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Kim H, Kim S, Lee HH, Heo H. In-Vivo Proton Magnetic Resonance Spectroscopy of 2-Hydroxyglutarate in Isocitrate Dehydrogenase-Mutated Gliomas: A Technical Review for Neuroradiologists. Korean J Radiol 2016; 17:620-32. [PMID: 27587950 PMCID: PMC5007388 DOI: 10.3348/kjr.2016.17.5.620] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 06/02/2016] [Indexed: 12/21/2022] Open
Abstract
The diagnostic and prognostic potential of an onco-metabolite, 2-hydroxyglutarate (2HG) as a proton magnetic resonance spectroscopy (1H-MRS) detectable biomarker of the isocitrate dehydrogenase (IDH)-mutated (IDH-MT) gliomas has drawn attention of neuroradiologists recently. However, due to severe spectral overlap with background signals, quantification of 2HG can be very challenging. In this technical review for neuroradiologists, first, the biochemistry of 2HG and its significance in the diagnosis of IDH-MT gliomas are summarized. Secondly, various 1H-MRS methods used in the previous studies are outlined. Finally, wereview previous in vivo studies, and discuss the current status of 1H-MRS in the diagnosis of IDH-MT gliomas.
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Affiliation(s)
- Hyeonjin Kim
- Department of Radiology, Seoul National University Hospital, Seoul 03080, Korea.; Department of Biomedical Sciences, Seoul National University, Seoul 03087, Korea.; Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul 03080, Korea
| | - Sungjin Kim
- Department of Radiology, Seoul National University Hospital, Seoul 03080, Korea
| | - Hyeong Hun Lee
- Department of Biomedical Sciences, Seoul National University, Seoul 03087, Korea
| | - Hwon Heo
- Department of Biomedical Sciences, Seoul National University, Seoul 03087, Korea
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An Z, Ganji SK, Tiwari V, Pinho MC, Patel T, Barnett S, Pan E, Mickey BE, Maher EA, Choi C. Detection of 2-hydroxyglutarate in brain tumors by triple-refocusing MR spectroscopy at 3T in vivo. Magn Reson Med 2016; 78:40-48. [PMID: 27454352 DOI: 10.1002/mrm.26347] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 05/26/2016] [Accepted: 06/27/2016] [Indexed: 12/25/2022]
Abstract
PURPOSE To test the efficacy of triple-refocusing MR spectroscopy (MRS) for improved detection of 2-hydroxyglutarate (2HG) in brain tumors at 3T in vivo. METHODS The triple-refocusing sequence parameters were tailored at 3T, with density-matrix simulations and phantom validation, for enhancing the 2HG 2.25-ppm signal selectivity with respect to the adjacent resonances of glutamate (Glu), glutamine (Gln), and gamma-aminobutyric acid (GABA). In vivo MRS data were acquired from 15 glioma patients and analyzed with LCModel using calculated basis spectra. Metabolites were quantified with reference to water. RESULTS A triple-refocusing sequence (echo time = 137 ms) was obtained for 2HG detection. The 2HG 2.25-ppm signal was large and narrow while the Glu and Gln signals between 2.2 and 2.3 ppm were minimal. The optimized triple refocusing offered improved separation of 2HG from Glu, Gln and GABA when compared with published MRS methods. 2HG was detected in all 15 patients, the estimated 2HG concentrations ranging from 2.4 to 15.0 mM, with Cramer-Rao lower bounds of 2%-11%. The 2HG estimates did not show significant correlation with total choline. CONCLUSION The optimized triple refocusing provides excellent 2HG signal discrimination from adjacent resonances and may confer reliable in vivo measurement of 2HG at relatively low concentrations. Magn Reson Med 78:40-48, 2017. © 2016 International Society for Magnetic Resonance in Medicine.
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Affiliation(s)
- Zhongxu An
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Sandeep K Ganji
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Vivek Tiwari
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Marco C Pinho
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Toral Patel
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Samuel Barnett
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Department of Otolaryngology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Edward Pan
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Harold C. Simmons Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Bruce E Mickey
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Harold C. Simmons Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Annette Strauss Center for Neuro-Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Elizabeth A Maher
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Harold C. Simmons Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Annette Strauss Center for Neuro-Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Changho Choi
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Harold C. Simmons Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Berrington A, Voets NL, Plaha P, Larkin SJ, Mccullagh J, Stacey R, Yildirim M, Schofield CJ, Jezzard P, Cadoux-Hudson T, Ansorge O, Emir UE. Improved localisation for 2-hydroxyglutarate detection at 3T using long-TE semi-LASER. Tomography 2016; 2:94-105. [PMID: 27547821 PMCID: PMC4990123 DOI: 10.18383/j.tom.2016.00139] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
2-hydroxyglutarate (2-HG) has emerged as a biomarker of tumour cell IDH mutations that may enable the differential diagnosis of glioma patients. At 3 Tesla, detection of 2-HG with magnetic resonance spectroscopy is challenging because of metabolite signal overlap and a spectral pattern modulated by slice selection and chemical shift displacement. Using density matrix simulations and phantom experiments, an optimised semi-LASER scheme (TE = 110 ms) improves localisation of the 2-HG spin system considerably compared to an existing PRESS sequence. This results in a visible 2-HG peak in the in vivo spectra at 1.9 ppm in the majority of IDH mutated tumours. Detected concentrations of 2-HG were similar using both sequences, although the use of semi-LASER generated narrower confidence intervals. Signal overlap with glutamate and glutamine, as measured by pairwise fitting correlation was reduced. Lactate was readily detectable across glioma patients using the method presented here (mean CLRB: (10±2)%). Together with more robust 2-HG detection, long TE semi-LASER offers the potential to investigate tumour metabolism and stratify patients in vivo at 3T.
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Affiliation(s)
- Adam Berrington
- Nuffield Department of Clinical Neurosciences, FMRIB Centre, John Radcliffe Hospital, University of Oxford, Oxford
| | - Natalie L. Voets
- Nuffield Department of Clinical Neurosciences, FMRIB Centre, John Radcliffe Hospital, University of Oxford, Oxford
| | - Puneet Plaha
- Department of Neurosurgery, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford
| | - Sarah J. Larkin
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford
| | | | - Richard Stacey
- Department of Neurosurgery, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford
| | | | | | - Peter Jezzard
- Nuffield Department of Clinical Neurosciences, FMRIB Centre, John Radcliffe Hospital, University of Oxford, Oxford
| | - Tom Cadoux-Hudson
- Department of Neurosurgery, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford
| | - Olaf Ansorge
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford
| | - Uzay E. Emir
- Nuffield Department of Clinical Neurosciences, FMRIB Centre, John Radcliffe Hospital, University of Oxford, Oxford
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Nagashima H, Tanaka K, Sasayama T, Irino Y, Sato N, Takeuchi Y, Kyotani K, Mukasa A, Mizukawa K, Sakata J, Yamamoto Y, Hosoda K, Itoh T, Sasaki R, Kohmura E. Diagnostic value of glutamate with 2-hydroxyglutarate in magnetic resonance spectroscopy for IDH1 mutant glioma. Neuro Oncol 2016; 18:1559-1568. [PMID: 27154922 DOI: 10.1093/neuonc/now090] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 03/30/2016] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Mutations in the isocitrate dehydrogenase 1 (IDH1) gene that are frequently observed in low-grade glioma are strongly associated with the accumulation of 2-hydroxyglutarate (2HG), which is a valuable diagnostic and prognostic biomarker of IDH1 mutant glioma. However, conventional MR spectroscopy (MRS)-based noninvasive detection of 2HG is challenging. In this study, we aimed to determine the additional value of other metabolites in predicting IDH1 mutations with conventional MRS. METHODS Forty-seven patients with glioma underwent conventional single voxel short echo time MRS prior to surgery. A stereotactic navigation-guided operation was performed to resect tumor tissues in the center of the MRS voxel. MRS-based measurements of metabolites were validated with gas chromatography-mass spectrometry. We also conducted integrated analyses of glioma cell lines and clinical samples to examine the other metabolite levels and molecular findings in IDH1 mutant gliomas. RESULTS A metabolomic analysis demonstrated higher levels of 2HG in IDH1 mutant glioma cells and surgical tissues. Interestingly, glutamate levels were significantly decreased in IDH1 mutant gliomas. Through an analysis of metabolic enzyme genes in glutamine pathways, it was shown that the expressions of branched-chain amino acid transaminase 1 were reduced and glutamate dehydrogenase levels were elevated in IDH1 mutant gliomas. Conventional MRS detection of glutamate and 2HG resulted in a high diagnostic accuracy (sensitivity 72%, specificity 96%) for IDH1 mutant glioma. CONCLUSIONS IDH1 mutations alter glutamate metabolism. Combining glutamate levels optimizes the 2HG-based monitoring of IDH1 mutations via MRS and represents a reliable clinical application for diagnosing IDH1 mutant gliomas.
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Affiliation(s)
- Hiroaki Nagashima
- Department of Neurosurgery, Kobe University Graduate School of Medicine and Kobe University Hospital, Kobe, Japan (H.N., K.T., T.S., N.S., K.M., J.S., Y.Y., K.H., E.K.); Division of Evidence-based Laboratory Medicine, Kobe University Graduate School of Medicine and Kobe University Hospital, Kobe, Japan (Y.I., Y.T.); Center for Radiology and Radiation Oncology, Kobe University Graduate School of Medicine and Kobe University Hospital, Kobe, Japan (K.K.); Department of Diagnostic Pathology, Kobe University Graduate School of Medicine and Kobe University Hospital, Kobe, Japan (T.I.); Division of Radiation Oncology, Kobe University Graduate School of Medicine and Kobe University Hospital, Kobe, Japan (R.S.); Department of Neurosurgery, University of Tokyo Hospital, Tokyo, Japan (A.M.)
| | - Kazuhiro Tanaka
- Department of Neurosurgery, Kobe University Graduate School of Medicine and Kobe University Hospital, Kobe, Japan (H.N., K.T., T.S., N.S., K.M., J.S., Y.Y., K.H., E.K.); Division of Evidence-based Laboratory Medicine, Kobe University Graduate School of Medicine and Kobe University Hospital, Kobe, Japan (Y.I., Y.T.); Center for Radiology and Radiation Oncology, Kobe University Graduate School of Medicine and Kobe University Hospital, Kobe, Japan (K.K.); Department of Diagnostic Pathology, Kobe University Graduate School of Medicine and Kobe University Hospital, Kobe, Japan (T.I.); Division of Radiation Oncology, Kobe University Graduate School of Medicine and Kobe University Hospital, Kobe, Japan (R.S.); Department of Neurosurgery, University of Tokyo Hospital, Tokyo, Japan (A.M.)
| | - Takashi Sasayama
- Department of Neurosurgery, Kobe University Graduate School of Medicine and Kobe University Hospital, Kobe, Japan (H.N., K.T., T.S., N.S., K.M., J.S., Y.Y., K.H., E.K.); Division of Evidence-based Laboratory Medicine, Kobe University Graduate School of Medicine and Kobe University Hospital, Kobe, Japan (Y.I., Y.T.); Center for Radiology and Radiation Oncology, Kobe University Graduate School of Medicine and Kobe University Hospital, Kobe, Japan (K.K.); Department of Diagnostic Pathology, Kobe University Graduate School of Medicine and Kobe University Hospital, Kobe, Japan (T.I.); Division of Radiation Oncology, Kobe University Graduate School of Medicine and Kobe University Hospital, Kobe, Japan (R.S.); Department of Neurosurgery, University of Tokyo Hospital, Tokyo, Japan (A.M.)
| | - Yasuhiro Irino
- Department of Neurosurgery, Kobe University Graduate School of Medicine and Kobe University Hospital, Kobe, Japan (H.N., K.T., T.S., N.S., K.M., J.S., Y.Y., K.H., E.K.); Division of Evidence-based Laboratory Medicine, Kobe University Graduate School of Medicine and Kobe University Hospital, Kobe, Japan (Y.I., Y.T.); Center for Radiology and Radiation Oncology, Kobe University Graduate School of Medicine and Kobe University Hospital, Kobe, Japan (K.K.); Department of Diagnostic Pathology, Kobe University Graduate School of Medicine and Kobe University Hospital, Kobe, Japan (T.I.); Division of Radiation Oncology, Kobe University Graduate School of Medicine and Kobe University Hospital, Kobe, Japan (R.S.); Department of Neurosurgery, University of Tokyo Hospital, Tokyo, Japan (A.M.)
| | - Naoko Sato
- Department of Neurosurgery, Kobe University Graduate School of Medicine and Kobe University Hospital, Kobe, Japan (H.N., K.T., T.S., N.S., K.M., J.S., Y.Y., K.H., E.K.); Division of Evidence-based Laboratory Medicine, Kobe University Graduate School of Medicine and Kobe University Hospital, Kobe, Japan (Y.I., Y.T.); Center for Radiology and Radiation Oncology, Kobe University Graduate School of Medicine and Kobe University Hospital, Kobe, Japan (K.K.); Department of Diagnostic Pathology, Kobe University Graduate School of Medicine and Kobe University Hospital, Kobe, Japan (T.I.); Division of Radiation Oncology, Kobe University Graduate School of Medicine and Kobe University Hospital, Kobe, Japan (R.S.); Department of Neurosurgery, University of Tokyo Hospital, Tokyo, Japan (A.M.)
| | - Yukiko Takeuchi
- Department of Neurosurgery, Kobe University Graduate School of Medicine and Kobe University Hospital, Kobe, Japan (H.N., K.T., T.S., N.S., K.M., J.S., Y.Y., K.H., E.K.); Division of Evidence-based Laboratory Medicine, Kobe University Graduate School of Medicine and Kobe University Hospital, Kobe, Japan (Y.I., Y.T.); Center for Radiology and Radiation Oncology, Kobe University Graduate School of Medicine and Kobe University Hospital, Kobe, Japan (K.K.); Department of Diagnostic Pathology, Kobe University Graduate School of Medicine and Kobe University Hospital, Kobe, Japan (T.I.); Division of Radiation Oncology, Kobe University Graduate School of Medicine and Kobe University Hospital, Kobe, Japan (R.S.); Department of Neurosurgery, University of Tokyo Hospital, Tokyo, Japan (A.M.)
| | - Katsusuke Kyotani
- Department of Neurosurgery, Kobe University Graduate School of Medicine and Kobe University Hospital, Kobe, Japan (H.N., K.T., T.S., N.S., K.M., J.S., Y.Y., K.H., E.K.); Division of Evidence-based Laboratory Medicine, Kobe University Graduate School of Medicine and Kobe University Hospital, Kobe, Japan (Y.I., Y.T.); Center for Radiology and Radiation Oncology, Kobe University Graduate School of Medicine and Kobe University Hospital, Kobe, Japan (K.K.); Department of Diagnostic Pathology, Kobe University Graduate School of Medicine and Kobe University Hospital, Kobe, Japan (T.I.); Division of Radiation Oncology, Kobe University Graduate School of Medicine and Kobe University Hospital, Kobe, Japan (R.S.); Department of Neurosurgery, University of Tokyo Hospital, Tokyo, Japan (A.M.)
| | - Akitake Mukasa
- Department of Neurosurgery, Kobe University Graduate School of Medicine and Kobe University Hospital, Kobe, Japan (H.N., K.T., T.S., N.S., K.M., J.S., Y.Y., K.H., E.K.); Division of Evidence-based Laboratory Medicine, Kobe University Graduate School of Medicine and Kobe University Hospital, Kobe, Japan (Y.I., Y.T.); Center for Radiology and Radiation Oncology, Kobe University Graduate School of Medicine and Kobe University Hospital, Kobe, Japan (K.K.); Department of Diagnostic Pathology, Kobe University Graduate School of Medicine and Kobe University Hospital, Kobe, Japan (T.I.); Division of Radiation Oncology, Kobe University Graduate School of Medicine and Kobe University Hospital, Kobe, Japan (R.S.); Department of Neurosurgery, University of Tokyo Hospital, Tokyo, Japan (A.M.)
| | - Katsu Mizukawa
- Department of Neurosurgery, Kobe University Graduate School of Medicine and Kobe University Hospital, Kobe, Japan (H.N., K.T., T.S., N.S., K.M., J.S., Y.Y., K.H., E.K.); Division of Evidence-based Laboratory Medicine, Kobe University Graduate School of Medicine and Kobe University Hospital, Kobe, Japan (Y.I., Y.T.); Center for Radiology and Radiation Oncology, Kobe University Graduate School of Medicine and Kobe University Hospital, Kobe, Japan (K.K.); Department of Diagnostic Pathology, Kobe University Graduate School of Medicine and Kobe University Hospital, Kobe, Japan (T.I.); Division of Radiation Oncology, Kobe University Graduate School of Medicine and Kobe University Hospital, Kobe, Japan (R.S.); Department of Neurosurgery, University of Tokyo Hospital, Tokyo, Japan (A.M.)
| | - Junichi Sakata
- Department of Neurosurgery, Kobe University Graduate School of Medicine and Kobe University Hospital, Kobe, Japan (H.N., K.T., T.S., N.S., K.M., J.S., Y.Y., K.H., E.K.); Division of Evidence-based Laboratory Medicine, Kobe University Graduate School of Medicine and Kobe University Hospital, Kobe, Japan (Y.I., Y.T.); Center for Radiology and Radiation Oncology, Kobe University Graduate School of Medicine and Kobe University Hospital, Kobe, Japan (K.K.); Department of Diagnostic Pathology, Kobe University Graduate School of Medicine and Kobe University Hospital, Kobe, Japan (T.I.); Division of Radiation Oncology, Kobe University Graduate School of Medicine and Kobe University Hospital, Kobe, Japan (R.S.); Department of Neurosurgery, University of Tokyo Hospital, Tokyo, Japan (A.M.)
| | - Yusuke Yamamoto
- Department of Neurosurgery, Kobe University Graduate School of Medicine and Kobe University Hospital, Kobe, Japan (H.N., K.T., T.S., N.S., K.M., J.S., Y.Y., K.H., E.K.); Division of Evidence-based Laboratory Medicine, Kobe University Graduate School of Medicine and Kobe University Hospital, Kobe, Japan (Y.I., Y.T.); Center for Radiology and Radiation Oncology, Kobe University Graduate School of Medicine and Kobe University Hospital, Kobe, Japan (K.K.); Department of Diagnostic Pathology, Kobe University Graduate School of Medicine and Kobe University Hospital, Kobe, Japan (T.I.); Division of Radiation Oncology, Kobe University Graduate School of Medicine and Kobe University Hospital, Kobe, Japan (R.S.); Department of Neurosurgery, University of Tokyo Hospital, Tokyo, Japan (A.M.)
| | - Kohkichi Hosoda
- Department of Neurosurgery, Kobe University Graduate School of Medicine and Kobe University Hospital, Kobe, Japan (H.N., K.T., T.S., N.S., K.M., J.S., Y.Y., K.H., E.K.); Division of Evidence-based Laboratory Medicine, Kobe University Graduate School of Medicine and Kobe University Hospital, Kobe, Japan (Y.I., Y.T.); Center for Radiology and Radiation Oncology, Kobe University Graduate School of Medicine and Kobe University Hospital, Kobe, Japan (K.K.); Department of Diagnostic Pathology, Kobe University Graduate School of Medicine and Kobe University Hospital, Kobe, Japan (T.I.); Division of Radiation Oncology, Kobe University Graduate School of Medicine and Kobe University Hospital, Kobe, Japan (R.S.); Department of Neurosurgery, University of Tokyo Hospital, Tokyo, Japan (A.M.)
| | - Tomoo Itoh
- Department of Neurosurgery, Kobe University Graduate School of Medicine and Kobe University Hospital, Kobe, Japan (H.N., K.T., T.S., N.S., K.M., J.S., Y.Y., K.H., E.K.); Division of Evidence-based Laboratory Medicine, Kobe University Graduate School of Medicine and Kobe University Hospital, Kobe, Japan (Y.I., Y.T.); Center for Radiology and Radiation Oncology, Kobe University Graduate School of Medicine and Kobe University Hospital, Kobe, Japan (K.K.); Department of Diagnostic Pathology, Kobe University Graduate School of Medicine and Kobe University Hospital, Kobe, Japan (T.I.); Division of Radiation Oncology, Kobe University Graduate School of Medicine and Kobe University Hospital, Kobe, Japan (R.S.); Department of Neurosurgery, University of Tokyo Hospital, Tokyo, Japan (A.M.)
| | - Ryohei Sasaki
- Department of Neurosurgery, Kobe University Graduate School of Medicine and Kobe University Hospital, Kobe, Japan (H.N., K.T., T.S., N.S., K.M., J.S., Y.Y., K.H., E.K.); Division of Evidence-based Laboratory Medicine, Kobe University Graduate School of Medicine and Kobe University Hospital, Kobe, Japan (Y.I., Y.T.); Center for Radiology and Radiation Oncology, Kobe University Graduate School of Medicine and Kobe University Hospital, Kobe, Japan (K.K.); Department of Diagnostic Pathology, Kobe University Graduate School of Medicine and Kobe University Hospital, Kobe, Japan (T.I.); Division of Radiation Oncology, Kobe University Graduate School of Medicine and Kobe University Hospital, Kobe, Japan (R.S.); Department of Neurosurgery, University of Tokyo Hospital, Tokyo, Japan (A.M.)
| | - Eiji Kohmura
- Department of Neurosurgery, Kobe University Graduate School of Medicine and Kobe University Hospital, Kobe, Japan (H.N., K.T., T.S., N.S., K.M., J.S., Y.Y., K.H., E.K.); Division of Evidence-based Laboratory Medicine, Kobe University Graduate School of Medicine and Kobe University Hospital, Kobe, Japan (Y.I., Y.T.); Center for Radiology and Radiation Oncology, Kobe University Graduate School of Medicine and Kobe University Hospital, Kobe, Japan (K.K.); Department of Diagnostic Pathology, Kobe University Graduate School of Medicine and Kobe University Hospital, Kobe, Japan (T.I.); Division of Radiation Oncology, Kobe University Graduate School of Medicine and Kobe University Hospital, Kobe, Japan (R.S.); Department of Neurosurgery, University of Tokyo Hospital, Tokyo, Japan (A.M.)
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Ganji SK, An Z, Tiwari V, McNeil S, Pinho MC, Pan E, Mickey BE, Maher EA, Choi C. In vivo detection of 2-hydroxyglutarate in brain tumors by optimized point-resolved spectroscopy (PRESS) at 7T. Magn Reson Med 2016; 77:936-944. [PMID: 26991680 DOI: 10.1002/mrm.26190] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 02/06/2016] [Accepted: 02/09/2016] [Indexed: 11/07/2022]
Abstract
PURPOSE To test the efficacy of 7T MRS for in vivo detection of 2-hydroxyglutarate (2HG) in brain tumors. METHODS The subecho times of point-resolved spectroscopy (PRESS) were optimized at 7T with density-matrix simulations and phantom validation to improve the 2HG signal selectivity with respect to the neighboring resonances of γ-aminobutyric acid (GABA), glutamate (Glu), and glutamine (Gln). MRS data were acquired from 12 subjects with gliomas in vivo and analyzed with LCModel using calculated basis spectra. Metabolite levels were quantified using unsuppressed short echo time (TE) water as a reference. RESULTS The PRESS TE was optimized as TE = 78 ms (TE1 = 58 ms and TE2 = 20 ms), at which the 2HG 2.25 ppm resonance appeared as a temporally maximum inverted narrow peak and the GABA, Glu, and Gln resonances between 2.2 and 2.5 ppm were all positive peaks. The PRESS TE = 78 ms method offered improved discrimination of 2HG from Glu, Gln, and GABA when compared with short-TE MRS. 2HG was detected in all patients enrolled in the study, the estimated 2HG concentrations ranging from 1.0 to 6.2 mM, with percentage standard deviation of 2%-7%. CONCLUSION Data indicate that the optimized MRS provides good selectivity of 2HG from other metabolite signals and may confer reliable in vivo detection of 2HG at relatively low concentrations. Magn Reson Med 77:936-944, 2017. © 2016 International Society for Magnetic Resonance in Medicine.
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Affiliation(s)
- Sandeep K Ganji
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Zhongxu An
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Vivek Tiwari
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Sarah McNeil
- Harold C. Simmons Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Annette Strauss Center for Neuro-Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Marco C Pinho
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Edward Pan
- Harold C. Simmons Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Bruce E Mickey
- Harold C. Simmons Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Annette Strauss Center for Neuro-Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Elizabeth A Maher
- Harold C. Simmons Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Annette Strauss Center for Neuro-Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Changho Choi
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Harold C. Simmons Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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56
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Viswanath P, Chaumeil MM, Ronen SM. Molecular Imaging of Metabolic Reprograming in Mutant IDH Cells. Front Oncol 2016; 6:60. [PMID: 27014635 PMCID: PMC4789800 DOI: 10.3389/fonc.2016.00060] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 02/28/2016] [Indexed: 12/31/2022] Open
Abstract
Mutations in the metabolic enzyme isocitrate dehydrogenase (IDH) have recently been identified as drivers in the development of several tumor types. Most notably, cytosolic IDH1 is mutated in 70-90% of low-grade gliomas and upgraded glioblastomas, and mitochondrial IDH2 is mutated in ~20% of acute myeloid leukemia cases. Wild-type IDH catalyzes the interconversion of isocitrate to α-ketoglutarate (α-KG). Mutations in the enzyme lead to loss of wild-type enzymatic activity and a neomorphic activity that converts α-KG to 2-hydroxyglutarate (2-HG). In turn, 2-HG, which has been termed an "oncometabolite," inhibits key α-KG-dependent enzymes, resulting in alterations of the cellular epigenetic profile and, subsequently, inhibition of differentiation and initiation of tumorigenesis. In addition, it is now clear that the IDH mutation also induces a broad metabolic reprograming that extends beyond 2-HG production, and this reprograming often differs from what has been previously reported in other cancer types. In this review, we will discuss in detail what is known to date about the metabolic reprograming of mutant IDH cells, and how this reprograming has been investigated using molecular metabolic imaging. We will describe how metabolic imaging has helped shed light on the basic biology of mutant IDH cells, and how this information can be leveraged to identify new therapeutic targets and to develop new clinically translatable imaging methods to detect and monitor mutant IDH tumors in vivo.
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Affiliation(s)
- Pavithra Viswanath
- Department of Radiology and Biomedical Imaging, University of California San Francisco , San Francisco, CA , USA
| | - Myriam M Chaumeil
- Department of Radiology and Biomedical Imaging, University of California San Francisco , San Francisco, CA , USA
| | - Sabrina M Ronen
- Department of Radiology and Biomedical Imaging, University of California San Francisco , San Francisco, CA , USA
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57
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Bisdas S, Chadzynski GL, Braun C, Schittenhelm J, Skardelly M, Hagberg GE, Ethofer T, Pohmann R, Shajan G, Engelmann J, Tabatabai G, Ziemann U, Ernemann U, Scheffler K. MR spectroscopy for in vivo assessment of the oncometabolite 2-hydroxyglutarate and its effects on cellular metabolism in human brain gliomas at 9.4T. J Magn Reson Imaging 2016; 44:823-33. [PMID: 26970248 DOI: 10.1002/jmri.25221] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 02/22/2016] [Indexed: 12/27/2022] Open
Abstract
PURPOSE To examine in vivo metabolic alterations in the isocitrate dehydrogenase (IDH) mutated gliomas using magnetic resonance spectroscopy (MRS) at magnetic field 9.4T. MATERIALS AND METHODS Spectra were acquired with a 9.4T whole-body scanner with the use of a custom-built head coil (16 channel transmit and 31 channel receive). A modified stimulated echo acquisition mode (STEAM) sequence was used for localization. Eighteen patients with brain tumors of probable glial origin participated in this study. The study was performed in accordance with the guidelines of the local Ethics Committee. RESULTS The increased spectral resolution allowed us to directly address metabolic alterations caused by the specific pathophysiology of IDH mutations including the presence of the oncometabolite 2-hydroxglutarate (2HG) and a significant decrease of the pooled glutamate and glutamine (20%, P = 0.024), which probably reflects an attempt to replenish α-ketoglutarate lost by conversion to 2HG. We also observed significantly reduced glutathione (GSH) levels (39%, P = 0.019), which could be similarly caused by depletion of dihydronicotinamide-adenine dinucleotide phosphate (NADPH) during this conversion in IDH mutant gliomas. CONCLUSION We demonstrate that MRS at 9.4T provides a noninvasive measure of 2HG in vivo, which may be used for therapy planning and prognostication, and may provide insights into related pathophysiologic metabolic alterations associated with IDH mutations. J. MAGN. RESON. IMAGING 2016;44:823-833.
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Affiliation(s)
- Sotirios Bisdas
- Department of Neuroradiology, Eberhard-Karls University Tübingen, Tübingen, Germany.,Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, University College London Hospitals, London, UK.,Center for CNS tumors, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Grzegorz L Chadzynski
- Department of Biomedical Magnetic Resonance, Eberhard-Karls University Tübingen, Tübingen, Germany. .,High-field Magnetic Resonance Center, Max Planck Institute for Biological Cybernetics, Tübingen, Germany.
| | - Christian Braun
- Center for CNS tumors, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany.,Department of Neurology & Stroke, Hertie Institute for Clinical Brain Research, Eberhard-Karls University Tübingen, Tübingen, Germany.,Interdisciplinary Division of Neuro-Oncology, University Hospital Tübingen, Hertie Institute for Clinical Brain Research, Eberahrd Karls University, Tübingen, Germany
| | - Jens Schittenhelm
- Center for CNS tumors, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany.,Interdisciplinary Division of Neuro-Oncology, University Hospital Tübingen, Hertie Institute for Clinical Brain Research, Eberahrd Karls University, Tübingen, Germany.,Department of Neuropathology, Eberhard-Karls University Tübingen, Tübingen, Germany.,Center for Personalized Medicine, Eberhard Karls University, Tübingen, Germany
| | - Marco Skardelly
- Center for CNS tumors, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany.,Interdisciplinary Division of Neuro-Oncology, University Hospital Tübingen, Hertie Institute for Clinical Brain Research, Eberahrd Karls University, Tübingen, Germany.,Center for Personalized Medicine, Eberhard Karls University, Tübingen, Germany.,Department of Neurosurgery, Eberhard-Karls University Tübingen, Tübingen, Germany
| | - Gisela E Hagberg
- Department of Biomedical Magnetic Resonance, Eberhard-Karls University Tübingen, Tübingen, Germany.,High-field Magnetic Resonance Center, Max Planck Institute for Biological Cybernetics, Tübingen, Germany
| | - Thomas Ethofer
- Department of Biomedical Magnetic Resonance, Eberhard-Karls University Tübingen, Tübingen, Germany.,Clinic for Psychiatry and Psychotherapy, Eberhard-Karls University Tübingen, Tübingen, Germany
| | - Rolf Pohmann
- High-field Magnetic Resonance Center, Max Planck Institute for Biological Cybernetics, Tübingen, Germany
| | - G Shajan
- High-field Magnetic Resonance Center, Max Planck Institute for Biological Cybernetics, Tübingen, Germany
| | - Jörn Engelmann
- Department of Biomedical Magnetic Resonance, Eberhard-Karls University Tübingen, Tübingen, Germany.,High-field Magnetic Resonance Center, Max Planck Institute for Biological Cybernetics, Tübingen, Germany
| | - Ghazaleh Tabatabai
- Center for CNS tumors, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany.,Department of Neurology & Stroke, Hertie Institute for Clinical Brain Research, Eberhard-Karls University Tübingen, Tübingen, Germany.,Interdisciplinary Division of Neuro-Oncology, University Hospital Tübingen, Hertie Institute for Clinical Brain Research, Eberahrd Karls University, Tübingen, Germany.,Center for Personalized Medicine, Eberhard Karls University, Tübingen, Germany.,German Cancer Consortium (DKTK), DKFZ partner site Tübingen, Tübingen, Germany
| | - Ulf Ziemann
- Center for CNS tumors, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany.,Department of Neurology & Stroke, Hertie Institute for Clinical Brain Research, Eberhard-Karls University Tübingen, Tübingen, Germany.,Center for Personalized Medicine, Eberhard Karls University, Tübingen, Germany
| | - Ulrike Ernemann
- Department of Neuroradiology, Eberhard-Karls University Tübingen, Tübingen, Germany.,Center for CNS tumors, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany.,Center for Personalized Medicine, Eberhard Karls University, Tübingen, Germany
| | - Klaus Scheffler
- Department of Biomedical Magnetic Resonance, Eberhard-Karls University Tübingen, Tübingen, Germany.,High-field Magnetic Resonance Center, Max Planck Institute for Biological Cybernetics, Tübingen, Germany
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Wishart DS. Emerging applications of metabolomics in drug discovery and precision medicine. Nat Rev Drug Discov 2016; 15:473-84. [PMID: 26965202 DOI: 10.1038/nrd.2016.32] [Citation(s) in RCA: 850] [Impact Index Per Article: 106.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Metabolomics is an emerging 'omics' science involving the comprehensive characterization of metabolites and metabolism in biological systems. Recent advances in metabolomics technologies are leading to a growing number of mainstream biomedical applications. In particular, metabolomics is increasingly being used to diagnose disease, understand disease mechanisms, identify novel drug targets, customize drug treatments and monitor therapeutic outcomes. This Review discusses some of the latest technological advances in metabolomics, focusing on the application of metabolomics towards uncovering the underlying causes of complex diseases (such as atherosclerosis, cancer and diabetes), the growing role of metabolomics in drug discovery and its potential effect on precision medicine.
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Affiliation(s)
- David S Wishart
- Department of Biological Sciences, CW 405, Biological Sciences Building, University of Alberta, Edmonton, Alberta, Canada T6G 2E9.,Department of Computing Science, 2-21 Athabasca Hall University of Alberta, Edmonton, Alberta, Canada T6G 2E8.,National Institute of Nanotechnology, National Research Council, Edmonton, Alberta, Canada T6G 2M9
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59
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Heo H, Kim S, Lee HH, Cho HR, Xu WJ, Lee SH, Park CK, Park S, Choi SH, Kim H. On the Utility of Short Echo Time (TE) Single Voxel 1H-MRS in Non-Invasive Detection of 2-Hydroxyglutarate (2HG); Challenges and Potential Improvement Illustrated with Animal Models Using MRUI and LCModel. PLoS One 2016; 11:e0147794. [PMID: 26820720 PMCID: PMC4731570 DOI: 10.1371/journal.pone.0147794] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 01/09/2016] [Indexed: 12/30/2022] Open
Abstract
Mutations in isocitrate dehydrogenase 1 and 2 (IDH1/2) are frequently found in brain tumors, and the resulting onco–metabolite, 2–hydroxyglutarate (2HG), has been suggested to be a potential diagnostic and prognostic biomarker of the diseases. Indeed, recent studies have demonstrated the feasibility of non–invasively detecting 2HG by using proton magnetic resonance spectroscopy (1H–MRS). Due to severe spectral overlaps of 2HG with its background metabolites and spectral baselines, however, the majority of those previous studies employed spectral editing methods with long echo times (TEs) instead of the most commonly used short TE approach with spectral fitting. Consequently, the results obtained with spectral editing methods may potentially be prone to errors resulting from substantial signal loss due to relaxation. Given that the spectral region where the main signal of 2HG resides is particularly sensitive to spectral baseline in metabolite quantification, we have investigated the impact of incorporating voxel–specifically measured baselines into the spectral basis set on the performance of the conventional short TE approach in 2HG detection in rodent models (Fisher 344 rats; n = 19) of IDH1/2 mutant–overexpressing F98 glioma at 9.4T. Metabolite spectra were acquired (SPECIAL sequence) for a tumor region and the contralateral normal region of the brain for each animal. For the estimation of spectral baselines metabolite–nulled spectra were obtained (double–inversion–recovery SPECIAL sequence) for each individual voxels. Data were post–processed with and without the measured baselines using MRUI and LCModel—the two most widely used data post–processing packages. Our results demonstrate that in–vivo detection of 2HG using the conventional short TE approach is challenging even at 9.4T. However, incorporation of voxel–specifically measured spectral baselines may potentially improve its performance. Upon more thorough validation in a larger number of animals and more importantly in human patients, the potential utility of the proposed short TE acquisition with voxel–specific baseline measurement approach in 2HG detection may need to be considered in the study design.
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Affiliation(s)
- Hwon Heo
- Department of Biomedical Sciences, Seoul National University, Seoul, Korea
| | - Sungjin Kim
- Department of Biomedical Sciences, Seoul National University, Seoul, Korea
| | - Hyeong Hun Lee
- Department of Biomedical Sciences, Seoul National University, Seoul, Korea
| | - Hye Rim Cho
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Wen Jun Xu
- College of Pharmacy, Natural Product Research Institute, Seoul National University, Seoul, Korea
| | - Se-Hoon Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Chul-Kee Park
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
| | - Sunghyouk Park
- College of Pharmacy, Natural Product Research Institute, Seoul National University, Seoul, Korea
| | - Seung Hong Choi
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
- * E-mail: (HK); (SHC)
| | - Hyeonjin Kim
- Department of Biomedical Sciences, Seoul National University, Seoul, Korea
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
- * E-mail: (HK); (SHC)
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Abstract
There is a wide variety of intra-axial primary and secondary brain neoplasms. Many of them have characteristic imaging features while other tumors can present in a similar fashion. There are peculiar posttreatment imaging phenomena that can present as intra-axial mass-like lesions (such as pseudoprogression or radiation necrosis), further complicating the diagnosis and clinical follow-up of patients with intracerebral tumors. The purpose of this chapter is to present a general overview of the most common intra-axial brain tumors and peculiar posttreatment changes that are very important in the diagnosis and clinical follow-up of patients with brain tumors.
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Affiliation(s)
- Otto Rapalino
- Division of Neuroradiology, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.
| | - Tracy Batchelor
- Departments of Neurology and Radiation Oncology, Division of Hematology/Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - R Gilberto González
- Division of Neuroradiology, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
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61
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Van Den Bent MJ, Bromberg JEC, Buckner J. Low-grade and anaplastic oligodendroglioma. HANDBOOK OF CLINICAL NEUROLOGY 2016; 134:361-80. [PMID: 26948366 DOI: 10.1016/b978-0-12-802997-8.00022-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Anaplastic oligodendrogliomas have long attracted interest because of their sensitivity to chemotherapy, in particular in the subset of 1p/19q co-deleted tumors. Recent molecular studies have shown that all 1p/19q co-deleted tumors have IDH mutations and most of them also have TERT mutations. Because of the presence of similar typical genetic alterations in astrocytoma and glioblastoma, the current trend is to diagnose these tumors on the basis of their molecular profile. Further long-term follow-up analysis of both EORTC and RTOG randomized studies on (neo)adjuvant procarbazine, lomustine, vincristine (PCV) chemotherapy have shown that adjuvant chemotherapy indeed improves outcome, and this is now standard of care. It is also equally clear that benefit to PCV chemotherapy is not limited to the 1p/19q co-deleted cases; potential other predictive factors are IDH mutations and MGMT promoter methylation. Moreover, a recent RTOG study on low-grade glioma also noted an improved outcome after adjuvant PCV chemotherapy, thus making (PCV) chemotherapy now standard of care for all 1p/19q co-deleted tumors regardless of grade. It remains unclear whether temozolomide provides the same survival benefit, as no data from well-designed clinical trials on adjuvant temozolomide in this tumor type are available. Another question that remains is whether one can safely leave out radiotherapy as part of initial treatment to avoid cognitive side-effects of radiotherapy. The current data suggest that delaying radiotherapy and treatment with chemotherapy only may be detrimental for overall survival.
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Affiliation(s)
- Martin J Van Den Bent
- Neuro-Oncology Unit, The Brain Tumor Center at Erasmus MC Cancer Center, Rotterdam, The Netherlands.
| | - Jacolien E C Bromberg
- Neuro-Oncology Unit, The Brain Tumor Center at Erasmus MC Cancer Center, Rotterdam, The Netherlands
| | - Jan Buckner
- Department of Oncology, Mayo Clinic, Rochester, MN, USA
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62
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Chaumeil MM, Lupo JM, Ronen SM. Magnetic Resonance (MR) Metabolic Imaging in Glioma. Brain Pathol 2015; 25:769-80. [PMID: 26526945 PMCID: PMC8029127 DOI: 10.1111/bpa.12310] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 08/25/2015] [Indexed: 12/25/2022] Open
Abstract
This review is focused on describing the use of magnetic resonance (MR) spectroscopy for metabolic imaging of brain tumors. We will first review the MR metabolic imaging findings generated from preclinical models, focusing primarily on in vivo studies, and will then describe the use of metabolic imaging in the clinical setting. We will address relatively well-established (1) H MRS approaches, as well as (31) P MRS, (13) C MRS and emerging hyperpolarized (13) C MRS methodologies, and will describe the use of metabolic imaging for understanding the basic biology of glioma as well as for improving the characterization and monitoring of brain tumors in the clinic.
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Affiliation(s)
| | - Janine M. Lupo
- Department of Radiology and Biomedical ImagingMission Bay Campus
| | - Sabrina M. Ronen
- Department of Radiology and Biomedical ImagingMission Bay Campus
- Brain Tumor Research CenterUniversity of CaliforniaSan FranciscoCA
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63
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Harting I, Boy N, Heringer J, Seitz A, Bendszus M, Pouwels PJW, Kölker S. (1)H-MRS in glutaric aciduria type 1: impact of biochemical phenotype and age on the cerebral accumulation of neurotoxic metabolites. J Inherit Metab Dis 2015; 38:829-38. [PMID: 25860816 DOI: 10.1007/s10545-015-9826-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 02/01/2015] [Accepted: 02/10/2015] [Indexed: 12/25/2022]
Abstract
BACKGROUND In glutaric aciduria type 1 (GA1) the neurotoxic metabolites glutaric acid (GA) and 3-hydroxyglutaric acid (3-OH-GA) accumulate within the brain. Due to limited efflux across the blood-brain-barrier biochemical monitoring of intracerebrally accumulating toxic metabolites is as yet not possible. AIMS To investigate brain metabolic patterns in glutaric aciduria type 1 using (1)H magnetic resonance spectroscopy ((1)H-MRS) with focus on detecting the disease-related neurotoxic metabolites GA and 3-OH-GA. PATIENTS AND METHODS Short echo time (1)H-MRS was performed in 13 treated metabolically stable patients. Twenty-one white matter and 16 basal ganglia spectra from 12 patients (age range 7 months - 22 years) were included. Subgroups based on age, biochemical phenotype and/or associated MRI changes were compared with control spectra. RESULTS GA was elevated in white matter of patients. 3-OH-GA was elevated in white matter of older patients with associated signal changes on MRI, which was structurally characterized by decreased creatine and phosphocreatine (tCr) and elevated choline (Cho). Metabolite changes differed with biochemical phenotype and disease duration: Low excretors with up to 30% residual enzyme activity had only mildly, non-significantly elevated GA and mildly subnormal N-acetylaspartate (tNAA). High excretors with complete lack of enzyme activity had significantly increased GA, tNAA was mildly subnormal in younger and decreased in older high excretors. CONCLUSIONS GA and 3-OH-GA are detectable by in vivo (1)H-MRS, which might finally allow biochemical follow-up monitoring of intracerebrally accumulating neurotoxic metabolites in GA1. A high excreting phenotype appears to be a risk factor for cerebral GA accumulation and progressive neuroaxonal compromise despite a similar clinical course in younger high and low excreting patients. This might have consequences for long-term outcome.
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Affiliation(s)
- Inga Harting
- Department of Neuroradiology, University of Heidelberg Medical Center, Im Neuenheimer Feld 400, D-69120, Heidelberg, Germany,
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Izquierdo-Garcia JL, Viswanath P, Eriksson P, Cai L, Radoul M, Chaumeil MM, Blough M, Luchman HA, Weiss S, Cairncross JG, Phillips JJ, Pieper RO, Ronen SM. IDH1 Mutation Induces Reprogramming of Pyruvate Metabolism. Cancer Res 2015; 75:2999-3009. [PMID: 26045167 DOI: 10.1158/0008-5472.can-15-0840] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 05/27/2015] [Indexed: 12/12/2022]
Abstract
Mutant isocitrate dehydrogenase 1 (IDH1) catalyzes the production of 2-hydroxyglutarate but also elicits additional metabolic changes. Levels of both glutamate and pyruvate dehydrogenase (PDH) activity have been shown to be affected in U87 glioblastoma cells or normal human astrocyte (NHA) cells expressing mutant IDH1, as compared with cells expressing wild-type IDH1. In this study, we show how these phenomena are linked through the effects of IDH1 mutation, which also reprograms pyruvate metabolism. Reduced PDH activity in U87 glioblastoma and NHA IDH1 mutant cells was associated with relative increases in PDH inhibitory phosphorylation, expression of pyruvate dehydrogenase kinase-3, and levels of hypoxia inducible factor-1α. PDH activity was monitored in these cells by hyperpolarized (13)C-magnetic resonance spectroscopy ((13)C-MRS), which revealed a reduction in metabolism of hyperpolarized 2-(13)C-pyruvate to 5-(13)C-glutamate, relative to cells expressing wild-type IDH1. (13)C-MRS also revealed a reduction in glucose flux to glutamate in IDH1 mutant cells. Notably, pharmacological activation of PDH by cell exposure to dichloroacetate (DCA) increased production of hyperpolarized 5-(13)C-glutamate in IDH1 mutant cells. Furthermore, DCA treatment also abrogated the clonogenic advantage conferred by IDH1 mutation. Using patient-derived mutant IDH1 neurosphere models, we showed that PDH activity was essential for cell proliferation. Taken together, our results established that the IDH1 mutation induces an MRS-detectable reprogramming of pyruvate metabolism, which is essential for cell proliferation and clonogenicity, with immediate therapeutic implications.
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Affiliation(s)
- Jose L Izquierdo-Garcia
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | - Pavithra Viswanath
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | - Pia Eriksson
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | - Larry Cai
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | - Marina Radoul
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | - Myriam M Chaumeil
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | - Michael Blough
- Department of Clinical Neurosciences and Southern Alberta Cancer Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - H Artee Luchman
- Department of Cell Biology and Anatomy and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Samuel Weiss
- Department of Clinical Neurosciences and Southern Alberta Cancer Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - J Gregory Cairncross
- Department of Clinical Neurosciences and Southern Alberta Cancer Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Joanna J Phillips
- Department of Neurological Surgery, Helen Diller Research Center, University of California San Francisco, San Francisco, California
| | - Russell O Pieper
- Department of Neurological Surgery, Helen Diller Research Center, University of California San Francisco, San Francisco, California
| | - Sabrina M Ronen
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California.
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Wick W, Hau P. [Personalized therapy for gliomas]. DER NERVENARZT 2015; 86:692, 694-6, 698-700. [PMID: 26022855 DOI: 10.1007/s00115-014-4226-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Current therapies for patients with malignant gliomas are starting to integrate molecular factors and age. Nonetheless, these therapies are still not sufficiently individualized. Some positive examples of transfer from basic science to clinical application are currently integrated into the standard treatment and guidelines. These are mainly genetic and other molecular factors that improve diagnosis and classification of gliomas and markers supporting prognostication. Examples for predictive biomarkers are methylation of the O-6-methylguanine-DNA methyltransferase (MGMT) promoter and the codeletion of chromosome arms 1p and 19q (1p/19q codel). The autoactive, truncated form of epidermal growth factor receptor (EGFRvIII) and the R132H mutation of isocitrate dehydrogenase 1 (IDH-1) are used as targets in currently running immunotherapeutic, targeted trials. Integration of functional imaging parameters into the monitoring and development of uniform assessment criteria improve the ability to evaluate therapy response and implement imaging biomarkers to guide therapies. As a result of the current efforts there are better classified prognostic groups and improved survival times with maintained functional and quality of life parameters in some glioma subgroups. Given the current dynamics, an improved, better differentiated classification of brain tumors including molecular parameters as well as more rational precise guiding of therapies with early, uniform response assessment is expected in the near future.
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Affiliation(s)
- W Wick
- Abteilung Neuroonkologie, Neurologische Klinik und Nationales Zentrum für Tumorerkrankungen, Universitätsklinikum Heidelberg, INF 400, 69120, Heidelberg, Deutschland,
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Natsumeda M, Igarashi H, Nomura T, Ogura R, Tsukamoto Y, Kobayashi T, Aoki H, Okamoto K, Kakita A, Takahashi H, Nakada T, Fujii Y. Accumulation of 2-hydroxyglutarate in gliomas correlates with survival: a study by 3.0-tesla magnetic resonance spectroscopy. Acta Neuropathol Commun 2014; 2:158. [PMID: 25376594 PMCID: PMC4236810 DOI: 10.1186/s40478-014-0158-y] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 10/22/2014] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Previous magnetic resonance spectroscopy (MRS) and mass spectroscopy studies have shown accumulation of 2-hydroxyglutarate (2HG) in mutant isocitrate dehydrogenase (IDH) gliomas. IDH mutation is known to be a powerful positive prognostic marker in malignant gliomas. Hence, 2HG accumulation in gliomas was assumed to be a positive prognostic factor in gliomas, but this has not yet been proven. Here, we analyzed 52 patients harboring World Health Organization (WHO) grade II and III gliomas utilizing 3.0-tesla MRS. RESULTS Mutant IDH gliomas showed significantly higher accumulation of 2HG (median 5.077 vs. 0.000, p =0.0002, Mann-Whitney test). 2HG was detectable in all mutant IDH gliomas, whereas in 10 out of 27 (37.0%) wild-type IDH gliomas, 2HG was below the detectable range (2HG =0) (p =0.0003, chi-squared test). Screening for IDH mutation by 2HG analysis was highly sensitive (cutoff 2HG =1.489 mM, sensitivity 100.0%, specificity 72.2%). Gliomas with high 2HG accumulation had better overall survival than gliomas with low 2HG accumulation (p =0.0401, Kaplan-Meier analysis). DISCUSSION 2HG accumulation detected by 3.0-tesla MRS not only correlates well with IDH status, but also positively correlates with survival in WHO grade II and III gliomas.
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67
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Bertolino N, Marchionni C, Ghielmetti F, Burns B, Finocchiaro G, Anghileri E, Bruzzone MG, Minati L. Accuracy of 2-hydroxyglutarate quantification by short-echo proton-MRS at 3 T: a phantom study. Phys Med 2014; 30:702-7. [PMID: 24685182 DOI: 10.1016/j.ejmp.2014.03.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2013] [Revised: 12/19/2013] [Accepted: 03/04/2014] [Indexed: 02/07/2023] Open
Abstract
PURPOSE We set out to investigate the potential confounding effect of variable concentration of N-acetyl-l-aspartate (NAA) and Glutamate (Glu) on measurement of the brain oncometabolite 2-hydroxyglutarate (2HG) using a standard MRS protocol. This issue may arise due to spectral overlap at clinical magnetic field strengths and thus complicate the usage of 2HG as a putative biomarker of gliomas bearing mutations of the isocitrate dehydrogenase (IDH) 1 and 2 genes. METHODS Spectra from 25 phantoms (50 mL falcon test tubes) containing a range of known concentrations of 2HG, NAA and Glu were acquired using a clinical 3 T scanner with a quadrature head coil, single-voxel point-resolved spectroscopy sequence with TE = 30 ms. Metabolite concentrations were estimated by linear combination analysis and a simulated basis set. RESULTS NAA and Glu concentrations can have a significant confounding effect on 2HG measurements, whereby the negative changes in concentration of these metabolites typically observed in (peri)lesional areas can lead to under-estimation of 2HG concentration with respect to spectra acquired in presence of physiological levels of NAA and Glu. CONCLUSION The confounding effect of NAA and Glu concentration changes needs to be considered: in patients, it may mask the presence of 2HG at low concentrations, however it is not expected to lead to false positives. 2HG data acquired using standard short echo-time MRS protocols should be considered with caution.
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Affiliation(s)
- Nicola Bertolino
- Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | | | - Francesco Ghielmetti
- Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Brian Burns
- Department of Bioengineering, UCLA, Los Angeles CA, USA
| | - Gaetano Finocchiaro
- Molecular Neuro-Oncology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Elena Anghileri
- Molecular Neuro-Oncology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Maria Grazia Bruzzone
- Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Ludovico Minati
- Scientific Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy.
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Choi C, Ganji SK, Madan A, Hulsey KM, An Z, Zhang S, Pinho MC, DeBerardinis RJ, Bachoo RM, Maher EA. In vivo detection of citrate in brain tumors by 1H magnetic resonance spectroscopy at 3T. Magn Reson Med 2013; 72:316-23. [PMID: 24123337 DOI: 10.1002/mrm.24946] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Revised: 08/15/2013] [Accepted: 08/19/2013] [Indexed: 11/06/2022]
Abstract
PURPOSE To test whether citrate is elevated in adult patients with gliomas using (1)H magnetic resonance spectroscopy (MRS) at 3T in vivo. METHODS Thirty-four adult patients were enrolled in the study, including six subjects with glioblastomas, eight subjects with astrocytomas (World Health Organization grade 3, n = 5; grade 2, n = 3), and 20 subjects with oligodendrogliomas (grade 3, n = 5; grade 2, n = 15). Five healthy volunteers were studied for baseline citrate data. Single-voxel localized spectra were collected with point-resolved spectroscopy (PRESS) echo times of 35 and 97 ms and were analyzed with LCModel software using numerically calculated basis spectra that included the effects of the PRESS radiofrequency and gradient pulses. RESULTS Citrate was not measurable by MRS in healthy brain but was detected in tumor patients at both echo times. The citrate concentration was estimated to be as high as 1.8 mM with reference to water at 42 M, with Cramér-Rao lower bounds (CRLB) as low as 5%. The mean citrate level was 0.7 ± 0.4 mM (mean ± SD, n = 32) with a median CRLB of ∼12%. No correlation was identified between citrate concentration and tumor grade or histological type. CONCLUSION Citrate was increased in the majority of gliomas in adult patients. The elevated citrate in our data indicates an altered metabolic state of tumor relative to healthy brain.
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Affiliation(s)
- Changho Choi
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA; Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA; Harold C. Simmons Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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