Primary brain tumors: Proton magnetic resonance spectroscopic analysis and histopathological correlation

Abstract

Objective: Recent advances in treatment of primary brain tumors have increased the interest in radiological imaging in respect to both the diagnosis of tumor and the evaluation of the efficiency of therapy. Conventional Magnetic Resonance (MR) imaging is commonly used for diagnosis and follows up of the primary brain tumors, but it fails in grading of the tumors. MR spectroscopy permits in-vivo biochemical evaluation of brain lesions. Methods: Twenty three patients with histopathologic diagnosis of primary brain tumor and control group consisting of 23 healthy volunteers were investigated. In addition to conventional MR imaging of all patients were underwent point resolved spectroscopy (PRESS) sequence via single voxel MR spectroscopy. Using MR spectroscopy, metabolites [N-acetyl aspartate (NAA), choline (Cho), myo-inositol (mI), lipid, lactate and alanine] and their ratio to creatine (Cr) were measured quantitatively. Results: MR spectroscopic imaging of neuroglial primary brain tumors revealed that the NAA/Cr and mI/Cr ratios were decreased. In extra axial primary brain tumors, which consist of meningioma, NAA wasn\'t detected, Cho/Cr ratio was remarkably increased, mI/Cr, lipid/Cr and lactate/Cr ratios were mildly increased. Alanine peak was detected only in meningioma. In high grade neuroglial tumors in proportion to low grade ones NAA/Cr and mI/Cr ratios were decreased, Cho/Cr, lipid/Cr and lactate/Cr ratios were remarkably increased. Conclusion: MR spectroscopy provides extra information in classification of primary brain tumors as intra-axial and extra-axial, and in grading of neuroglial primary brain tumors as high grade or low grade. It was concluded that using conventional MR imaging in cooperation with MR spectroscopy is beneficial in differential diagnosis and in grading of primary brain tumors. J Clin Exp Invest 2014; 5 (2): 233-241

Keywords

• Magnetic resonance spectroscopy, brain tumors, grading

Primer beyin tümörleri: Proton manyetik rezonans spektroskopik analiz ve histopatolojik korelasyon

Öz

Amaç: Primer beyin tümörlerinin tedavisindeki son gelişmeler, tümörün tanısı yanı sıra, tedavi etkinliğinin de değerlenmesi açısından, radyolojik görüntüleme yöntemlerine olan ilgiyi arttırmıştır. Konvansiyonel Manyetik Rezonans (MR) görünteleme primer beyin tümörlerinin tanı ve takibinde yaygın olarak kullanılmakla birlikte malignitelerinin derecelendirilmesinde yetersiz kalmaktadır. MR spektroskopi ile beyin lezyonlarında invivo biyokimyasal değerlendirme yapılabilmektedir. Çalışmamızda MR spektroskopinin primer beyin tümörlerinin ayırıcı tanısı ve malignitelerinin derecelendirilmesindeki yeri araştırıldı. Yöntemler: Histopatolojik olarak primer beyin tümörü tanısı alan 23 olgu ile 31 sağlıklı gönüllüden oluşan kontrol grubu incelendi. Tüm olgularda rutin konvansiyonel MR görüntüleme ile birlikte point resolved spectroscopy (PRESS) sekansı, single voksel MR spektroskopi (TE: 31 ve 136 msn) elde edildi. MR spektroskopide kantitatif olarak metabolitler [N-asetil aspartat (NAA), kolin (Cho), myoinositol (mI), lipid, laktat ve alanin] ile bunların kreatin (Cr)\'e oranları ölçüldü. Bulgular: Nöroglial primer beyin tümörlerinde NAA/Cr ve mI/Cr oranları azalmış, Cho/Cr, lipid/Cr ve laktat/Cr oranları artmış olarak saptandı. Menenjiomlardan oluşan ekstraaksiyel primer beyin tümörlerinde NAA saptanmadı, Cho/Cr oranı belirgin olarak artmış, mI/Cr, lipid/Cr ve laktat/Cr hafif artmış olarak saptandı. Alanin piki sadece menenjiomlarda saptandı. Yüksek grade'li nöroglial tümörlerde düşük grade\'lilere göre NAA/Cr ve mI/Cr'de azalma, Cho/Cr, lipid/Cr ve laktat/Cr\'de belirgin artma gözlendi. Sonuç: MR spektroskopi primer beyin tümörlerinin intraaksiyel ve ekstraaksiyel olarak sınıflandırılmasında, nöroglial primer beyin tümörlerinin ise; yüksek ve düşük grade'li olarak ayırımında konvansiyonel MR görüntüleme yöntemlerine, ek tanısal veriler sağlar. Primer beyin tümörlerinin ayırıcı tanısında ve malignite derecelerinin belirlenmesinde rutin konvansiyonel MR görüntüleme yöntemleri ile birlikte kullanılmasının yararlı olacağı kanısına varıldı.

Anahtar Kelimeler

• Manyetik rezonans spektroskopi, beyin tümörleri, grade'leme.

Kaynakça

1. Wrensch M, Minn Y, Chew T, et al. Epidemiology of primary brain tumors: current concepts and review of the literature. Neuro Oncol 2002;4:278-299.
2. Sharma S, Karak AK, Sarkar C, et al. A grading study of gliomas using computer aided malignancy clas- sification and histologic morphometry. J Neurooncol 1996;27:75-85.
3. Okamoto K, Ito J, Takahashi K, et al. MRI of high-grade astrocytic tumors: early appearance and evolution. Neuroradiol 2002;44:395-402.
4. Sole AD, Falini A, Ravasi L, et al. Anatomical and bio- chemical investigation of primary brain tumors. Eur J Nucl Med 2001;28:1851-1872.
5. Dowling C, Bollen AW, Nomorolski SM, et al. Preopera- tive proton MR spectroscopic imaging of brain tumors: correlation with histopatologic analysis of resection specimens. AJNR Am J Neuroradiol 2001;22:604- 612.
6. Alkan A, Kutlu R, Siğirci A, et al. MR spectroscopy in the differential diagnosis of focal brain lesions in neu- rofibromatosis type 1 patients. Tani Girisim Radyol 2003;9:166-170.
7. Hakyemez B, Parlak M. İntrakranial kistik ya da nekro- tik kitlelerde proton MR spektroskopinin klinik tanıya katkısı. Tani Girisim Radyol 2002;8:182-186.
8. Kaminogo M, Ishimaru H, Morikawa M, et al. Diagnos- tik potential of short echo time MR spectroscopy of gliomas with single-voxel and point-resolved spastial- ly localised proton spectroscopy of brain. Neuroradiol 2001;43:353-363.

9. Li X, Lu Y, Pirzkall A, et al. Analisis of spatial character- istics of metabolic abnormalities in newly diagnosed glioma patients. J Magn Reson Imaging 2002;16:229- 237.
10. Wu W-C, Chen CY, Chung H-W, et al. Discrepant MR spectroscopy and perfusion imaging results in a case of malignant transformation of cerebral glioma. AJNR 2002;23:1775-1778.
11. Sinha S, BastinME, Whittle IR, Wardlaw JM. Diffusion tensor MR imaging of high-grade cerebral gliomas. AJNR 2002;23:520-527.
12. Go KG, Kamman RL, Mooyaart EL, et al. Localised proton spectroscopy and spectroscopic imaging in ce- rebral gliomas, with comparison to positron emission tomography. Neuroradiol 1995;37:198-206.
13. Tzika AA, Zarifi MK, Goumnerova L, et al. Neuroim- aging in pediatric brain tumors: Gd-DTPA-enhanced, Hemodynamic, and Diffusion MR Imaging Compared with MR Spectroscopic Imaging. AJNR 2002;23:322- 333.
14. Go KG, Kamman RL, Mooyaart EL, et al. Localised proton spectroscopy and spectroscopic imaging in ce- rebral gliomas, with comparison to positron emission tomography. Neuroradiol 1995;37:198-206.
15. Majos C, Alonso J, Aguilera C, et al. Proton magnetic resonance spectroscopy (1H MRS) of human brain tu- mors: assessment of differences between tumor types and its applicability in brain tumour categorzation. Eur Radiol 2003;13:582-591.
16. Grachev ID, Apkarian V. Chemical heterogeneity of the living human brain: A proton MR spectroscopy study on the effects of sex, age, and brain region. NeuroImag 2000;11:554-563.
17. Möller-Hartmann WM, Herminghaus S, Krings T, et al. Clinical application of proton magnetic resonance spectroscopy in the diognosis of intracranial mass le- sions. Neuroradiol 2002;44:371-381.
18. Gutowski HJ, Gomez-Anson B, Torpey N, et al. Oli- godendroglial gliomatozis cerebri: 1H-MRS sug- gests elevated glycine/inositol levels. Neuroradiol 1999;41:650-653.
19. Gotris ED, Fountas K, Kapsalaki E, et al. In vivo MR spectroscopy: The diagnostic possibilities of lipid resonances in brain tumors. Anticancer Research 1996;16:1565-1568.
20. Manton DJ, Lowry M, Rowland-Hill C, et al. Combined proton MR spectroscopy and dynamic contrast en- hanced imaging of human intracranial tumours in vivo. NMR Biomed 2000;13:449-459.
21. Lee PL, Gonzales RG. Magnetic resonance spectros- copy of brain tumors. Curr Opin Oncol 2000;12:199- 204.
22. Smith JK, Kwock L, Castillo M. Effects of contrast material on single-volume proton MR spectroscopy. AJNR 2002;21:1084-1089.
23. Liu ZL, Zhou Q, Zeng QS, et al. Noninvasive evaluation of cerebral glioma grade by using diffusion-weighted imaging-guided single-voxel proton magnetic reso- nance spectroscopy. J Int Med Res 2012;40:76-84.
24. Angelie E, Bonmartin A, Boudraa A, Gonnaud P-R. Mallet J-J. Sappey-Marinier D. Regional differences and metabolic changes in normal aging of the human brain: Proton MR spectroscopic imaging study. AJNR 2002;22:119-127.
25. Ishimaru H, Morikawa M, Iwanaga S, Kaminogo M, Ochi M, Hayashi K. Differentiation between high-grade glioma and metastatic brain tumor using single-voxel proton MR spectroscopy. Eur Radiol 2001;11:1784- 1791.
26. Youkilis AS, Park P, McKeever PE, Chandler WF. Parasagittal ependymoma resembling falcine menin- gioma. AJNR 2001;22:1105-1108.
27. Sener RN. Astroblastoma: diffusion MRI, and pro- ton MR spectroscopy. Comput Med Imaging Graph 2002;26:187-191.
28. Spampinato MV, Smith JK, Kwock L, et al. Cerebral blood volume measurements and proton MR spec- troscopy in grading of oligodendroglial tumors. AJR 2007;188:204-212.
29. Castillo M, Smith JK, Kwock L. Correlation of myo- inositol levels and grading of cerebral astrocytomas. AJNR 2000;21:1645-1649.
30. Kwock L, Smith JK, Castillo M, et al. Clinical role of proton magnetic resonance spectroscopy in oncol- ogy: brain, breast, and prostate cancer. Lancet Oncol 2006;7:859-868.
31. Yoneoka Y, Fujii Y, Takahashi, Nakada T. Pre-opera- tive histopathological evaluation of meningiomas by 3.0T T2R MRI. Acta Neurochir 2002;144:953-957.