• cerebri. Neuroradiology 2000; 42:612–615.
• Uysal E, Erturk M, Yildirim H, et al. Multivoxel
• magnetic resonance spectroscopy in gliomatosis cerebri.
• Acta Radiol 2005; 46:621-624.
• Garg M, Gupta RK, Husain M, et al. Brain abscesses:
• etiologic categorization with in vivo proton MR
• spectroscopy. Radiology 2004; 230:519-527.
• Kim DG, Choe WJ, Chang KH, et al. In vivo proton
• magnetic resonance spectroscopy of central
• neurocytomas. Neurosurgery 2000; 46:329-334.
• 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.
• Sener RN. Neuro-Behcet's disease: diffusion MR
• imaging and proton MR spectroscopy. AJNR Am J
• Neuroradiol 2003; 24:1612-1614.
• Baysal T, Ozisik HI, Karlidag R, et al. Proton MRS in
• Behcet’s disease with and without neurological findings.
• Neuroradiol 2003; 45:860-864.
• 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.