Article Text

PDF
Value of 1H-magnetic resonance spectroscopy chemical shift imaging for detection of anaplastic foci in diffusely infiltrating gliomas with non-significant contrast-enhancement
  1. Georg Widhalm1,2,
  2. Martin Krssak3,
  3. Georgi Minchev1,
  4. Adelheid Wöhrer2,
  5. Tatjana Traub-Weidinger4,
  6. Thomas Czech1,
  7. Susanne Asenbaum5,
  8. Christine Marosi6,
  9. Engelbert Knosp1,
  10. Johannes A Hainfellner2,
  11. Daniela Prayer3,
  12. Stefan Wolfsberger1
  1. 1Department of Neurosurgery, Medical University Vienna, Vienna, Austria
  2. 2Institute of Neurology, Medical University Vienna, Vienna, Austria
  3. 3Department of Radiology, Medical University Vienna, Vienna, Austria
  4. 4Department of Nuclear Medicine, Medical University Vienna, Vienna, Austria
  5. 5Department of Neurology, Medical University Vienna, Vienna, Austria
  6. 6Department of Internal Medicine I, Medical University Vienna, Vienna, Austria
  1. Correspondence to Dr Stefan Wolfsberger, Department of Neurosurgery, Medical University Vienna, Waehringer Guertel 18–20, 1097 Vienna, Austria; stefan.wolfsberger{at}meduniwien.ac.at

Abstract

Objective In diffusely infiltrating gliomas (DIG), positron emission tomography (PET) imaging is a powerful method for detection of anaplastic foci. Recently, 1H-magnetic resonance spectroscopy chemical shift imaging (CSI) using choline/creatine (Cho/Cr) or choline/N-acetylaspartate (Cho/NAA) ratios has emerged as a new non-invasive, widely available alternative. The authors therefore correlated CSI with 11C-methionine (MET)-PET data in a series of DIG with non-significant contrast-enhancement (CE).

Methods Thirty-two patients with DIG were examined with single-slice CSI on a 3 T MRI and MET-PET. Maximum pathological intratumoural ratios of CSI (=CSImax) and maximum tumour-to-normal-brain PET ratios (=PETmax; T/N ratio) were determined. Coregistration of MRI with CSI and PET was performed, and the topographic overlap of CSImax and PETmax was analysed. Histological criteria of anaplasia as well as cell proliferation rate were assessed in tumour samples inside and outside CSImax.

Results CSI showed a pathological ratio in all patients, whereas PET demonstrated a pathological T/N ratio in 21/32 patients. Topographical correlation of CSImax and PETmax revealed a ≥50% overlap in 18/21 and <50% overlap in 3/21 patients, respectively. Cho/Crmax and Cho/NAAmax showed a ≥50% overlap in 24/32 and a <50% overlap in 8/32 patients. Cell proliferation rate was significantly higher inside than outside the CSImax (13.6% vs 6.9%, p<0.001).

Conclusion The results indicate that CSI is a promising method for detection of anaplastic foci within DIG with non-significant CE. Intraoperative use of CSI by multimodal neuronavigation may increase the reliability of detection of malignant areas in glioma surgery and therefore optimise allocation of patients to adjuvant treatments.

  • Diffusely infiltrating gliomas
  • chemical shift imaging
  • methionine positron emission tomography
  • correlation of maxima
  • proliferation rate
  • MRI
  • MRS
  • Neurosurgery
  • PET
  • Tumours

Statistics from Altmetric.com

Footnotes

  • Competing interests None.

  • Ethics approval Ethics approval was provided by the ethics committee of the Medical University of Vienna.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.