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Seelen LWF, van den Wildenberg L, van der Kemp WJM, Mohamed Hoesein FAA, Mohammad NH, Molenaar IQ, van Santvoort HC, Prompers JJ, Klomp DWJ. Prospective of 31 P MR Spectroscopy in Hepatopancreatobiliary Cancer: A Systematic Review of the Literature. J Magn Reson Imaging 2023; 57:1144-1155. [PMID: 35916278 DOI: 10.1002/jmri.28372] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 07/13/2022] [Accepted: 07/14/2022] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The incidence of liver and pancreatic cancer is rising. Patients benefit from current treatments, but there are limitations in the evaluation of (early) response to treatment. Tumor metabolic alterations can be measured noninvasively with phosphorus (31 P) magnetic resonance spectroscopy (MRS). PURPOSE To conduct a quantitative analysis of the available literature on 31 P MRS performed in hepatopancreatobiliary cancer and to provide insight into its current and potential for therapy (non-) response assessment. POPULATION Patients with hepatopancreatobiliary cancer. FIELD STRENGTH/SEQUENCE: 31 P MRS. ASSESSMENT The PubMed, EMBASE, and Cochrane library databases were systematically searched for studies published to 17 March 17, 2022. All 31 P MRS studies in hepatopancreatobiliary cancer reporting 31 P metabolite levels were included. STATISTICAL TESTS Relative differences in 31 P metabolite levels/ratios between patients before therapy and healthy controls, and the relative changes in 31 P metabolite levels/ratios in patients before and after therapy were determined. RESULTS The search yielded 10 studies, comprising 301 subjects, of whom 132 (44%) healthy volunteers and 169 (56%) patients with liver cancer of various etiology. To date, 31 P MRS has not been applied in pancreatic cancer. In liver cancer, alterations in levels of 31 P metabolites involved in cell proliferation (phosphomonoesters [PMEs] and phosphodiesters [PDEs]) and energy metabolism (ATP and inorganic phosphate [Pi]) were observed. In particular, liver tumors were associated with elevations of PME/PDE and PME/Pi compared to healthy liver tissue, although there was a broad variety among studies (elevations of 2%-267% and 21%-233%, respectively). Changes in PME/PDE in liver tumors upon therapy were substantial, yet very heterogeneous and both decreases and increases were observed, whereas PME/Pi was consistently decreased after therapy in all studies (-13% to -76%). DATA CONCLUSION 31 P MRS has great potential for treatment monitoring in oncology. Future studies are needed to correlate the changes in 31 P metabolite levels in hepatopancreatobiliary tumors with treatment response. EVIDENCE LEVEL 3 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Leonard W F Seelen
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Surgery, UMC Utrecht Cancer Center and St Antonius Hospital Nieuwegein: Regional Academic Cancer Center Utrecht, Utrecht, The Netherlands
| | | | - Wybe J M van der Kemp
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Firdaus A A Mohamed Hoesein
- Department of Surgery, UMC Utrecht Cancer Center and St Antonius Hospital Nieuwegein: Regional Academic Cancer Center Utrecht, Utrecht, The Netherlands
| | - Nadia Haj Mohammad
- Department of Medical Oncology, UMC Utrecht Cancer Center, Regional Academic Cancer Center Utrecht, Utrecht, The Netherlands
| | - I Quintus Molenaar
- Department of Surgery, UMC Utrecht Cancer Center and St Antonius Hospital Nieuwegein: Regional Academic Cancer Center Utrecht, Utrecht, The Netherlands
| | - Hjalmar C van Santvoort
- Department of Surgery, UMC Utrecht Cancer Center and St Antonius Hospital Nieuwegein: Regional Academic Cancer Center Utrecht, Utrecht, The Netherlands
| | - Jeanine J Prompers
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Dennis W J Klomp
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
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Barshop NJ, Sirlin CB, Schwimmer JB, Lavine JE. Review article: epidemiology, pathogenesis and potential treatments of paediatric non-alcoholic fatty liver disease. Aliment Pharmacol Ther 2008; 28:13-24. [PMID: 18397387 DOI: 10.1111/j.1365-2036.2008.03703.x] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Non-alcoholic fatty liver disease (NAFLD) is the most common cause of paediatric liver disease. Similar to NAFLD in adults, NAFLD in children is associated with obesity and insulin resistance and requires liver histology for diagnosis and staging. However, significant histological differences exist between adult and paediatric NAFLD to warrant caution in extrapolation of adult data. AIM To review the available data on the epidemiology, pathogenesis, diagnosis and treatment of paediatric NAFLD. METHODS Relevant articles were identified by Medline searches using the keywords: nonalcoholic fatty liver disease, steatohepatitis, obesity and children. RESULTS The rise in childhood obesity has been accompanied by an increase in paediatric NAFLD. Age, gender and race/ethnicity are significant determinants of risk, and sex hormones, insulin sensitivity and adipocytokines are implicated in the pathogenesis of paediatric NAFLD. There is no consensus for treatment of NAFLD; however, data suggest that diet, exercise and some pharmacological therapies may be of benefit. CONCLUSIONS To evaluate and effectively treat paediatric NAFLD, the pathophysiology and natural history of the disease should be clarified and non-invasive methods for screening, diagnosis, and longitudinal assessment developed. Randomized, controlled, double-blind trials of pharmacological therapies in children with biopsy-proven disease are necessary.
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Affiliation(s)
- N J Barshop
- Department of Pediatrics, University of California, San Diego, CA, USA
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Noren B, Dahlqvist O, Lundberg P, Almer S, Kechagias S, Ekstedt M, Franzén L, Wirell S, Smedby O. Separation of advanced from mild fibrosis in diffuse liver disease using 31P magnetic resonance spectroscopy. Eur J Radiol 2007; 66:313-20. [PMID: 17646074 DOI: 10.1016/j.ejrad.2007.06.004] [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: 09/19/2006] [Revised: 05/08/2007] [Accepted: 06/04/2007] [Indexed: 12/12/2022]
Abstract
31P-MRS using DRESS was used to compare absolute liver metabolite concentrations (PME, Pi, PDE, gammaATP, alphaATP, betaATP) in two distinct groups of patients with chronic diffuse liver disorders, one group with steatosis (NAFLD) and none to moderate inflammation (n=13), and one group with severe fibrosis or cirrhosis (n=16). All patients underwent liver biopsy and extensive biochemical evaluation. A control group (n=13) was also included. Absolute concentrations and the anabolic charge, AC=[PME]/([PME]+[PDE]), were calculated. Comparing the control and cirrhosis groups, lower concentrations of PDE (p=0.025) and a higher AC (p<0.001) were found in the cirrhosis group. Also compared to the NAFLD group, the cirrhosis group had lower concentrations of PDE (p=0.01) and a higher AC (p=0.009). No significant differences were found between the control and NAFLD group. When the MRS findings were related to the fibrosis stage obtained at biopsy, there were significant differences in PDE between stage F0-1 and stage F4 and in AC between stage F0-1 and stage F2-3. Using a PDE concentration of 10.5mM as a cut-off value to discriminate between mild, F0-2, and advanced, F3-4, fibrosis the sensitivity and specificity were 81% and 69%, respectively. An AC cut-off value of 0.27 showed a sensitivity of 93% and a specificity of 54%. In conclusion, the results suggest that PDE is a marker of liver fibrosis, and that AC is a potentially clinically useful parameter in discriminating mild fibrosis from advanced.
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Affiliation(s)
- Bengt Noren
- Department of Radiology, Linköping University, SE-581 85 Linköping, Sweden
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Norén B, Lundberg P, Ressner M, Wirell S, Almer S, Smedby O. Absolute quantification of human liver metabolite concentrations by localized in vivo 31P NMR spectroscopy in diffuse liver disease. Eur Radiol 2004; 15:148-57. [PMID: 15351899 DOI: 10.1007/s00330-004-2434-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2003] [Revised: 06/04/2004] [Accepted: 06/28/2004] [Indexed: 12/13/2022]
Abstract
Phosphorus-31 NMR spectroscopy using slice selection (DRESS) was used to investigate the absolute concentrations of metabolites in the human liver. Absolute concentrations provide more specific biochemical information compared to spectrum integral ratios. Nine patients with histopathologically proven diffuse liver disease and 12 healthy individuals were examined in a 1.5-T MR scanner (GE Signa LX Echospeed plus). The metabolite concentration quantification procedures included: (1) determination of optimal depth for the in vivo measurements, (2) mapping the detection coil characteristics, (3) calculation of selected slice and liver volume ratios using simple segmentation procedures and (4) spectral analysis in the time domain. The patients had significantly lower concentrations of phosphodiesters (PDE), 6.3+/-3.9 mM, and ATP-beta, 3.6+/-1.1 mM, (P<0.05) compared with the control group (10.0+/-4.2 mM and 4.2+/-0.3 mM, respectively). The concentrations of phosphomonoesters (PME) were higher in the patient group, although this was not significant. Constructing an anabolic charge (AC) based on absolute concentrations, [PME]/([PME] + [PDE]), the patients had a significantly larger AC than the control subjects, 0.29 vs. 0.16 (P<0.005). Absolute concentration measurements of phosphorus metabolites in the liver are feasible using a slice selective sequence, and the technique demonstrates significant differences between patients and healthy subjects.
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Affiliation(s)
- Bengt Norén
- Depatment of Radiology/IMV, Linköping University, 581-85 Linköping, Sweden
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Abstract
Magnetic resonance spectroscopy (MRS) remains the technique of choice for observing tumour metabolism non-invasively. Although initially 31P MR spectroscopy showed much promise as a non-invasive diagnostic tool, studies of a wide range of hepatic tumours have conclusively shown that this technique cannot be utilized to distinguish between different tumour types. This lack of specificity and sensitivity appears to be a consequence of the fact that hepatic tumours develop with a range of modalities and not as a single abnormal disease process, and also because of the limited availability of MR detectable metabolic markers. This has led, in recent years, to a re-evaluation of the role of 31P MR spectroscopy, re-emerging as a non-invasive tool to follow the efficacy of the treatment regime. Furthermore, since the principal changes observed in tumours by 31P MRS appear to be an elevation in the concentration of phosphorylcholine (PCho) and phosphoethanolamine (PEth), new research using a combination of MRS and tissue culture of cell lines which carry a combination of known inducible oncogenes, are helping to elucidate some of the metabolic pathways that give rise to these metabolic alterations.
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Affiliation(s)
- J D Bell
- MR Unit, Hammersmith Hospital, London, UK.
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Abstract
Assessment of the response of liver tumors to hepatic perfusion is strongly based on cross-sectional imaging. CT and MRI have gained considerably in diagnostic accuracy with the introduction of new, fast acquisition techniques such as spiral CT or breath-hold techniques in MRI. In addition, the administration of contrast agents has improved and has led to new injection protocols in spiral CT and the development of liver-specific contrast agents in MRI. Imaging techniques, however, strongly rely on changes in morphology such as size, vascularization and signs of necrosis. Functional signs of tumor metabolism cannot be visualized directly. While most functional imaging techniques at present are based on nuclear medicine, MR spectroscopy (MRS) offers the potential to assess tumor metabolism. Its promise is a direct match between the morphologic information of MRI and the metabolic information provided by MRS. The application of MRS to the liver, however, is still in this infancy. This article will give an overview of the multitude of CT and MR techniques that can be used to monitor tumor response. It will discuss the various signs of tumor regression and some typical complications of hepatic perfusion therapy. In particular, the influence of tumor characteristics-tics on the optimum choice of imaging technique will be demonstrated.
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Affiliation(s)
- M Prokop
- Medizinische Hochschule Hannover, Germany
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Brinkmann G, Melchert UH, Lalk G, Emde L, Link J, Muhle C, Steffens JC, Heller M. The total entropy for evaluating 31P-magnetic resonance spectra of the liver in healthy volunteers and patients with metastases. Invest Radiol 1997; 32:100-4. [PMID: 9039582 DOI: 10.1097/00004424-199702000-00005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
RATIONALE AND OBJECTIVES The authors describe the clinical status of liver tissue with only a single numerical quantity (total entropy) derived from spectroscopic data of 31P-magnetic resonance (MR) spectra. METHODS Twenty-four patients with liver metastases and 20 volunteers were investigated with image-guided volume selective 31P-MR spectroscopy on a 1.5-T whole body scanner. From each in vivo 31P-MR spectrum, the ratios of phosphomonoester (PME)/beta-adenosine triphosphate (ATP), inorganic phosphate (Pi)/beta-ATP and phosphodiester (PDE)/ beta-ATP and the total entropy (H*) were calculated. Mean values and standard deviations were determined and significance of the differences were tested with Student's t test. RESULTS For patients, the H* = 4.7 +/- 4.3, PME/beta-ATP 0.72 +/- 0.28, Pi/beta-ATP = 1.00 +/- 0.39, PDE/beta-ATP = 1.68 +/- 0.59. For the volunteers, H* = 7.6 +/- 2.5, PME/beta-ATP = 0.39 +/- 0.15, Pi/beta-ATP = 0.90 +/- 0.19, PDE/beta-ATP = 1.25 +/- 0.28. The total entropy of patients' spectra showed significantly lower values compared with those of volunteers. PME/beta-ATP and PDE/beta-ATP of the patients increased and differed significantly from volunteer data. CONCLUSIONS It was demonstrated that the results of in vivo 31P-MR spectroscopy may be described with a single criterion by means of the total entropy.
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Affiliation(s)
- G Brinkmann
- Department of Diagnostic Radiology, Christian-Albrechts-University of Kiel, Germany
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Vallée JP, Hiltbrand E, Zimmermann H, Lazeyras F, Binzoni T, Howarth N, Zimmermann A, Reichen J, Terrier F. Dynamic phosphorus-31 spectroscopy after fructose load in experimental biliary liver cirrhosis. Acad Radiol 1997; 4:26-34. [PMID: 9040867 DOI: 10.1016/s1076-6332(97)80158-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
RATIONALE AND OBJECTIVES The authors investigated the usefulness of dynamic phosphorus-31 magnetic resonance (MR) spectroscopy in the assessment of hepatic function by studying the effect of a fructose load on a rat model of liver cirrhosis. METHODS In vivo P-31 MR liver spectra of eight rats with bile duct ligature and 10 control rats were obtained every 4.6 minutes before and after intraperitoneal fructose load (10 mmol per kilogram of body weight). RESULTS In the basal spectra of the experimental group, the phosphomonoester peak was higher than in the control group (P = .026). After the fructose load, the phosphomonoester peak increase and the inorganic phosphate peak decrease were significantly less marked in the experimental group (P = .003). There was a linear correlation between the serum level of bilirubin and the phosphomonoester increase (r = .61, P < .001). CONCLUSION Dynamic P-31 MR spectroscopy may be useful in the assessment of hepatic function in chronic liver disease.
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Affiliation(s)
- J P Vallée
- Department of Radiology, University of Geneva, Switzerland
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Li CW, Negendank WG, Murphy-Boesch J, Padavic-Shaller K, Brown TR. Molar quantitation of hepatic metabolites in vivo in proton-decoupled, nuclear Overhauser effect enhanced 31P NMR spectra localized by three-dimensional chemical shift imaging. NMR IN BIOMEDICINE 1996; 9:141-155. [PMID: 9015801 DOI: 10.1002/(sici)1099-1492(199606)9:4<141::aid-nbm403>3.0.co;2-p] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Proton decoupling and nuclear Overhauser effect (NOE) enhancement significantly improve the signal-to-noise ratio and enhance resolution of metabolites in in vivo 31P MRS. We obtained proton-decoupled, NOE-enhanced, phospholipid-saturated 31P spectra localized to defined regions within the normal liver using three-dimensional chemical shift imaging. Proton-decoupling resulted in the resolution of two major peaks in the phosphomonoester (PME) region, three peaks in the phosphodiester (PDE) region and a diphosphodiester peak. In order to obtain molar quantitation, we measured the NOE of all hepatic phosphorus resonances, and we corrected for saturation effects by measuring hepatic metabolite T1 using the variable nutation angle method with phase-cycled, B1-independent rotation, adiabatic pulses. After corrections for saturation effects, NOE enhancement, B1 variations and point spread effects, the following mean concentrations (mmol/l of liver) (+/-SD) were obtained: [PME1] = 1.2 +/- 0.4, [PME2 + 2,3-DPG] = 1.1 +/- 0.1, [Pi + 2,3-DPG] = 2.8 +/- 0.5, [GPEth] = 2.8 +/- 0.7, [GPChol] = 3.5 +/- 0.6 and [beta-NTP] = 3.8 +/- 0.3. T1 and NOE enhancement were strongly correlated (r = 90), and indicated that the fractional contribution of 1H-31P dipolar relaxation to total 31P relaxation is minimal for NTPs, moderate for PMEs and high for PDEs in liver. Proton-decoupling and NOE enhancement permit one to obtain more information about in vivo metabolism of liver than previously available and should enhance the utility of 31P MRS for the study of hepatic disorders.
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Affiliation(s)
- C W Li
- Department of Nuclear Magnetic Resonance and Medical Spectroscopy, Fox Chase Cancer Center, Philadelphia, PA 19111, USA
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Brinkmann G, Melchert UH, Muhle C, Brossmann J, Link J, Reuter M, Heller M. Influence of different fasting periods on P-31-MR-spectroscopy of the liver in normals and patients with liver metastases. Eur Radiol 1996; 6:62-5. [PMID: 8797952 DOI: 10.1007/bf00619955] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The purpose of this study was to determine the influence of different fasting periods on the in vivo P-31-MR spectroscopy of the healthy liver and patients with liver metastases. Image-guided localized P-31-MRS was performed in 24 patients with liver metastases and in 20 healthy volunteers. The spectra were obtained with a whole body scanner operating at 1.5 T using a surface coil. The P-31-MRS was performed after a fasting period of 3-5 h (group 1) and after overnight fasting (group 2). The PME/beta-NTP, PDE/beta-NTP and Pi/beta-NTP were calculated from P-31-MR spectra and were compared in relation to the nutrition status of the volunteers and patients. The PME/beta-NTP and PDE/beta-NTP were significantly increased in spectra of patients with metastases. There were no significant changes in the ratios of phosphorus metabolites in healthy liver tissue or in liver metastases after a fasting period of 3-5 h as compared with overnight fasting.
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Affiliation(s)
- G Brinkmann
- Department of Diagnostic Radiology, Christian-Albrechts-University of Kiel, Germany
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Abstract
The literature describing 31P, 1H, 13C, 23Na and 19F MRS in vivo in human cancers is reviewed. Cancers have typical metabolic characteristics in 31P and 1H MRS including high levels of phospholipid metabolites and a cellular pH more alkaline than normal. These alone are not specific for cancer but are diagnostic in appropriate clinical settings. Some metabolic characteristics appear to be prognostic indices and correlation with treatment response is emerging as an important potentially cost-effective use of MRS in oncology. 19F MRS examines pharmacokinetics of 5-fluorouracil and by demonstrating its retention predicts response of a cancer to treatment. Current needs include improvement of diagnostic specificity by use of techniques like multivoxel MRS, proton decoupling of 31P, short echo time and fat-suppressed 1H MRS, 13C MRS direct or via 1H-observe, and statistical analysis of multiple spectral features. Trials in large populations in well defined clinical settings are needed to determine if MRS can provide independent prognostic indices useful in cancer management.
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Affiliation(s)
- W Negendank
- Department of NMR and Medical Spectroscopy, Fox Chase Cancer Center, Philadelphia, PA 19111
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