1
|
Abstract
Magnetic resonance spectroscopy (MRS), being able to identify and measure some brain components (metabolites) in pathologic lesions and in normal-appearing tissue, offers a valuable additional diagnostic tool to assess several pediatric neurological diseases. In this review we will illustrate the basic principles and clinical applications of brain proton (H1; hydrogen) MRS (H1MRS), by now the only MRS method widely available in clinical practice. Performing H1MRS in the brain is inherently less complicated than in other tissues (e.g., liver, muscle), in which spectra are heavily affected by magnetic field inhomogeneities, respiration artifacts, and dominating signals from the surrounding adipose tissues. H1MRS in pediatric neuroradiology has some advantages over acquisitions in adults (lack of motion due to children sedation and lack of brain iron deposition allow optimal results), but it requires a deep knowledge of pediatric pathologies and familiarity with the developmental changes in spectral patterns, particularly occurring in the first two years of life. Examples from our database, obtained mainly from a 1.5 Tesla clinical scanner in a time span of 15 years, will demonstrate the efficacy of H1MRS in the diagnosis of a wide range of selected pediatric pathologies, like brain tumors, infections, neonatal hypoxic-ischemic encephalopathy, metabolic and white matter disorders.
Collapse
Affiliation(s)
- Roberto Liserre
- Department of Radiology, Neuroradiology Unit, ASST Spedali Civili University Hospital, Brescia, Italy
| | - Lorenzo Pinelli
- Department of Radiology, Neuroradiology Unit, ASST Spedali Civili University Hospital, Brescia, Italy
| | - Roberto Gasparotti
- Neuroradiology Unit, Department of Medical-Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| |
Collapse
|
2
|
Lequin M, Hendrikse J. Advanced MR Imaging in Pediatric Brain Tumors, Clinical Applications. Neuroimaging Clin N Am 2017; 27:167-190. [DOI: 10.1016/j.nic.2016.08.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
3
|
Shiroishi MS, Panigrahy A, Moore KR, Nelson MD, Gilles FH, Gonzalez-Gomez I, Blüml S. Combined MRI and MRS improves pre-therapeutic diagnoses of pediatric brain tumors over MRI alone. Neuroradiology 2015; 57:951-6. [PMID: 26141852 DOI: 10.1007/s00234-015-1553-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 06/22/2015] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The specific goal of this study was to determine whether the inclusion of MRS had a measureable and positive impact on the accuracy of pre-surgical MR examinations of untreated pediatric brain tumors over that of MRI alone in clinical practice. METHODS Final imaging reports of 120 pediatric patients with newly detected brain tumors who underwent combined MRI/MRS examinations were retrospectively reviewed. Final pathology was available in all cases. Group A comprised 60 subjects studied between June 2001 and January 2005, when MRS was considered exploratory and radiologists utilized only conventional MRI to arrive at a diagnosis. For group B, comprising 60 subjects studied between January 2005 and March 2008, the radiologists utilized information from both MRI and MRS. Furthermore, radiologists revisited group A (blind review, time lapse >4 years) to determine whether the additional information from MRS would have altered their interpretation. RESULTS Sixty-three percent of patients in group A were diagnosed correctly, whereas in 10% the report was partially correct with the final tumor type mentioned (but not mentioned as most likely tumor), while in 27% of cases the reports were wrong. For group B, the diagnoses were correct in 87%, partially correct in 5%, and incorrect in 8% of the cases, which is a significant improvement (p < 0.005). Re-review of combined MRI and MRS of group A resulted 87% correct, 7% partially correct, and 7% incorrect diagnoses, which is a significant improvement over the original diagnoses (p < 0.05). CONCLUSION Adding MRS to conventional MRI significantly improved diagnostic accuracy in preoperative pediatric patients with untreated brain tumors.
Collapse
Affiliation(s)
- Mark S Shiroishi
- Department of Radiology, Children's Hospital Los Angeles/Keck School of Medicine of USC, MS 81, 4650 Sunset Boulevard, Los Angeles, CA, 90027, USA
| | - Ashok Panigrahy
- Department of Radiology, Children's Hospital Los Angeles/Keck School of Medicine of USC, MS 81, 4650 Sunset Boulevard, Los Angeles, CA, 90027, USA
- Department of Pediatric Radiology, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Kevin R Moore
- Department of Radiology, Primary Children's Medical Center, Salt Lake City, UT, USA
| | - Marvin D Nelson
- Department of Radiology, Children's Hospital Los Angeles/Keck School of Medicine of USC, MS 81, 4650 Sunset Boulevard, Los Angeles, CA, 90027, USA
| | - Floyd H Gilles
- Department of Pathology, Children's Hospital Los Angeles/Keck School of Medicine of USC, Los Angeles, CA, USA
| | | | - Stefan Blüml
- Department of Radiology, Children's Hospital Los Angeles/Keck School of Medicine of USC, MS 81, 4650 Sunset Boulevard, Los Angeles, CA, 90027, USA.
- Rudi Schulte Research Institute, Santa Barbara, CA, USA.
| |
Collapse
|
4
|
Abstract
Pediatric brain tumors are the most common solid tumor of childhood. This article focuses on the metabolic signature of common pediatric brain tumors using MR spectroscopic analyses.
Collapse
Affiliation(s)
- Lara A Brandão
- Clínica Felippe Mattoso, Barra Da Tijuca, Rio De Janeiro, Brazil.
| | | |
Collapse
|
5
|
|
6
|
Shah T, Jayasundar R, Singh VP, Sarkar C. In vivo MRS study of intraventricular tumors. J Magn Reson Imaging 2011; 34:1053-9. [DOI: 10.1002/jmri.22711] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2011] [Accepted: 06/07/2011] [Indexed: 11/05/2022] Open
|
7
|
Magnetic resonance spectroscopy in pediatric neuroradiology: clinical and research applications. Pediatr Radiol 2010; 40:3-30. [PMID: 19937238 DOI: 10.1007/s00247-009-1450-z] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2009] [Revised: 10/01/2009] [Accepted: 10/19/2009] [Indexed: 10/20/2022]
Abstract
Magnetic resonance spectroscopy (MRS) offers a unique, noninvasive approach to assess pediatric neurological abnormalities at microscopic levels by quantifying cellular metabolites. The most widely available MRS method, proton ((1)H; hydrogen) spectroscopy, is FDA approved for general use and can be ordered by clinicians for pediatric neuroimaging studies if indicated. There are a multitude of both acquisition and post-processing methods that can be used in the implementation of MR spectroscopy. MRS in pediatric neuroimaging is challenging to interpret because of dramatic normal developmental changes that occur in metabolites, particularly in the first year of life. Still, MRS has been proven to provide additional clinically relevant information for several pediatric neurological disease processes such as brain tumors, infectious processes, white matter disorders, and neonatal injury. MRS can also be used as a powerful quantitative research tool. In this article, specific research applications using MRS will be demonstrated in relation to neonatal brain injury and pediatric brain tumor imaging.
Collapse
|
8
|
Rosol M, Harutyunyan I, Xu J, Melendez E, Smbatyan G, Finlay JL, Krieger MD, Gonzalez-Gomez I, Reynolds CP, Nelson MD, Erdreich-Epstein A, Blüml S. Metabolism of Orthotopic Mouse Brain Tumor Models. Mol Imaging 2009. [DOI: 10.2310/7290.2009.00019] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Michael Rosol
- From the Department of Radiology, Division of Hematology-Oncology, Department of Pediatrics, Division of Neurosurgery, and Department of Pathology, Saban Research Institute at Children's Hospital Los Angeles and the University of Southern California Keck School of Medicine, Los Angeles, CA; and Rudi Schulte Research Institute, Santa Barbara, CA
| | - Ira Harutyunyan
- From the Department of Radiology, Division of Hematology-Oncology, Department of Pediatrics, Division of Neurosurgery, and Department of Pathology, Saban Research Institute at Children's Hospital Los Angeles and the University of Southern California Keck School of Medicine, Los Angeles, CA; and Rudi Schulte Research Institute, Santa Barbara, CA
| | - JingYing Xu
- From the Department of Radiology, Division of Hematology-Oncology, Department of Pediatrics, Division of Neurosurgery, and Department of Pathology, Saban Research Institute at Children's Hospital Los Angeles and the University of Southern California Keck School of Medicine, Los Angeles, CA; and Rudi Schulte Research Institute, Santa Barbara, CA
| | - Elizabeth Melendez
- From the Department of Radiology, Division of Hematology-Oncology, Department of Pediatrics, Division of Neurosurgery, and Department of Pathology, Saban Research Institute at Children's Hospital Los Angeles and the University of Southern California Keck School of Medicine, Los Angeles, CA; and Rudi Schulte Research Institute, Santa Barbara, CA
| | - Goar Smbatyan
- From the Department of Radiology, Division of Hematology-Oncology, Department of Pediatrics, Division of Neurosurgery, and Department of Pathology, Saban Research Institute at Children's Hospital Los Angeles and the University of Southern California Keck School of Medicine, Los Angeles, CA; and Rudi Schulte Research Institute, Santa Barbara, CA
| | - Jonathan L. Finlay
- From the Department of Radiology, Division of Hematology-Oncology, Department of Pediatrics, Division of Neurosurgery, and Department of Pathology, Saban Research Institute at Children's Hospital Los Angeles and the University of Southern California Keck School of Medicine, Los Angeles, CA; and Rudi Schulte Research Institute, Santa Barbara, CA
| | - Mark D. Krieger
- From the Department of Radiology, Division of Hematology-Oncology, Department of Pediatrics, Division of Neurosurgery, and Department of Pathology, Saban Research Institute at Children's Hospital Los Angeles and the University of Southern California Keck School of Medicine, Los Angeles, CA; and Rudi Schulte Research Institute, Santa Barbara, CA
| | - Ignacio Gonzalez-Gomez
- From the Department of Radiology, Division of Hematology-Oncology, Department of Pediatrics, Division of Neurosurgery, and Department of Pathology, Saban Research Institute at Children's Hospital Los Angeles and the University of Southern California Keck School of Medicine, Los Angeles, CA; and Rudi Schulte Research Institute, Santa Barbara, CA
| | - C. Patrick Reynolds
- From the Department of Radiology, Division of Hematology-Oncology, Department of Pediatrics, Division of Neurosurgery, and Department of Pathology, Saban Research Institute at Children's Hospital Los Angeles and the University of Southern California Keck School of Medicine, Los Angeles, CA; and Rudi Schulte Research Institute, Santa Barbara, CA
| | - Marvin D. Nelson
- From the Department of Radiology, Division of Hematology-Oncology, Department of Pediatrics, Division of Neurosurgery, and Department of Pathology, Saban Research Institute at Children's Hospital Los Angeles and the University of Southern California Keck School of Medicine, Los Angeles, CA; and Rudi Schulte Research Institute, Santa Barbara, CA
| | - Anat Erdreich-Epstein
- From the Department of Radiology, Division of Hematology-Oncology, Department of Pediatrics, Division of Neurosurgery, and Department of Pathology, Saban Research Institute at Children's Hospital Los Angeles and the University of Southern California Keck School of Medicine, Los Angeles, CA; and Rudi Schulte Research Institute, Santa Barbara, CA
| | - Stefan Blüml
- From the Department of Radiology, Division of Hematology-Oncology, Department of Pediatrics, Division of Neurosurgery, and Department of Pathology, Saban Research Institute at Children's Hospital Los Angeles and the University of Southern California Keck School of Medicine, Los Angeles, CA; and Rudi Schulte Research Institute, Santa Barbara, CA
| |
Collapse
|
9
|
Haki C, Gümüştaş OG, Bora I, Gümüştaş AU, Parlak M. Proton magnetic resonance spectroscopy study of bilateral thalamus in juvenile myoclonic epilepsy. Seizure 2007; 16:287-95. [PMID: 17391993 DOI: 10.1016/j.seizure.2007.02.017] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2006] [Revised: 10/29/2006] [Accepted: 02/20/2007] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To investigate neuronal dysfunction in the thalami of juvenile myoclonic epilepsy (JME) by using proton magnetic resonance spectroscopy (MRS). METHODS We performed single-voxel proton MRS over the right and the left thalami of 15 consecutive patients (10 women, 5 men) with JME (mean age 20.3 years) and 16 healthy volunteers (10 women, 6 men) (mean age 24.5 years). All patients had seizure onset in late childhood-teenage, normal neurologic examination, typical electroencephalogram (EEG) of JME and normal magnetic resonance imaging (MRI). We determined N-acetylaspartate (NAA) values and NAA over creatine-phosphocreatine (Cr) values. Mann-Whitney U-test was used to evaluate group differences. RESULTS Group analysis showed that echo time (TE) 270 integral value of NAA over left thalamus were significantly decreased in JME patients as compared with controls (34.6033+/-15.8386; 48.0362+/-22.2407, respectively, P=0.019). Also group analysis showed that thalami NAA/Cr ratios were significantly decreased in JME patients (right side, 2.21+/-1.07; left side 2.00+/-0.72) as compared with controls (right side, 3.45+/-1.50; left side, 3.08+/-1.60; P=0.011 and P=0.030, respectively). CONCLUSION In the previous studies, NAA values in patients with JME found that they were not statistically lower in thalami than control group. But, in our study, NAA value was found low as well. It has been known that NAA is a neuronal marker and hence it is a valuable metabolite in the neuron physiopathology. As a result, in the patients with JME we tried to support the theory that the underlying mechanism of the generalized seizures was the abnormal thalamocortical circuity, determining the thalamic neuronal dysfunction in MRS statistically.
Collapse
Affiliation(s)
- Cemile Haki
- Department of Neurology, Uludag University Medical Faculty, Gorukle Campus, Bursa, Turkey
| | | | | | | | | |
Collapse
|
10
|
Hazany S, Hesselink JR, Healy JF, Imbesi SG. Utilization of glutamate/creatine ratios for proton spectroscopic diagnosis of meningiomas. Neuroradiology 2006; 49:121-7. [PMID: 17086406 DOI: 10.1007/s00234-006-0167-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2006] [Accepted: 09/18/2006] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Our purpose was to determine the potential of metabolites other than alanine to diagnose intracranial meningiomas on proton magnetic resonance spectroscopy (MRS). METHODS Using a 1.5-T MR system the lesions were initially identified on FLAIR, and T1- and T2-weighted images. Employing standard point-resolved spectroscopy (PRESS) for single voxel proton MRS (TR 1500 ms, TE 30 ms, 128 acquisitions, voxel size 2 x 2 x 2 cm, acquisition time 3.12 min), MR spectra were obtained from 5 patients with meningiomas, from 20 with other intracranial lesions, and from 4 normal controls. Peak heights of nine resonances, including lipid, lactate, alanine, NAA (N-acetylaspartate), beta/gamma-Glx (glutamate + glutamine), creatine, choline, myo-inositol, and alpha-Glx/glutathione, were measured in all spectra. The relative quantity of each metabolite was measured as the ratio of its peak height to the peak height of creatine. RESULTS Relative quantities of alpha-Glx/glutathione, beta/gamma-Glx, and total Glx/glutathione were significantly elevated in meningiomas compared to the 20 other intracranial lesions and the normal control brains. Alanine was found in four of five meningiomas, but lactate partially masked the alanine in three meningiomas. None of the other lesions or control brains showed an alanine peak. The one meningioma with no alanine and the three others with lactate had elevated Glx. CONCLUSION While alanine is a relatively unique marker for meningioma, our results support the hypothesis that the combination of glutamate/creatine ratios and alanine on proton MRS is more specific and reliable for the diagnosis of meningiomas than alanine alone.
Collapse
Affiliation(s)
- Saman Hazany
- School of Medicine, University of California, San Diego, CA, USA
| | | | | | | |
Collapse
|
11
|
Hourani R, Horská A, Albayram S, Brant LJ, Melhem E, Cohen KJ, Burger PC, Weingart JD, Carson B, Wharam MD, Barker PB. Proton magnetic resonance spectroscopic imaging to differentiate between nonneoplastic lesions and brain tumors in children. J Magn Reson Imaging 2006; 23:99-107. [PMID: 16374884 DOI: 10.1002/jmri.20480] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To investigate whether in vivo proton magnetic resonance spectroscopic imaging (MRSI) can differentiate between 1) tumors and nonneoplastic brain lesions, and 2) high- and low-grade tumors in children. MATERIALS AND METHODS Thirty-two children (20 males and 12 females, mean age = 10 +/- 5 years) with primary brain lesions were evaluated retrospectively. Nineteen patients had a neuropathologically confirmed brain tumor, and 13 patients had a benign lesion. Multislice proton MRSI was performed at TE = 280 msec. Ratios of N-acetyl aspartate/choline (NAA/Cho), NAA/creatine (Cr), and Cho/Cr were evaluated in the lesion and the contralateral hemisphere. Normalized lesion peak areas (Cho(norm), Cr(norm), and NAA(norm)) expressed relative to the contralateral hemisphere were also calculated. Discriminant function analysis was used for statistical evaluation. RESULTS Considering all possible combinations of metabolite ratios, the best discriminant function to differentiate between nonneoplastic lesions and brain tumors was found to include only the ratio of Cho/Cr (Wilks' lambda, P = 0.012; 78.1% of original grouped cases correctly classified). The best discriminant function to differentiate between high- and low-grade tumors included the ratios of NAA/Cr and Cho(norm) (Wilks' lambda, P = 0.001; 89.5% of original grouped cases correctly classified). Cr levels in low-grade tumors were slightly lower than or comparable to control regions and ranged from 53% to 165% of the control values in high-grade tumors. CONCLUSION Proton MRSI may have a promising role in differentiating pediatric brain lesions, and an important diagnostic value, particularly for inoperable or inaccessible lesions.
Collapse
Affiliation(s)
- Roula Hourani
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, Maryland 21205, USA
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Kovanlikaya A, Panigrahy A, Krieger MD, Gonzalez-Gomez I, Ghugre N, McComb JG, Gilles FH, Nelson MD, Blüml S. Untreated pediatric primitive neuroectodermal tumor in vivo: quantitation of taurine with MR spectroscopy. Radiology 2005; 236:1020-5. [PMID: 16118174 DOI: 10.1148/radiol.2363040856] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To retrospectively investigate whether quantitation of taurine (Tau) concentrations with proton magnetic resonance (MR) spectroscopy in vivo improves the differentiation of primitive neuroectodermal tumors (PNET) from other common brain tumors in pediatric patients. MATERIALS AND METHODS The institutional review board approved this review of clinical data; it was not necessary to obtain parental consent. This study was HIPAA compliant. Single-voxel proton spectroscopy was added to the preoperative MR imaging work-up of 29 patients (12 boys and 17 girls; mean age, 6.5 years +/- 3.5) with untreated brain tumors; 13 had PNETs, and 16 had other tumors. Absolute concentrations (measured in millimoles per kilogram of brain tissue) of metabolites of the proton spectrum were determined. Student t tests were used for statistical comparisons. RESULTS Elevated absolute Tau concentration proved to be the most significant metabolite in the differentiation of PNETs from other tumors (6.09 mmol/kg +/- 2.24 vs 0.76 mmol/kg +/- 0.95, P < .001). PNETs also exhibited a higher ratio of Tau relative to choline (1.21 +/- 0.48 vs 0.28 +/- 0.39, P < .001), a higher ratio of Tau relative to creatine (1.28 +/- 0.44 vs 0.38 +/- 0.67, P < .001), a reduced a ratio of N-acetyl-aspartate relative to choline (0.20 +/- 0.20 vs 0.79 +/- 0.56, P < .001), and an increased choline concentration (5.30 mmol/kg +/- 1.64 vs 3.08 mmol/kg +/- 2.53, P < .05). Tau concentrations ranged from 2.62 to 11.15 mmol/kg in individual patients with a PNET. CONCLUSION Single-voxel quantitative (1)H MR spectroscopy performed in patients with untreated pediatric brain tumors showed that the Tau concentration was significantly elevated in PNETs and was useful in the differentiation of PNETs from other tumors.
Collapse
Affiliation(s)
- Arzu Kovanlikaya
- Department of Radiology, Division of Neurosurgery, and Department of Neuropathology, Children's Hospital Los Angeles, 4650 Sunset Blvd, MS 81, Los Angeles, CA 90027, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Krieger MD, Panigrahy A, McComb JG, Nelson MD, Liu X, Gonzalez-Gomez I, Gilles F, Bluml S. Differentiation of choroid plexus tumors by advanced magnetic resonance spectroscopy. Neurosurg Focus 2005. [DOI: 10.3171/foc.2005.18.6.5] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
The management of pediatric intraventricular tumors is highly dependent on identification of the tumor type. Choroid plexus papillomas, a common intraventricular tumor in children, can be difficult to distinguish radiographically from choroid plexus carcinomas and other common pediatric central nervous system (CNS) tumors. In this study to overcome the limitations of current noninvasive imaging modalities, the authors use novel magnetic resonance (MR) spectroscopy techniques in vivo to elucidate the identifying biochemical features of choroid plexus tumors that may facilitate diagnosis and treatment.
Methods
Based on an Internal Review Board–approved protocol, six children with newly diagnosed, untreated intraventricular brain tumors were identified. On retrospective review, this series included three choroid plexus papillomas and three choroid plexus carcinomas. Single-voxel proton MR spectroscopy with a short echo time was performed, and absolute metabolite concentrations (in mmol/kg) were determined using fully automated quantitation. These results were compared with MR spectroscopy profiles obtained in 54 other untreated CNS neoplasms in children.
The myo-inositol (mI) level was significantly higher in choroid plexus papillomas (> 10 mmol/kg), uniquely distinguishing these tumors from choroid plexus carcinomas and all other tumors. Choroid plexus carcinomas, on the other hand, had significantly elevated levels of choline when compared with choroid plexus papillomas.
Conclusions
In this study the authors find that mI is a biochemical constituent that uniquely identifies choroid plexus papillomas and can be used as a noninvasive means of diagnosis and for follow-up evaluations in patients with this disease.
Collapse
|
14
|
Meyers SP, Khademian ZP, Chuang SH, Pollack IF, Korones DN, Zimmerman RA. Choroid plexus carcinomas in children: MRI features and patient outcomes. Neuroradiology 2005; 46:770-80. [PMID: 15309348 DOI: 10.1007/s00234-004-1238-7] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Choroid plexus carcinomas (CPC) are rare malignant intracranial neoplasms usually occurring in young children. The objectives of this study were to characterize the preoperative MRI features of CPC, determine the frequency of disseminated disease in the CNS at diagnosis, and assess patient outcomes. The preoperative cranial MR images of 11 patients with CPC were retrospectively reviewed for lesion location, lesion size, un-enhanced and enhanced MRI signal characteristics, and presence of disseminated intracranial tumor. Postoperative cranial and spinal MRI images were reviewed for residual, recurrent, and/or disseminated tumor. The study group included six male and five female patients ranging in age from 5 months to 5.3 years (median= 1.8 years). CPC were located in the lateral (n = 8), fourth (n = 1), and third (n = 1) ventricles, and foramen of Luschka (n = 1). Mean tumor size was 5.2 cm x 4.9 cm x 5.0 cm. On short-TR images, CPC had heterogeneous, predominantly intermediate signal with foci of high signal in 45% of lesions from areas of hemorrhage. On long-TR/long-TE images, solid portions of CPC typically had heterogeneous, intermediate-to-slightly-high signal. Small zones of low signal on long-TR/long-TE images were seen in 55% of the lesions secondary to areas of hemorrhage and/or calcifications. Tubular flow voids representing blood vessels were seen in 55% of the lesions. Zones of high signal comparable to CSF were seen in 64% of CPC secondary to cystic/necrotic zones. All CPC showed prominent contrast enhancement. Irregular enhancing margins suggesting subependymal invasion were seen in 73% of the lesions. Findings consistent with edema in the brain adjacent to the enhancing lesions were seen in 73% of CPC. CPC caused hydrocephalus in 82% of patients at diagnosis. Two patients died from hemorrhagic complications from surgical biopsies. Disseminated tumor in the leptomeninges was present in 45% of patients at diagnosis and was associated with a poor prognosis. The 1-year and 5-year survival probabilities were 55% and 45%, respectively. In conclusion, MRI features commonly associated with CPC include large intraventricular lesions with irregular enhancing margins; heterogeneous signal on long TR/long TE images and short-TR images; edema in adjacent brain; hydrocephalus; and presence of disseminated tumor. MRI evidence of disseminated tumor at diagnosis is associated with a poor prognosis.
Collapse
Affiliation(s)
- Steven P Meyers
- Department of Radiology, University of Rochester School of Medicine, Strong Memorial Hospital, Rochester, NY, USA.
| | | | | | | | | | | |
Collapse
|
15
|
Abstract
The purpose of this article is to familiarize readers with new imaging applications, identify the relative strengths of imaging modalities, and emphasize practical applications of imaging the child's nervous system. Because of recent advances in MRI, the article emphasizes the expanding role of MRI in evaluating children with neurologic disease.
Collapse
Affiliation(s)
- Gary L Hedlund
- Department of Pediatric Medical Imaging, Primary Children's Medical Center, University of Utah, 100 North Medical Drive, Salt Lake City, UT 84113, USA.
| |
Collapse
|
16
|
Abstract
Proton magnetic resonance (MR) spectroscopy is a complementary method to MR imaging for understanding disease processes in the pediatric brain. By demonstrating the presence of various metabolites in the sampled tissue, MR spectroscopy helps in the understanding of abnormalities detected by MR imaging or clinical examination. This capability is especially pertinent in the pediatric brain, where the manifestation of pathology is superimposed upon a background of normal or abnormal brain development. In this article, we review the major metabolites demonstrated by MR spectroscopy and present examples of MR spectra obtained in various pathological processes encountered in children.
Collapse
Affiliation(s)
- K M Cecil
- Department of Radiology and Division of Pediatrics, Children's Hospital Medical Center and the University of Cincinnati, Cincinnati, Ohio 45229, USA.
| | | |
Collapse
|
17
|
Horská A, Ulug AM, Melhem ER, Filippi CG, Burger PC, Edgar MA, Souweidane MM, Carson BS, Barker PB. Proton magnetic resonance spectroscopy of choroid plexus tumors in children. J Magn Reson Imaging 2001; 14:78-82. [PMID: 11436218 DOI: 10.1002/jmri.1154] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
A variety of lesions may present as intraventricular masses in children. We report quantitative proton magnetic resonance spectroscopy (MRS) of two intraventricular tumors of the choroid plexus: choroid plexus carcinoma (CPC) and choroid plexus papilloma (CPP). Both lesions were characterized by high levels of choline-containing compounds and a complete absence of creatine and the neuronal/axonal marker N-acetyl aspartate. The CPC showed higher levels of choline compared to the CPP, and it also had elevated lactate. These preliminary results, if confirmed in a larger cohort of patients, indicate that proton MRS may have a role in the presurgical diagnosis of choroid plexus tumors in children, which may also have important implications for therapy and prognosis.
Collapse
Affiliation(s)
- A Horská
- Department of Radiology, Johns Hopkins University, Baltimore, Maryland 21205, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
18
|
|
19
|
Kim DG, Choe WJ, Chang KH, Song IC, Han MH, Jung HW, Cho BK. In vivo proton magnetic resonance spectroscopy of central neurocytomas. Neurosurgery 2000; 46:329-33; discussion 333-4. [PMID: 10690721 DOI: 10.1097/00006123-200002000-00013] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE The authors report on the metabolic features of central neurocytomas observed during in vivo single-voxel proton magnetic resonance spectroscopy. METHODS Volume-selective single-voxel proton magnetic resonance spectroscopy was performed with a 1.5-T unit using a point-resolved spectroscopy sequence (TR/TE = 2000 ms/135 and 270 ms) to obtain spectra of a single 8-cc voxel. The subjects were five patients in the Department of Neurosurgery of Seoul National University Hospital whose central neurocytomas had been diagnosed histologically. The peak intensities of compounds containing choline (Cho), N-acetylaspartate, creatine/phosphocreatine, and lactate were analyzed. RESULTS The ratios of Cho to creatine/phosphocreatine and Cho to N-acetylaspartate were significantly higher than ratios in normal brains. A lactate signal was present, and an unidentified signal was also observed at 3.55 ppm, which might have been produced by inositol or glycine. CONCLUSION A combination of the signal at 3.55 ppm and a prominent Cho peak seems to be a characteristic feature of central neurocytomas. Volume-selective single-voxel proton magnetic resonance spectroscopy could provide additional information to aid in diagnosing this condition.
Collapse
Affiliation(s)
- D G Kim
- Department of Neurosurgery, Seoul National University College of Medicine, Korea
| | | | | | | | | | | | | |
Collapse
|
20
|
Lazareff JA, Gupta RK, Alger J. Variation of post-treatment H-MRSI choline intensity in pediatric gliomas. J Neurooncol 1999; 41:291-8. [PMID: 10359150 DOI: 10.1023/a:1006120623949] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Pediatric brain gliomas are not always amenable for complete surgical excision, therefore adjuvant treatment for a large tumor mass is often required. As tumor volume shrinkage may not be a reliable method for assessing response to treatment, information about the tumor growth potential is desirable for an adequate follow-up of the patients. Choline (Cho) signal intensity, determined by proton magnetic resonance spectroscopy imaging (H-MRSI), has proved to be a reliable indicator of the metabolic activity and of tumor progression in various intracranial tumors. In this study we have sought to determine if H-MRSI can be of use in monitoring the response of pediatric gliomas to different forms of therapy. We performed pretreatment and post-treatment H-MRSI in 10 children with biopsed or partially excised brain gliomas. The follow-up period ranged between 6 and 40 months. A total of 38 H-MRSI were performed. All the patients had chemotherapy or radiotherapy. As an indicator of tumor activity we utilized the ratio between tumor/brain Cho signal intensity. Treatment response was evaluated as a function of tumor volume and clinical outcome. In 6 patients whose tumor volume decreased or remained stable we observed that the Cho ratio decreased (p < 0.01) after treatment and remained low during longitudinal follow-up. In the 4 patients whose tumors progressed the Cho ratio increased after treatment. These observations suggest that serial H-MRSI can provide valuable information regarding the response to therapy in pediatric gliomas and therefore be of use in the follow-up of these neoplasms of childhood.
Collapse
Affiliation(s)
- J A Lazareff
- Department of Surgery, University of California Los Angeles School of Medicine, 90095-7039, USA
| | | | | |
Collapse
|
21
|
Lazareff JA, Bockhorst KH, Curran J, Olmstead C, Alger JR. Pediatric low-grade gliomas: prognosis with proton magnetic resonance spectroscopic imaging. Neurosurgery 1998; 43:809-17; discussion 817-8. [PMID: 9766308 DOI: 10.1097/00006123-199810000-00053] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Our aim was to assess the correlation between the low-grade glioma (LGG) metabolic profile and tumor progression. Using in vivo proton magnetic resonance spectroscopic imaging, we specifically asked whether and which metabolic features are associated with tumor regrowth or recurrence. METHODS Eleven pediatric patients with histologically proven partially resected (<20% resection) midline LGG were treated and followed up for a period of 2 years. All patients underwent proton magnetic resonance spectroscopic imaging studies before any management was determined. Tumor progression was defined as radiological evidence of mass enlargement (>25%) during the follow-up period. Proton magnetic resonance spectroscopic imaging was performed using a PRESS-CSI sequence on a General Electric 1.5-tesla scanner (General Electric Medical System, Waukesha, WI). The signal intensities of N-acetylaspartate, choline (CHO), and creatine from the tumor and the normal brain were used to calculate normalized metabolite intensities and metabolite ratios. RESULTS Tumors that progressed during a 2-year period displayed higher normalized CHO than those that remained stable (Mann-Whitney test, P < 0.03). The majority (five of six) of the rapidly growing LGG showed values of normalized CHO of at least 1, whereas the nonprogressors had a normalized CHO value of less than 1. CONCLUSION In association with pediatric LGG, high normalized CHO values seem to herald the potential for rapid tumor growth. These observations may be valuable for defining subsets of patients with LGG who may benefit from early therapeutic interventions.
Collapse
Affiliation(s)
- J A Lazareff
- Division of Neurosurgery, University of California, Los Angeles, 90095-7039, USA
| | | | | | | | | |
Collapse
|
22
|
Kim MO, Im JH, Choi CG, Lee MC. Proton MR spectroscopic findings in paroxysmal kinesigenic dyskinesia. Mov Disord 1998; 13:570-5. [PMID: 9613757 DOI: 10.1002/mds.870130334] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Although paroxysmal kinesigenic dyskinesia (PKD) has characteristic clinical features, the pathophysiology of PKD has remained unknown. The purpose of this study was to investigate the pathophysiology of idiopathic PKD by performing proton magnetic resonance spectroscopy (1H-MRS) in five patients with idiopathic PKD. Three patients were familial and two sporadic. Single-voxel 1H-MRS was performed on a GE 1.5-T SIGNA MR system. Localized 1H-MR spectra were obtained from the basal ganglia (n = 5), thalamus (n = 3), and supplementary motor area (SMA; n = 4) using STEAM sequence (stimulated echo acquisition mode; TR = 3.0 sec, TE = 30 msec, 64 AVG, volume = 8 mL) or PRESS (point resolved spectroscopy; TR = 3.0 sec, TE = 135 msec, volume = 4 mL). Peak ratios of Cho/Cr (Cho: choline, Cr: creatine) and mI/Cr (mI: myoinositol) were decreased significantly in the unilateral basal ganglia of two patients. In one, decreased peak ratio of mI/Cr in the unilateral basal ganglia was the only abnormality. In the remaining two, there was no significant abnormality. 1H-MR spectra obtained from the thalamus and SMA were all within normal limits. In conclusion, these results suggest that underlying pathophysiological mechanism of PKD may be at least partially associated with the dysfunction of cholinergic system in the basal ganglia.
Collapse
Affiliation(s)
- M O Kim
- Department of Neurology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, South Korea
| | | | | | | |
Collapse
|