1
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Gill SK, Rose HEL, Wilson M, Rodriguez Gutierrez D, Worthington L, Davies NP, MacPherson L, Hargrave DR, Saunders DE, Clark CA, Payne GS, Leach MO, Howe FA, Auer DP, Jaspan T, Morgan PS, Grundy RG, Avula S, Pizer B, Arvanitis TN, Peet AC. Characterisation of paediatric brain tumours by their MRS metabolite profiles. NMR IN BIOMEDICINE 2024; 37:e5101. [PMID: 38303627 DOI: 10.1002/nbm.5101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 11/20/2023] [Accepted: 12/04/2023] [Indexed: 02/03/2024]
Abstract
1H-magnetic resonance spectroscopy (MRS) has the potential to improve the noninvasive diagnostic accuracy for paediatric brain tumours. However, studies analysing large, comprehensive, multicentre datasets are lacking, hindering translation to widespread clinical practice. Single-voxel MRS (point-resolved single-voxel spectroscopy sequence, 1.5 T: echo time [TE] 23-37 ms/135-144 ms, repetition time [TR] 1500 ms; 3 T: TE 37-41 ms/135-144 ms, TR 2000 ms) was performed from 2003 to 2012 during routine magnetic resonance imaging for a suspected brain tumour on 340 children from five hospitals with 464 spectra being available for analysis and 281 meeting quality control. Mean spectra were generated for 13 tumour types. Mann-Whitney U-tests and Kruskal-Wallis tests were used to compare mean metabolite concentrations. Receiver operator characteristic curves were used to determine the potential for individual metabolites to discriminate between specific tumour types. Principal component analysis followed by linear discriminant analysis was used to construct a classifier to discriminate the three main central nervous system tumour types in paediatrics. Mean concentrations of metabolites were shown to differ significantly between tumour types. Large variability existed across each tumour type, but individual metabolites were able to aid discrimination between some tumour types of importance. Complete metabolite profiles were found to be strongly characteristic of tumour type and, when combined with the machine learning methods, demonstrated a diagnostic accuracy of 93% for distinguishing between the three main tumour groups (medulloblastoma, pilocytic astrocytoma and ependymoma). The accuracy of this approach was similar even when data of marginal quality were included, greatly reducing the proportion of MRS excluded for poor quality. Children's brain tumours are strongly characterised by MRS metabolite profiles readily acquired during routine clinical practice, and this information can be used to support noninvasive diagnosis. This study provides both key evidence and an important resource for the future use of MRS in the diagnosis of children's brain tumours.
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Affiliation(s)
- Simrandip K Gill
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Heather E L Rose
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Martin Wilson
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
| | | | - Lara Worthington
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
- Department of Imaging and Medical Physics, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Nigel P Davies
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
- Department of Imaging and Medical Physics, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Darren R Hargrave
- Paediatric Oncology Unit, Great Ormond Street Hospital For Sick Children, London, UK
| | - Dawn E Saunders
- Paediatric Oncology Unit, Great Ormond Street Hospital For Sick Children, London, UK
| | - Christopher A Clark
- Developmental Imaging and Biophysics Section, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Geoffrey S Payne
- CRUK Cancer Imaging Centre, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - Martin O Leach
- CRUK Cancer Imaging Centre, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - Franklyn A Howe
- Neurosciences Research Section, Molecular and Clinical Sciences Research Institute, St George's, University of London, London, UK
| | - Dorothee P Auer
- The Children's Brain Tumour Research Centre, University of Nottingham, Nottingham, UK
- Radiological Sciences, Department of Clinical Neuroscience, University of Nottingham, Nottingham, UK
- Neuroradiology, Nottingham University Hospital, Queen's Medical Centre, Nottingham, UK
| | - Tim Jaspan
- The Children's Brain Tumour Research Centre, University of Nottingham, Nottingham, UK
- Neuroradiology, Nottingham University Hospital, Queen's Medical Centre, Nottingham, UK
| | - Paul S Morgan
- Medical Physics, Nottingham University Hospital, Queen's Medical Centre, Nottingham, UK
- The Children's Brain Tumour Research Centre, University of Nottingham, Nottingham, UK
| | - Richard G Grundy
- The Children's Brain Tumour Research Centre, University of Nottingham, Nottingham, UK
| | - Shivaram Avula
- Department of Radiology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Barry Pizer
- Department of Paediatric Oncology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Theodoros N Arvanitis
- Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
- Department of Electronic, Electrical and Systems Engineering, University of Birmingham, Birmingham, UK
| | - Andrew C Peet
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
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2
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Proton MR Spectroscopy of Pediatric Brain Disorders. Diagnostics (Basel) 2022; 12:diagnostics12061462. [PMID: 35741272 PMCID: PMC9222059 DOI: 10.3390/diagnostics12061462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/07/2022] [Accepted: 06/08/2022] [Indexed: 11/17/2022] Open
Abstract
In vivo MR spectroscopy is a non -invasive methodology that provides information about the biochemistry of tissues. It is available as a “push-button” application on state-of-the-art clinical MR scanners. MR spectroscopy has been used to study various brain diseases including tumors, stroke, trauma, degenerative disorders, epilepsy/seizures, inborn errors, neuropsychiatric disorders, and others. The purpose of this review is to provide an overview of MR spectroscopy findings in the pediatric population and its clinical use.
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3
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Zhao D, Grist JT, Rose HEL, Davies NP, Wilson M, MacPherson L, Abernethy LJ, Avula S, Pizer B, Gutierrez DR, Jaspan T, Morgan PS, Mitra D, Bailey S, Sawlani V, Arvanitis TN, Sun Y, Peet AC. Metabolite selection for machine learning in childhood brain tumour classification. NMR IN BIOMEDICINE 2022; 35:e4673. [PMID: 35088473 DOI: 10.1002/nbm.4673] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 12/01/2021] [Accepted: 12/02/2021] [Indexed: 06/14/2023]
Abstract
MRS can provide high accuracy in the diagnosis of childhood brain tumours when combined with machine learning. A feature selection method such as principal component analysis is commonly used to reduce the dimensionality of metabolite profiles prior to classification. However, an alternative approach of identifying the optimal set of metabolites has not been fully evaluated, possibly due to the challenges of defining this for a multi-class problem. This study aims to investigate metabolite selection from in vivo MRS for childhood brain tumour classification. Multi-site 1.5 T and 3 T cohorts of patients with a brain tumour and histological diagnosis of ependymoma, medulloblastoma and pilocytic astrocytoma were retrospectively evaluated. Dimensionality reduction was undertaken by selecting metabolite concentrations through multi-class receiver operating characteristics and compared with principal component analysis. Classification accuracy was determined through leave-one-out and k-fold cross-validation. Metabolites identified as crucial in tumour classification include myo-inositol (P < 0.05, AUC = 0 . 81 ± 0 . 01 ), total lipids and macromolecules at 0.9 ppm (P < 0.05, AUC = 0 . 78 ± 0 . 01 ) and total creatine (P < 0.05, AUC = 0 . 77 ± 0 . 01 ) for the 1.5 T cohort, and glycine (P < 0.05, AUC = 0 . 79 ± 0 . 01 ), total N-acetylaspartate (P < 0.05, AUC = 0 . 79 ± 0 . 01 ) and total choline (P < 0.05, AUC = 0 . 75 ± 0 . 01 ) for the 3 T cohort. Compared with the principal components, the selected metabolites were able to provide significantly improved discrimination between the tumours through most classifiers (P < 0.05). The highest balanced classification accuracy determined through leave-one-out cross-validation was 85% for 1.5 T 1 H-MRS through support vector machine and 75% for 3 T 1 H-MRS through linear discriminant analysis after oversampling the minority. The study suggests that a group of crucial metabolites helps to achieve better discrimination between childhood brain tumours.
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Affiliation(s)
- Dadi Zhao
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Oncology, Birmingham Children's Hospital, Birmingham, UK
| | - James T Grist
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Oncology, Birmingham Children's Hospital, Birmingham, UK
| | - Heather E L Rose
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Oncology, Birmingham Children's Hospital, Birmingham, UK
| | - Nigel P Davies
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Oncology, Birmingham Children's Hospital, Birmingham, UK
- Imaging and Medical Physics, University Hospitals Birmingham, Birmingham, UK
| | - Martin Wilson
- Centre for Human Brain Health, University of Birmingham, Birmingham, UK
| | | | | | | | - Barry Pizer
- Paediatric Oncology, Alder Hey Children's Hospital, Liverpool, UK
| | - Daniel R Gutierrez
- Children's Brain Tumour Research Centre, University of Nottingham, Nottingham, UK
- Medical Physics, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Tim Jaspan
- Children's Brain Tumour Research Centre, University of Nottingham, Nottingham, UK
- Neuroradiology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Paul S Morgan
- Children's Brain Tumour Research Centre, University of Nottingham, Nottingham, UK
- Medical Physics, Nottingham University Hospitals NHS Trust, Nottingham, UK
- Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Dipayan Mitra
- Neuroradiology, The Newcastle upon Tyne Hospitals, Newcastle upon Tyne, UK
| | - Simon Bailey
- Paediatric Oncology, Great North Children's Hospital, Newcastle upon Tyne, UK
| | - Vijay Sawlani
- Radiology, Queen Elizabeth Hospital Birmingham, Birmingham, UK
- School of Psychology, University of Birmingham, Birmingham, UK
| | - Theodoros N Arvanitis
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Oncology, Birmingham Children's Hospital, Birmingham, UK
- Institute of Digital Healthcare, WMG, University of Warwick, Coventry, UK
| | - Yu Sun
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Oncology, Birmingham Children's Hospital, Birmingham, UK
- University of Birmingham and Southeast University Joint Research Centre for Biomedical Engineering, Suzhou, China
| | - Andrew C Peet
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Oncology, Birmingham Children's Hospital, Birmingham, UK
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McGee KP, Hwang KP, Sullivan DC, Kurhanewicz J, Hu Y, Wang J, Li W, Debbins J, Paulson E, Olsen JR, Hua CH, Warner L, Ma D, Moros E, Tyagi N, Chung C. Magnetic resonance biomarkers in radiation oncology: The report of AAPM Task Group 294. Med Phys 2021; 48:e697-e732. [PMID: 33864283 PMCID: PMC8361924 DOI: 10.1002/mp.14884] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 03/24/2021] [Accepted: 03/28/2021] [Indexed: 12/16/2022] Open
Abstract
A magnetic resonance (MR) biologic marker (biomarker) is a measurable quantitative characteristic that is an indicator of normal biological and pathogenetic processes or a response to therapeutic intervention derived from the MR imaging process. There is significant potential for MR biomarkers to facilitate personalized approaches to cancer care through more precise disease targeting by quantifying normal versus pathologic tissue function as well as toxicity to both radiation and chemotherapy. Both of which have the potential to increase the therapeutic ratio and provide earlier, more accurate monitoring of treatment response. The ongoing integration of MR into routine clinical radiation therapy (RT) planning and the development of MR guided radiation therapy systems is providing new opportunities for MR biomarkers to personalize and improve clinical outcomes. Their appropriate use, however, must be based on knowledge of the physical origin of the biomarker signal, the relationship to the underlying biological processes, and their strengths and limitations. The purpose of this report is to provide an educational resource describing MR biomarkers, the techniques used to quantify them, their strengths and weakness within the context of their application to radiation oncology so as to ensure their appropriate use and application within this field.
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Affiliation(s)
- Kiaran P McGee
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Ken-Pin Hwang
- Department of Imaging Physics, Division of Diagnostic Imaging, MD Anderson Cancer Center, University of Texas, Houston, Texas, USA
| | - Daniel C Sullivan
- Department of Radiology, Duke University, Durham, North Carolina, USA
| | - John Kurhanewicz
- Department of Radiology, University of California, San Francisco, California, USA
| | - Yanle Hu
- Department of Radiation Oncology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Jihong Wang
- Department of Radiation Oncology, MD Anderson Cancer Center, University of Texas, Houston, Texas, USA
| | - Wen Li
- Department of Radiation Oncology, University of Arizona, Tucson, Arizona, USA
| | - Josef Debbins
- Department of Radiology, Barrow Neurologic Institute, Phoenix, Arizona, USA
| | - Eric Paulson
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jeffrey R Olsen
- Department of Radiation Oncology, University of Colorado Denver - Anschutz Medical Campus, Denver, Colorado, USA
| | - Chia-Ho Hua
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | | | - Daniel Ma
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Eduardo Moros
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Neelam Tyagi
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Caroline Chung
- Department of Radiation Oncology, MD Anderson Cancer Center, University of Texas, Houston, Texas, USA
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Carlin D, Babourina-Brooks B, Arvanitis TN, Wilson M, Peet AC. Short-acquisition-time JPRESS and its application to paediatric brain tumours. MAGMA (NEW YORK, N.Y.) 2019; 32:247-258. [PMID: 30460431 PMCID: PMC6424926 DOI: 10.1007/s10334-018-0716-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 10/26/2018] [Accepted: 10/29/2018] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To develop and assess a short-duration JPRESS protocol for detection of overlapping metabolite biomarkers and its application to paediatric brain tumours at 3 Tesla. MATERIALS AND METHODS The short-duration protocol (6 min) was optimised and compared for spectral quality to a high-resolution (38 min) JPRESS protocol in a phantom and five healthy volunteers. The 6-min JPRESS was acquired from four paediatric brain tumours and compared with short-TE PRESS. RESULTS Metabolite identification between the 6- and 38-min protocols was comparable in phantom and volunteer data. For metabolites with Cramer-Rao lower bounds > 50%, interpretation of JPRESS increased confidence in assignment of lactate, myo-Inositol and scyllo-Inositol. JPRESS also showed promise for the detection of glycine and taurine in paediatric brain tumours when compared to short-TE MRS. CONCLUSION A 6-min JPRESS protocol is well tolerated in paediatric brain tumour patients. Visual inspection of a 6-min JPRESS spectrum enables identification of a range of metabolite biomarkers of clinical interest.
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Affiliation(s)
- Dominic Carlin
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, West Midlands, UK
- Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, West Midlands, UK
| | - Ben Babourina-Brooks
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, West Midlands, UK
- Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, West Midlands, UK
| | - Theodoros N Arvanitis
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, West Midlands, UK
- Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, West Midlands, UK
- Institute of Digital Healthcare, WMG, University of Warwick, Coventry, UK
| | - Martin Wilson
- Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, West Midlands, UK
- Centre for Human Brain Health, School of Psychology, University of Birmingham, Birmingham, West Midlands, UK
| | - Andrew C Peet
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, West Midlands, UK.
- Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, West Midlands, UK.
- Clinical Research Block, Institute of Child Health, Whittall Street, Birmingham, B4 6NH, UK.
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de Blank P, Badve C, Gold DR, Stearns D, Sunshine J, Dastmalchian S, Tomei K, Sloan AE, Barnholtz-Sloan JS, Lane A, Griswold M, Gulani V, Ma D. Magnetic Resonance Fingerprinting to Characterize Childhood and Young Adult Brain Tumors. Pediatr Neurosurg 2019; 54:310-318. [PMID: 31416081 DOI: 10.1159/000501696] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 06/23/2019] [Indexed: 11/19/2022]
Abstract
OBJECT Magnetic resonance fingerprinting (MRF) allows rapid, simultaneous mapping of T1 and T2 relaxation times and may be an important diagnostic tool to measure tissue characteristics in pediatric brain tumors. We examined children and young adults with primary brain tumors to determine whether MRF can discriminate tumor from normal-appearing white matter and distinguish tumor grade. METHODS MRF was performed in 23 patients (14 children and 9 young adults) with brain tumors (19 low-grade glioma, 4 high-grade tumors). T1 and T2 values were recorded in regions of solid tumor (ST), peritumoral white matter (PWM), and contralateral white matter (CWM). Nonparametric tests were used for comparison between groups and regions. RESULTS Median scan time for MRF and a sequence for tumor localization was 11 min. MRF-derived T1 and T2 values distinguished ST from CWM (T1: 1,444 ± 254 ms vs. 938 ± 96 ms, p = 0.0002; T2: 61 ± 22 ms vs. 38 ± 9 ms, p = 0.0003) and separated high-grade tumors from low-grade tumors (T1: 1,863 ± 70 ms vs. 1,355 ± 187 ms, p = 0.007; T2: 90 ± 13 ms vs. 56 ± 19 ms, p = 0.013). PWM was distinct from CWM (T1: 1,261 ± 359 ms vs. 933 ± 104 ms, p = 0.0008; T2: 65 ± 51 ms vs. 38 ± 8 ms, p = 0.008), as well as from tumor (T1: 1,261 ± 371 ms vs. 1,462 ± 248 ms, p = 0.047). CONCLUSIONS MRF is a fast sequence that can rapidly distinguish important tissue components in pediatric brain tumor patients. MRF-derived T1 and T2 distinguished tumor from normal-appearing white matter, differentiated tumor grade, and found abnormalities in peritumoral regions. MRF may be useful for rapid quantitative measurement of tissue characteristics and distinguish tumor grade in children and young adults with brain tumors.
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Affiliation(s)
- Peter de Blank
- Department of Pediatrics, University of Cincinnati and the Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA,
| | - Chaitra Badve
- Department of Radiology, University Hospitals Cleveland, Cleveland, Ohio, USA
| | - Deborah Rukin Gold
- Department of Neurology, University Hospitals Cleveland, Cleveland, Ohio, USA
| | - Duncan Stearns
- Department of Pediatrics, University Hospitals Cleveland, Cleveland, Ohio, USA
| | - Jeffrey Sunshine
- Department of Radiology, University Hospitals Cleveland, Cleveland, Ohio, USA
| | - Sara Dastmalchian
- Department of Radiology, University Hospitals Cleveland, Cleveland, Ohio, USA
| | - Krystal Tomei
- Department of Neurosurgery, University Hospitals Cleveland, Cleveland, Ohio, USA
| | - Andrew E Sloan
- Department of Neurosurgery, University Hospitals Cleveland, Cleveland, Ohio, USA.,Case Comprehensive Cancer Center, Cleveland, Ohio, USA
| | - Jill S Barnholtz-Sloan
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.,Case Comprehensive Cancer Center, Cleveland, Ohio, USA
| | - Adam Lane
- Department of Pediatrics, University of Cincinnati and the Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Mark Griswold
- Department of Radiology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Vikas Gulani
- Department of Radiology, University Hospitals Cleveland, Cleveland, Ohio, USA
| | - Dan Ma
- Department of Radiology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
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Manias KA, Peet A. What is MR spectroscopy? Arch Dis Child Educ Pract Ed 2018; 103:213-216. [PMID: 28844055 DOI: 10.1136/archdischild-2017-312839] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 07/03/2017] [Accepted: 07/17/2017] [Indexed: 11/03/2022]
Abstract
1H-Magnetic Resonance Spectroscopy (MRS) is a novel advanced imaging technique used as an adjunct to MRI to reveal complementary non-invasive information about the biochemical composition of imaged tissue. Clinical uses in paediatrics include aiding diagnosis of brain tumours, neonatal disorders such as hypoxic-ischaemic encephalopathy, inherited metabolic diseases, traumatic brain injury, demyelinating conditions and infectious brain lesions. MRS has potential to improve diagnosis and treatment monitoring of childhood brain tumours and other CNS diseases, facilitate biopsy and surgical planning, and provide prognostic biomarkers. MRS is employed as a research tool outside the brain in liver disease and disorders of muscle metabolism. The range of clinical uses is likely to increase with growing evidence for added value. Multicentre trials are needed to definitively establish the benefits of MRS in specific clinical scenarios and integrate this promising new technique into routine practice to improve patient care. This article gives a brief overview of MRS and its potential clinical applications, and addresses challenges surrounding translation into practice.
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Affiliation(s)
- Karen Angela Manias
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, West Midlands, UK.,Department of Paediatric Oncology, Birmingham Children's Hospital, Birmingham, West Midlands, UK
| | - Andrew Peet
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, West Midlands, UK.,Department of Paediatric Oncology, Birmingham Children's Hospital, Birmingham, West Midlands, UK
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Gaudino S, Martucci M, Russo R, Visconti E, Gangemi E, D'Argento F, Verdolotti T, Lauriola L, Colosimo C. MR imaging of brain pilocytic astrocytoma: beyond the stereotype of benign astrocytoma. Childs Nerv Syst 2017; 33:35-54. [PMID: 27757570 DOI: 10.1007/s00381-016-3262-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 10/03/2016] [Indexed: 01/21/2023]
Abstract
BACKGROUND Pilocytic astrocytoma (PA) is the most common pediatric brain glioma and is considered the prototype of benign circumscribed astrocytoma. Despite its low malignancy, the CT and MRI features of brain PA may resemble those of much more aggressive brain tumors. Misdiagnosis of PA is particularly easy when it demonstrates MR morphological and non-morphological findings that are inconsistent with its non-aggressive nature and that overlap with the features of more aggressive brain tumors. METHOD Basing on the evidence that the variation in the histological, genetic, and metabolic "fingerprint" for brain PA is dependent on tumor location, and the hypothesis that tumor location is related to the broad spectrum of morphological and non-morphological MR imaging findings, the authors discuss the MR imaging appearance of brain PA using a location-based approach to underline the typical and less typical imaging features and the main differential diagnosis of brain PA. A brief summary of the main pathological and clinical features, the natural history, and the treatment of brain PA is also provided. RESULT A combination of morphological and non-morphological MR imaging features and a site-based approach to differential diagnosis are required for a pre-operative diagnosis. The new "cutting-edge" MR imaging sequences have the potential to impact the ease and confidence of pediatric brain tumor interpretation and offer a more efficient diagnostic work-up. CONCLUSIONS Although the typical imaging features of brain pilocytic astrocytoma make radiological diagnosis relatively easy, an atypical and more aggressive appearance can lead to misdiagnosis. Knowing the broad spectrum of imaging characteristics on conventional and advanced MR imaging is important for accurate pre-operative radiological diagnosis and correctly interpreting changes during follow-up.
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Affiliation(s)
- Simona Gaudino
- Institute of Radiology, Fondazione Policlinico Universitario Agostino Gemelli, Largo A. Gemelli, 1, 00168, Rome, Italy.
| | - Matia Martucci
- Institute of Radiology, Fondazione Policlinico Universitario Agostino Gemelli, Largo A. Gemelli, 1, 00168, Rome, Italy
| | - Rosellina Russo
- Institute of Radiology, Fondazione Policlinico Universitario Agostino Gemelli, Largo A. Gemelli, 1, 00168, Rome, Italy
| | - Emiliano Visconti
- Institute of Radiology, Fondazione Policlinico Universitario Agostino Gemelli, Largo A. Gemelli, 1, 00168, Rome, Italy
| | - Emma Gangemi
- Institute of Radiology, Fondazione Policlinico Universitario Agostino Gemelli, Largo A. Gemelli, 1, 00168, Rome, Italy
| | - Francesco D'Argento
- Institute of Radiology, Fondazione Policlinico Universitario Agostino Gemelli, Largo A. Gemelli, 1, 00168, Rome, Italy
| | - Tommaso Verdolotti
- Institute of Radiology, Fondazione Policlinico Universitario Agostino Gemelli, Largo A. Gemelli, 1, 00168, Rome, Italy
| | - Libero Lauriola
- Institute of Pathological Anatomy, Fondazione Policlinico Universitario Agostino Gemelli, Largo A. Gemelli, 1, 00168, Rome, Italy
| | - Cesare Colosimo
- Institute of Radiology, Fondazione Policlinico Universitario Agostino Gemelli, Largo A. Gemelli, 1, 00168, Rome, Italy
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9
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Manias KA, Gill SK, MacPherson L, Foster K, Oates A, Peet AC. Magnetic resonance imaging based functional imaging in paediatric oncology. Eur J Cancer 2016; 72:251-265. [PMID: 28011138 DOI: 10.1016/j.ejca.2016.10.037] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 09/26/2016] [Accepted: 10/30/2016] [Indexed: 12/16/2022]
Abstract
Imaging is central to management of solid tumours in children. Conventional magnetic resonance imaging (MRI) is the standard imaging modality for tumours of the central nervous system (CNS) and limbs and is increasingly used in the abdomen. It provides excellent structural detail, but imparts limited information about tumour type, aggressiveness, metastatic potential or early treatment response. MRI based functional imaging techniques, such as magnetic resonance spectroscopy, diffusion and perfusion weighted imaging, probe tissue properties to provide clinically important information about metabolites, structure and blood flow. This review describes the role of and evidence behind these functional imaging techniques in paediatric oncology and implications for integrating them into routine clinical practice.
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Affiliation(s)
- Karen A Manias
- Institute of Cancer and Genomic Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK; Department of Paediatric Oncology, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK.
| | - Simrandip K Gill
- Institute of Cancer and Genomic Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK; Department of Paediatric Oncology, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK.
| | - Lesley MacPherson
- Department of Radiology, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK.
| | - Katharine Foster
- Department of Radiology, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK.
| | - Adam Oates
- Department of Radiology, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK.
| | - Andrew C Peet
- Institute of Cancer and Genomic Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK; Department of Paediatric Oncology, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK.
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10
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Gill SK, Wilson M, Davies NP, MacPherson L, English M, Arvanitis TN, Peet AC. Diagnosing relapse in children's brain tumors using metabolite profiles. Neuro Oncol 2013; 16:156-64. [PMID: 24305716 DOI: 10.1093/neuonc/not143] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Malignant brain tumors in children generally have a very poor prognosis when they relapse and improvements are required in their management. It can be difficult to accurately diagnose abnormalities detected during tumor surveillance, and new techniques are required to aid this process. This study investigates how metabolite profiles measured noninvasively by (1)H magnetic resonance spectroscopy (MRS) at relapse reflect those at diagnosis and may be used in this monitoring process. METHODS Single-voxel MRS (1.5 T, point-resolved spectroscopy, echo time 30 ms, repetition time 1500 ms was performed on 19 children with grades II-IV brain tumors during routine MRI scans prior to treatment for a suspected brain tumor and at suspected first relapse. MRS was analyzed using TARQUIN software to provide metabolite concentrations. Paired Student's t-tests were performed between metabolite profiles at diagnosis and at first relapse. RESULTS There was no significant difference (P > .05) in the level of any metabolite, lipid, or macromolecule from tumors prior to treatment and at first relapse. This was true for the whole group (n = 19), those with a local relapse (n = 12), and those with a distant relapse (n = 7). Lipids at 1.3 ppm were close to significance when comparing the level at diagnosis with that at distant first relapse (P = .07, 6.5 vs 12.9). In 5 cases the MRS indicative of tumor preceded a formal diagnosis of relapse. CONCLUSIONS Tumor metabolite profiles, measured by MRS, do not change greatly from diagnosis to first relapse, and this can aid the confirmation of the presence of tumor.
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Affiliation(s)
- Simrandip K Gill
- Corresponding author: Andrew C. Peet, MRCPCH, PhD, Institute of Child Health, Clinical Research Block, Whittall Street, Birmingham B4 6NH, UK.
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Orphanidou-Vlachou E, Auer D, Brundler M, Davies N, Jaspan T, MacPherson L, Natarajan K, Sun Y, Arvanitis T, Grundy R, Peet A. 1H magnetic resonance spectroscopy in the diagnosis of paediatric low grade brain tumours. Eur J Radiol 2013; 82:e295-301. [DOI: 10.1016/j.ejrad.2013.01.030] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Revised: 01/13/2013] [Accepted: 01/29/2013] [Indexed: 11/26/2022]
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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.
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Affiliation(s)
- Lara A Brandão
- Clínica Felippe Mattoso, Barra Da Tijuca, Rio De Janeiro, Brazil.
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13
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Potential of MR spectroscopy for assessment of glioma grading. Clin Neurol Neurosurg 2012; 115:146-53. [PMID: 23237636 DOI: 10.1016/j.clineuro.2012.11.002] [Citation(s) in RCA: 131] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Revised: 10/21/2012] [Accepted: 11/07/2012] [Indexed: 11/23/2022]
Abstract
BACKGROUND Magnetic resonance spectroscopy (MRS) is an imaging diagnostic method based that allows non-invasive measurement of metabolites in tissues. There are a number of metabolites that can be identified by standard brain proton MRS but only a few of them has a clinical significance in diagnosis of gliomas including N-acetylaspartate, choline, creatine, myo-inositol, lactate, and lipids. METHODS In this review, we describe potential of MRS for grading of gliomas. RESULTS Low-grade gliomas are generally characterized by a relatively high concentration of N-acetylaspartate, low level of choline and absence of lactate and lipids. The increase in creatine concentration indicates low-grade gliomas with earlier progression and malignant transformation. Progression in grade of a glioma is reflected in the progressive decrease in the N-acetylaspartate and myo-inositol levels on the one hand and elevation in choline level up to grade III on the other. Malignant transformation of the glial tumors is also accompanied by the presence of lactate and lipids in MR spectra of grade III but mainly grade IV gliomas. It follows that MRS is a helpful method for detection of glioma regions with aggressive growth or upgrading due to favorable correlation of the choline and N-acetylaspartate levels with histopathological proliferation index Ki-67. Thus, magnetic resonance spectroscopy is also a suitable method for the targeting of brain biopsies. CONCLUSIONS Gliomas of each grade have some specific MRS features that can be used for improvement of the diagnostic value of conventional magnetic resonance imaging in non-invasive assessment of glioma grade.
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Abstract
Imaging is a key component in the management of brain tumours, with MRI being the preferred modality for most clinical scenarios. However, although conventional MRI provides mainly structural information, such as tumour size and location, it leaves many important clinical questions, such as tumour type, aggressiveness and prognosis, unanswered. An increasing number of studies have shown that additional information can be obtained using functional imaging methods (which probe tissue properties), and that these techniques can give key information of clinical importance. These techniques include diffusion imaging, which can assess tissue structure, and perfusion imaging and magnetic resonance spectroscopy, which measures tissue metabolite profiles. Tumour metabolism can also be investigated using PET, with 18F-deoxyglucose being the most readily available tracer. This Review discusses these methods and the studies that have investigated their clinical use. A strong emphasis is placed on the measurement of quantitative parameters, which is a move away from the qualitative nature of conventional radiological reporting and presents major challenges, particularly for multicentre studies.
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Kauppinen RA, Peet AC. Using magnetic resonance imaging and spectroscopy in cancer diagnostics and monitoring: preclinical and clinical approaches. Cancer Biol Ther 2012; 12:665-79. [PMID: 22004946 DOI: 10.4161/cbt.12.8.18137] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Nuclear Magnetic Resonance (MR) based imaging has become an integrated domain in today's oncology research and clinical management of cancer patients. MR is a unique imaging modality among numerous other imaging modalities by providing access to anatomical, physiological, biochemical and molecular details of tumour with excellent spatial and temporal resolutions. In this review we will cover established and investigational MR imaging (MRI) and MR spectroscopy (MRS) techniques used for cancer imaging and demonstrate wealth of information on tumour biology and clinical applications MR techniques offer for oncology research both in preclinical and clinical settings. Emphasis is given not only to the variety of information which may be obtained but also the complementary nature of the techniques. This ability to determine tumour type, grade, invasiveness, degree of hypoxia, microvacular characteristics, and metabolite phenotype, has already profoundly transformed oncology research and patient management. It is evident from the data reviewed that MR techniques will play a key role in uncovering molecular fingerprints of cancer, developing targeted treatment strategies and assessing responsiveness to treatment for personalized patient management, thereby allowing rapid translation of imaging research conclusions into the benefit of clinical oncology.
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Sridhar K, Sridhar R, Venkatprasanna G. Management of posterior fossa gliomas in children. J Pediatr Neurosci 2011; 6:S72-7. [PMID: 22069433 PMCID: PMC3208911 DOI: 10.4103/1817-1745.85714] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Brain tumours form the most common type of solid tumour in children and more that 50% of these are infratentorial. Cerebellar astrocytomas and brain stem gliomas are the commonest posterior fossa glial tumours in children. Cerebellar astrocytomas represent up to 10% of all primary brain tumours and up to 25% of posterior fossa tumors in children, with Low grade gliomas forming the commonest of the cerebellar gliomas. They commonly present with symptoms and signs of raised intracranial pressure due to obstructive hydrocephalus. Radiologically they may be solid or cystic with or without a mural nodule. Surgical excision is the mainstay of treatment and forms the most consistent factor influencing progression free and long term survival. While majority of the tumours are pilocytic astrocytomas, they may also be fibrillary astrocytomas or even high grade tumours. Tumour histology does not appear to be an independent factor in the prognosis of these children, and therefore no palliative treatment after surgery is advocated. Brain stem gliomas account for approximately 10% of all pediatric brain tumours. Cranial nerve signs, ataxia and cerebellar signs with or without symptoms and signs of raised intracranial pressure are classically described symptoms and signs. Radiographic findings and clinical correlates can be used to categorize brain stem tumours into four types: diffuse, focal, exophytic and cervicomedullary. Histologically most brain stem gliomas are fibrillary astrocytomas. Diffuse brain stem gliomas are the most commonly seen tumour in the brain stem. These lesions are malignant high grade fibrillary astrocytomas. Focal tumours of the brain stem are demarcated lesions generally less than 2 cms in size, without associated edema. Most commonly seen in the midbrain or medulla, they form a heterogeneous pathological group, showing indolent growth except when the lesion is a PNET. Dorsally exophytic tumours lie in the fourth ventricle, while cervicomedullary lesions are similar to spinal intramedullary tumours. Expanding lesions are the only lesions amenable for excision while infiltrative and ventral lesions are not.
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Affiliation(s)
- K Sridhar
- Department of Neurosurgery, Fortis Malar Hospital, Chennai, India
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de Groot J, Sontheimer H. Glutamate and the biology of gliomas. Glia 2010; 59:1181-9. [PMID: 21192095 DOI: 10.1002/glia.21113] [Citation(s) in RCA: 202] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2010] [Accepted: 10/29/2010] [Indexed: 11/05/2022]
Abstract
Several important and previously unrecognized roles for the neurotransmitter glutamate in the biology of primary brain tumors have recently been elucidated. Glutamate is produced and released from glioma cells via the system x(c) (-) cystine glutamate transporter as a byproduct of glutathione synthesis. Glutamate appears to play a central role in the malignant phenotype of glioma via multiple mechanisms. By binding to peritumoral neuronal glutamate receptors, glutamate is responsible for seizure induction and similarly causes excitotoxicity, which aids the expansion of tumor cells into the space vacated by destroyed tissue. Glutamate also activates ionotropic and metabotropic glutamate receptors on glioma cells in a paracrine and autocrine manner. α-Amino-3-hydroxy-5-methyl-4-isoaxazolepropionate acid (AMPA) glutamate receptors lack the GluR2 subunit rendering them Ca(2+) permeable and capable of activating the AKT and MAPK pathways. Furthermore, these receptors are critical in aiding the invasion of glioma cells into normal brain. AMPA-Rs accumulate at focal adhesion sites where they may indirectly mediate interactions between the extracellular matrix and integrins. Glutamate receptor stimulation results in activation of focal adhesion kinase, which is critical to the regulation of growth factor and integrin-stimulated cell motility and invasion. The multitude of effects of glutamate on glioma biology supports the rationale for pharmacological targeting of glutamate receptors and transporters. Several ongoing and recently completed clinical trials are exploring the therapeutic potential of interrupting glutamate-mediated brain tumor growth.
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Affiliation(s)
- John de Groot
- Department of Neuro-Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
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Porto L, Kieslich M, Franz K, Lehrbecher T, Pilatus U, Hattingen E. Proton magnetic resonance spectroscopic imaging in pediatric low-grade gliomas. Brain Tumor Pathol 2010; 27:65-70. [PMID: 21046307 DOI: 10.1007/s10014-010-0268-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2009] [Accepted: 05/13/2010] [Indexed: 11/25/2022]
Abstract
Our purpose was to investigate whether in vivo proton magnetic resonance spectroscopic imaging, using normalized concentrations of total choline (tCho) and total creatine (tCr), can differentiate between WHO grade I pilocytic astrocytoma (PA) and diffuse, fibrillary WHO grade II astrocytoma (DA) in children. Data from 16 children with astrocytomas (11 children with PA and 5 children with DA) were evaluated retrospectively. MRS was performed before treatment in all patients with histologically proven low-grade astrocytomas. Metabolite concentrations of tCho and tCr were normalized to the respective concentration in contralateral brain tissue. The Mann-Whitney U test was performed to evaluate differences between these two groups. Normalized tCho did not show any statistically significant difference between the two groups. There was a strong trend (P = 0.07) toward higher values of normalized tCr in the DA group. For 3 of 5 children with DA, lactate was detectable, but only 1 of 11 children with PA showed lactate. We concluded that choline as a single parameter is not reliable in the differential diagnosis of low-grade astrocytomas in children. Our results suggest that tCr concentrations combined with lactate will be helpful in the differential diagnosis of PA and DA in children.
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Affiliation(s)
- Luciana Porto
- Neuroradiology Department, Institut für Neuroradiologie, Klinikum der Johann Wolfgang Goethe-Universität, Schleusenweg 2-16, D-60528, Frankfurt am Main, Germany.
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Mirbahai L, Wilson M, Shaw CS, McConville C, Malcomson RDG, Griffin JL, Kauppinen RA, Peet AC. 1H magnetic resonance spectroscopy metabolites as biomarkers for cell cycle arrest and cell death in rat glioma cells. Int J Biochem Cell Biol 2010; 43:990-1001. [PMID: 20633697 DOI: 10.1016/j.biocel.2010.07.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2010] [Revised: 06/13/2010] [Accepted: 07/05/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Improved non-invasive imaging biomarkers of treatment response contribute to optimising cancer management and metabolites detected by proton magnetic resonance spectroscopy ((1)H MRS) show promise in this area. Understanding (1)H MRS changes occurring in cells during cell stress and cell death in vitro should aid the selection of pertinent biomarkers for clinical use. METHODS BT4C glioma cells in culture were exposed to either 50 μM cis-dichlorodiammineplatinum II (cisplatin) or starvation by culture in phosphate buffered saline. High resolution magic angle spinning (1)H MRS was performed on cells using a Varian 600 MHz nanoprobe and metabolites were quantified by a time domain fitting method. Cell viability was assessed by trypan blue, H&E, 4',6-diamino-2-phenylindole (DAPI), DNA laddering and annexin V-FITC labelled flow cytometry; propidium iodide flow cytometry was used to assess the cell cycle phase. RESULTS With cisplatin exposure, cells initially accumulated in the G1 stage of the cell cycle with low numbers of apoptotic and necrotic cells and this was associated with decreases in phosphocholine, succinate, alanine, taurine, glycine and glutamate and increases in lactate and glycerophosphocholine (GPC). Starvation, leading to necrotic cell death within 6-18 h, caused decreases in succinate, alanine, glycine, and glutamate and increases in GPC. Principal component analysis revealed two patterns of metabolite changes, one common to both types of cell stress and another specific for necrosis secondary to cell starvation. CONCLUSIONS (1)H MRS reveals alterations in multiple metabolites during cell cycle arrest and cell death which may provide early biomarker profiles of treatment efficacy in vivo.
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Affiliation(s)
- Ladan Mirbahai
- School of Sport and Exercise Sciences, University of Birmingham, Edgbaston, Birmingham, UK
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Porto L, Kieslich M, Franz K, Lehrbecher T, Vlaho S, Pilatus U, Hattingen E. Spectroscopy of untreated pilocytic astrocytomas: do children and adults share some metabolic features in addition to their morphologic similarities? Childs Nerv Syst 2010; 26:801-6. [PMID: 20091040 DOI: 10.1007/s00381-009-1062-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2009] [Accepted: 11/19/2009] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Pilocytic astrocytomas may show heterogeneous histopathological and imaging features which are commonly attributed to malignant gliomas. Using magnetic resonance (MR) spectroscopy, we assessed if pilocytic astrocytomas show increased choline (tCho), classically related to proliferation and malignancy of gliomas. METHODS Sixteen patients (five adults, age 20-55 years and 11 children, age 6 months-15 years) with histologically proven pilocytic astrocytomas were evaluated retrospectively. MR spectroscopy was performed prior to surgery or biopsy in all patients. Intensities of tCho and total creatine (tCr) signals were normalised to the respective signal intensity of contralateral brain tissue and statistically evaluated for group differences between adults and children. RESULTS The tCho levels covered a wide range with a trend towards elevated values, especially in the adult group. tCho levels ranged from 0.78 to 2.92 in the paediatric group (mean 1.15) and from 1.15 to 3.03 in the adult group (mean 1.35). Diminished or normal tCr values were observed in all patients but one. CONCLUSIONS The well-known positive correlation between increase of tCho and the grade of gliomas seems to be violated by WHO grade I pilocytic astrocytomas showing a wide range of tCho values with an even marked increase in some cases. No significant differences have been identified in the MR spectroscopy metabolite profiles between paediatric and adult pilocytic astrocytomas.
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Affiliation(s)
- Luciana Porto
- Neuroradiology Department, Goethe-Universität, Frankfurt am Main, Germany.
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[Proton magnetic resonance spectroscopic imaging and other types of metabolic imaging for radiotherapy planning in adult and pediatric high-grade gliomas]. Cancer Radiother 2009; 13:556-61. [PMID: 19766525 DOI: 10.1016/j.canrad.2009.07.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2009] [Revised: 06/15/2009] [Accepted: 07/01/2009] [Indexed: 11/23/2022]
Abstract
Radiation therapy improves survival in high-grade gliomas but most patients relapse and usually within radiation fields. This may be due to uncertainties in target delineation and difficulties in identifying radioresistant regions for dose escalation. The use of T1 and T2-weighted magnetic resonance imaging (MRI) coregistration on the planning CT improves the target volume definition but magnetic resonance spectroscopic imaging (MRSI) and other types of metabolic and functional imaging (perfusion MRI, diffusion-weighted MRI, positron emission tomography (PET) imaging) may give useful additional information for target delineation. This article focuses on the potential of each imaging modality: assessment of response to treatment, detection of abnormalities not seen on MRI, predictive value for the site of local relapse. The incorporation of such techniques may improve target volume definition.
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Hamlat A, Saikali S, Diabira S, Messerer M, Riffaud L. Diagnosis of childhood astrocytomas. EXPERT OPINION ON MEDICAL DIAGNOSTICS 2009; 3:501-522. [PMID: 23495981 DOI: 10.1517/17530050903032679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Astrocytomas are the most common brain tumours, accounting for 28 - 50% of all primary CNS tumours. Diagnosis of CNS tumours remains difficult because the varied and nonspecific presentations of CNS tumours in childhood. Objectives/method: The clinical presentations of CNS astrocytomas vary with their sites of location; therefore, a period of uncertainty often precedes diagnosis, and approximately 42% of patients with an intracranial process make several visits to various physicians between the onset and diagnosis. However, on clinical suspicion of a brain tumour, a wide range of neuroimaging techniques may be used to assess the diagnosis of paediatric brain lesions. In this review the authors, for ease of presentation, describe the clinical presentations of supratentorial, infratentorial and spinal cord astrocytomas as well as their radiological and pathological features, and discuss their differential diagnoses. RESULTS/CONCLUSIONS Understanding and mastering the numerous imaging features of several subtypes of primary brain tumours affecting children, in addition to radiological features of non-tumoural disorders, remains a significant challenge and demands increased awareness of the paediatric brain diseases.
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Affiliation(s)
- Abderrahmane Hamlat
- Department of Neurosurgery, CHU Pontchaillou, 2 Rue Henri Le Guilloux, 35000 Rennes Cedex 2, France +33 2 99 28 43 21 ; +33 2 99 28 41 80 ;
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