Extremity bone tumors: evaluation by P-31 MR spectroscopy

An 19F Magnetic Resonance–Based In Vivo Assay of Solid Tumor Methotrexate Resistance: Proof of Principle

PURPOSE

Studies in oncology have implicated multiple molecular mechanisms as contributors to intrinsic and acquired tumor resistance to antifolate therapy. Here we show the utility of an (19)F-labeled methotrexate (FMTX) with (19)F magnetic resonance to differentiate between sensitive and resistant tumors in vivo and thus predict therapeutic response.

EXPERIMENTAL DESIGN

Human sarcoma xenografts in nude mice were used in this study. The sarcoma cell lines chosen for this study (HT-1080, HS-16, and M-805) are well characterized in terms of their methotrexate sensitivity and molecular mechanisms of resistance. The pharmacokinetics of tumor uptake/washout of FMTX were monitored via in vivo (19)F magnetic resonance spectroscopy (pulse/acquire with surface coil localization) following an i.v. bolus injection. Response post-therapy, following leucovorin rescue, was monitored via tumor growth.

RESULTS

The three tumor models show differences in both the peak concentrations of tumor FMTX and the dynamics of uptake/retention. These differences are most pronounced for time points late in the magnetic resonance observation period (225-279 minutes post-injection). A statistically significant linear correlation between tumor tissue concentrations of FMTX at these late time points and therapeutic response in the days/weeks post-treatment is shown (R = 0.81, F = 9.27, P < 0.001). Interestingly, a 400 mg/kg i.v. bolus injection of FMTX is a more potent cytotoxic agent in vivo against methotrexate-sensitive tumors than is the parent compound (P = 0.011).

CONCLUSIONS

In principle, the assay method described herein could be implemented in the clinic as a diagnostic tool to make decisions regarding therapeutic protocol for the treatment of osteosarcoma on a case-by-case basis.

Magnetic resonance imaging of soft-tissue tumors in children

Magnetic resonance imaging (MRI) has become an important diagnostic tool in the detection and characterization and local anatomic staging of soft-tissue tumors in children. This article outlines some of the procedural issues unique to the pediatric population.

31Phosphorus-magnetic resonance spectroscopy to assess histologic tumor response noninvasively after isolated limb perfusion for soft tissue tumors

BACKGROUND

In patients with unresectable soft tissue sarcoma of the extremities, isolated limb perfusion (ILP) has been reported to result in significant tumor regression enabling limb-sparing resection in the majority of patients. However, clinical tumor response as evaluated by imaging and histopathology (extent of tumor necrosis) often differ significantly. The current study was initiated to evaluate prospectively the role of 31phosphorus-magnetic resonance spectroscopy (31P-MRS) in the noninvasive assessment of histologic response in patients treated with ILP.

METHODS

Thirty-two patients with locally advanced and unresectable soft tissue tumors (sarcoma in 28 patients and bulky melanoma in 4 patients) were treated by ILP with recombinant human tumor necrosis factor-alpha and melphalan or with cytostatics. 31P-MRS was performed prior to treatment and at regular intervals after ILP until definite tumor resection. Clinical response parameters according to the World Health Organization as well as the histopathologic necrosis rate of the resection specimen were correlated with changes in the energy-rich phosphorous metabolites phosphocreatine (PCR); alpha-, beta-, gamma-adenosine triphosphate (ATP); phosphomonoesters (PME); and inorganic phosphate (Pi).

RESULTS

Clinically, 15 of 32 patients (response rate [RR] of 47%) demonstrated a partial response (PR). The ratios of PME/PCR and PME/beta-ATP decreased significantly after ILP in comparison with preoperative values (P < 0.001). The changes in the PME/beta-ATP ratio were significantly different between clinical responders and nonresponders (P < 0.02) in contrast with the PME/PCR ratios (P < 0.09). Histologic necrosis of > 90% (pathologic (p) PR) was present in 17 resection specimens, 7 of which demonstrated no clinical response. Seven tumors demonstrated a pathologic complete response (pCR). When combining PR, pPR, and pCR (RR of 68%), 31P-MRS was able to predict response with a specificity of 94% and a sensitivity of 68% (P < 0.006, by the chi-square test).

CONCLUSIONS

The considerable difference between clinical and pathologic RR after ILP underlines the shortcomings of established response criteria. Utilizing changes in PME/beta-ATP ratios, 31P-MRS is a highly specific tool with which to predict histologic response in this setting. This finding may be of major value in those patients in whom the decision to perform a major resection or amputation must be made for local tumor control.

Phosphorus MR spectroscopy in the treatment of human extremity sarcomas

The application of 31P MR spectroscopy in the characterization and treatment of malignant human extremity tumors is reviewed and placed in the perspective of results obtained in murine sarcomas. Despite the now widespread acquisition of gradient localized spectral maps, the low spatial resolution that can be achieved at 1.5 or 2 T with 31P MRS, greatly limits its use in the study of tumor heterogeneity. The potential of 31P MRS is in the evaluation and monitoring of large inoperable extremity tumors. There are early spectral changes in human extremity sarcomas monitored after therapy, and recent studies have shown that the 31P MR spectra measured before treatment, and the changes in phosphate metabolites measured shortly thereafter, correlate with the clinical response after 2 or 3 months. Larger clinical studies are needed to confirm whether correlations of, for instance, pretreatment tumor pH with necrosis at resection and Pi decrease with tumor regression, can be used as a predictive test for clinical response.

Tumor pH: implications for treatment and novel drug design

Although limited data exist, electrode-measured pH values of human tumors and adjacent normal tissues, which are concurrently obtained by the same investigator in the same patient, consistently show that the electrode pH (believed to represent tissue extracellular pH primarily) is substantially and consistently lower in tumor than in normal tissue. In contrast, the 31P-magnetic resonance spectroscopy-estimated intracellular pH is essentially identical or slightly more basic in tumor compared with normal tissue. As a consequence, the cellular pH gradient is substantially reduced or reversed in these tissues. This difference provides an exploitable avenue for the treatment of cancer. The extent to which drugs exhibiting weakly acid or basic properties are ionized depends on their ionization potential (pKa) and the pH of their milieu. Weakly acidic drugs that are lipid soluble in their nonionized state diffuse freely across the cell membrane and on entering a relatively basic intracellular compartment become trapped and accumulate within the cell. This may lead to substantial (10-fold or more) differences in the intracellular-to-extracellular drug distribution between tumor and normal tissue for cytotoxics, hypoxic cell sensitizers, or other drugs exhibiting appropriate pKa. Experimental in vitro evaluation of these predictions confirms both the predicted pH gradient-dependent changes in cellular drug accumulation and toxicity.

P-31 changes as a measure of therapy response in resistant and sensitive osteosarcomas implanted into nude mice

OBJECTIVE

To determine if changes in PCr/Pi and PME can be used to predict lack of tumor response to chemotherapy in a murine model of a chemotherapy-resistant human osteosarcoma.

MATERIAL AND METHODS

Cisplatin-resistant sublines were grown from high-grade cisplatin-sensitive human osteosarcoma. Surface coil localized 31P NMR spectroscopy of implanted cisplatin-resistant and sensitive osteosarcoma tumors in nude mice was performed.

RESULTS

A cisplatin-resistant subline of a sensitive human osteosarcoma was developed that was five times more resistant to cisplatin than the parent cell line. Our NMR data shows a statistically significant difference in the change in the PCr/Pi ratio after treatment between sensitive and resistant osteosarcomas at the alpha = 0.05 level. Changes in PME were seen in the sensitive tumors but were not statistically significant.

CONCLUSIONS

Changes in PCr/Pi predict lack of tumor treatment response in human osteosarcoma implanted into nude mice with a specificity of 70% and a sensitivity of 54%. Monitoring of PCr/Pi in human osteosarcoma patients may allow detection of response to chemotherapy before conventional imaging techniques.

Characterization of a phosphonium analog of choline as a probe in 31P NMR studies of phospholipid metabolism

Tumors and transformed cells have been shown by 31P NMR to contain elevated concentrations of two phosphomonoesters, phosphorylcholine and phosphorylethanolamine, involved in phospholipid metabolism. In order to understand the biochemical basis for these phenomena new methods are needed to allow for analysis of the relevant metabolic pathways in intact cells. One such promising tool may be phosphonium-choline, a 31P NMR-visible analog of choline in which the trimethyl-ammonium group of choline has been replaced with a trimethyl-phosphonium moiety. As shown previously [Sim et al. Biochem. J. 154, 303 (1976)], this compound is non-toxic and readily metabolized by cultured cells into phospholipids. In this paper we describe in greater detail some of the chemical and NMR spectroscopic properties of this material. Most significantly we show here that the chemical shift of phosphonium-choline is sensitive to the phosphorylation state of the analog and that the phosphonium nucleus is NMR-visible even after its incorporation into phospholipid. The unique properties of this analog should make it possible to use high-field 31P NMR to follow the flux of phosphonium-choline through the Kennedy pathway in intact perfused cells cultures.

31P changes as a measure of therapy response in human osteosarcomas implanted into nude mice

Our objective was to determine whether changes in PME and PCr/Pi can be used to predict lack of tumor response to chemotherapy in a murine model of human osteosarcoma. A chemotherapy-sensitive human osteosarcoma cell line was implanted into the flank of 22 nude mice. Cisplatin was administered to 11 of the mice 9 days postimplantation. 31P MR spectroscopy was performed pre- and post-chemotherapy in both sets of mice. Statistically significant changes in PCr/Pi occur from post-chemotherapy in the treated mice, but not in the untreated mice during the same time. Change in PME parallels changes in tumor volume. Changes in PCr/Pi predict lack of chemotherapy treatment in human osteosarcoma implanted into nude mice with a specificity of 80% and a sensitivity of 63%. The change in PCr/Pi occurs prior to any changes in volume of the tumor [corrected].

Carcinogens stimulate phosphorylation of ethanolamine derived from increased hydrolysis of phosphatidylethanolamine in C3H/101/2 fibroblasts

Many human tumors contain high concentrations of ethanolamine phosphate (EtnP). An important question is whether increased formation of EtnP is merely the consequence of cell transformation, or is it associated with the process of carcinogenesis. Here we show that in C3H/10T1/2 embryonic fibroblasts, an established cellular model for the study of carcinogenesis, the environmental carcinogens, 7,12-dimethylbenz[a]anthracene (DMBA) and benzo[a]pyrene (B[a]P) (0.1-1 microgram/ml concentration; 24 h treatment), stimulate phosphorylation of ethanolamine derived from increased hydrolysis of phosphatidylethanolamine. The results suggest that increased formation of EtnP is associated with the early stages of carcinogenesis. This observation may have prognostic value.

Studies of human tumors by MRS: a review

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.

MRI of aggressive bone lesions of childhood

MRI can yield valuable information about involvement of bone and soft tissue by aggressive bone lesions of childhood. The 18 lesions evaluated with MRI included osteosarcoma, Ewing's sarcoma, histiocytosis, osteomyelitis, osteoblastoma, giant cell tumor, aneurysmal bone cyst, ossifying fibroma, and fibrous dysplasia. In 12 children, where CT correlation was available, MRI provided equal or more information than CT. Our study shows that MRI should be the modality of choice in the evaluation of aggressive bone lesions of childhood, after conventional radiography.

In vivo phosphorus 31 magnetic resonance spectroscopy of human uveal melanomas and other intraocular tumors

We studied the feasibility of using the surface coil probe technique for the noninvasive in vivo study of ocular tumors by phosphorus 31 magnetic resonance spectroscopy. The characteristic organophosphate metabolites of suspected uveal melanomas before proton beam irradiation were determined qualitatively by phosphorus 31 magnetic resonance spectroscopy in vivo using a three-turn surface coil. Spectra of choroidal hemangioma, osteoma, and metastasis were also obtained in vivo and compared with those of uveal melanomas. Analysis of spectra performed at 1.5 T showed significant peaks of phosphomonoesters, inorganic phosphate, phosphodiesters, phosphocreatine, and adenosine 5'-triphosphates. The unusually high concentration of phosphodiesters may be considered as a marker for uveal melanomas and other choroidal tumors. By analyzing the ratio of phosphocreatine to phosphodiesters spectral area values, we interpreted qualitatively spectra of intraocular tumors to differentiate malignant tumors from benign lesions. Nevertheless, the main limitation of interpreting the spectra was their contamination by signals from surrounding tissues.

Imaging bone tumors in the 1990s

Progress in bone tumor management has occurred as a result of cooperation among surgeons, oncologists, pathologists, and radiologists. During the 1990s radiologists will contribute to care of patients with bone tumors in major ways. Tumor detection and preliminary diagnosis will be accomplished by radiography. Tumor local extent will be assessed by magnetic resonance imaging (MRI) and to a lesser degree by computed tomography (CT). Distant spread of malignancy will be documented by radionuclide scintigraphy (skeleton) and by CT (lungs). The combined estimate of local extent and distant spread will assure adequate staging before definitive management decisions. Preoperative closed percutaneous biopsy for histologic diagnosis will be accomplished on an outpatient basis under fluoroscopic or CT guidance. Arteriography will be employed for delivery of local chemotherapy. Some combination of arteriography, MRI, and MR spectroscopy will be used to evaluate tumor response. After limb-salvage surgery, MRI will sequentially assess the tumor bed; bone scintigraphy and CT will detect skeletal and pulmonary metastases. The radiologist's role will undergo continuous redefinition.

A double quantum coherence transfer proton NMR spectroscopy technique for monitoring steady-state tumor lactic acid levels in vivo

If proton nuclear magnetic resonance (1H NMR) spectroscopy is to provide a clinically useful modality for monitoring tumor growth and treatment, the technique must be able to unambiguously detect steady-state metabolite concentrations in human tumors and differentiate these from normal tissue levels. To address this problem, a two-dimensional double quantum coherence transfer spectroscopy (2DDQCT) method was developed and tested in a series of tumor cell lines implanted in mice. Lactate-edited proton NMR spectra were determined from a roughly 1-cm3 region of interest in EMT6, RIF-1, and fibroma. In two-dimensional data matrix representations of the 2DDQCT experiments (double quantum frequency on the vertical axis and chemical shift on the horizontal axis) the lactate signal (330 Hz with the transmitter set at the water resonance) was well-resolved from lipid (480 Hz, 600 Hz). The resolution in the double quantum dimension was also sufficient to conclude that a detectable level of alanine, which would reside at 358 Hz, was not present in the three tumor types. Following the NMR experiment, tumors were chemically assayed for lactate giving 8.17, 9.1, and 6.73 mumols/g wet wt for RIF-1, EMT6, and fibroma, respectively. This technique is likely to provide a noninvasive method for monitoring the steady-state lactic acid levels in small tumors before and after therapy, as well as in tissues with impaired oxygen delivery using clinical and research NMR systems.

In vivo magnetic resonance imaging and spectroscopy of humans with a 4 T whole-body magnet

A research-type 4 T whole-body magnet, built by Siemens AG, Erlangen, FRG, was used to investigate magnetic resonance at high field strengths. Designs for head and body coils operating at 170 MHz are described. Proton images of the human head and body are degraded by dielectric resonances and penetration effects. The nature of the dielectric resonances was demonstrated in phantoms containing distilled and saline doped water. Radiation damping at 170 MHz generates secondary echoes after a spin echo sequence. This effect was observed in phantoms and with reduced amplitude in the human head. Hydrogen spectra of the human head were selected utilizing stimulated and spin echoes. The latter technique allows the volume size to be reduced to 1 cm3. Examples of brain tumors that have been routinely investigated with volumes of 8 cm3 are given. Natural abundance carbon and phosphorus spectra of muscle and liver demonstrate the expected increase in spectral resolution and signal to noise ratio. Carbon spectra from the liver show the glycogen signal. Fluorine spectroscopy was used to study the time course of the absorption and emptying of a fluorinated antibiotic from the human stomach.

Detection of metabolic heterogeneity of human intracranial tumors in vivo by 1H NMR spectroscopic imaging

Patients with intracranial tumors (gliomas) were examined by means of localized water-suppressed 1H NMR single volume spectroscopy and spectroscopic imaging. The 1H NMR spectra of the tumors exhibit signal intensities of the N-acetyl aspartate, choline compounds, and creatine plus phosphocreatine resonance lines that are different from the corresponding intensities observed on normal brain tissue. Also, for 6 out of the 10 patients examined so far, lactate resonance lines were detected in the tumor spectra. For one patient, abnormal 1H NMR spectra were obtained of a hemisphere which appeared normal with 1H NMR imaging. Metabolic heterogeneity of the tumorous regions could be demonstrated with 1H NMR spectroscopic imaging, using a spatial resolution in the order of 1 cm. These results suggest a spectrum of metabolic observations that may ultimately provide an important means for characterizing brain tumors.

The use of magnetic resonance imaging and spectroscopy in the assessment of patients with head and neck and other superficial human malignancies

The proper demarcation of diseased tissue is important for radiation therapy planning and treatment. The volume to be irradiated is usually identified on radiographs or on x-ray computed tomography (CT) sections. Magnetic resonance (MR)-derived images of the proton T2 relaxation times in small pixel elements, typically 0.5 mm2 or less, provide significantly sharper differentiation between normal and diseased tissue. The T2 values in tissue depend on the tissue composition, histologic condition, and physiologic environment within the tumor. Furthermore, for many tumors the histogram of T2 values has a clear biphasic distribution suggesting that T2 maps may be useful for the identification of necrotic or hypoxic regions within tumors. The distribution of T2 values within the tumor bed shows the general pattern that the T2 values are elevated with a range greater than that seen in normal muscle. Elevated T2 values are not by themselves diagnostic of malignancy; however, they demonstrate the heterogeneity of the microenvironment present within a tumor. The spatial distribution of T2 values is being explored as a method for computer assistance in the delineation of the target volume for treatment planning. In addition, MR P-31 spectroscopic examinations were performed on 30 patients with squamous cell carcinomas of the head and neck. Although hampered by muscle contamination in some P-31 spectra obtained with surface coil profile localization techniques, significant trends can still be appreciated in our data. These trends include the following: (1) the P-31 spectra from malignant tissue have well-resolved spectral lines in the upfield region that correspond to Pi, phosphomonoester (PME), and phosphodiester (PDE) not usually seen in normal muscle; (2) the PDE/B-ATP and PME/B-ATP ratios are greater than unity in all cases; and (3) most of the tumors have higher PME peaks than PDE peaks. The P-31 spectra from patients treated with ionizing radiation changed during and after therapy. Some of the changes could be associated with alteration of the tumor metabolic activity or synthesis and breakdown of lipoproteins. These studies suggest that magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS) studies may be useful for both radiotherapy treatment planning and the noninvasive monitoring of patients both before and during treatment.

1H image-guided localized 31P MR spectroscopy of human brain: quantitative analysis of 31P MR spectra measured on volunteers and on intracranial tumor patients

1H image-guided 31P MR spectra of normal human brain and of intracranial tumors have been analyzed quantitatively. Tumor types examined include prolactinoma, lymphoma, and various grade gliomas. The experimental signals were processed by means of a time-domain least-square fitting procedure, which yields the spectral parameters, as well as a prediction of the standard deviations. Significant spectral variations are observed within both populations of normal brain and of intracranial tumor 31P MR spectra. The metabolic ratios derived from the glioma 31P MR spectra and from corresponding uninfiltrated brain tissue do not differ significantly. Significant differences are, however, observed between the metabolic ratios of prolactinoma and uninfiltrated tissue 31P MR spectra. Alkaline pH values are found for the prolactinoma and the high-grade gliomas. Furthermore, spectral differences are observed between the patient's uninfiltrated tissue 31P MR spectra and those of an unmatched population of volunteers. This underscores the necessity for control measurements on the uninfiltrated tissue of the patient and for controls from a matched population of healthy individuals.

Experimental approaches to image localized human 31P NMR spectroscopy

Experimental procedures for obtaining localized 31P NMR spectra of humans by means of the ISIS sequence are discussed in detail. The technique is optimized for use with volume coils and with surface coils in order to measure localized 31P NMR spectra of different tissues and organs. Selective frequency-modulated (FM) inversion and excitation pulses are applied for optimal inversion or excitation despite B1 inhomogeneity. Pulse imperfection may lead to spurious signal contributions from outside the selected volume; this contamination is reduced by using long pulse intervals, by properly ordering the ISIS acquisitions, and by using FM excitation pulses. Simultaneous measurement of multiple volumes was implemented by including an additional selective inversion pulse, and an extension of the ISIS addition/subtraction scheme. Localized T1 measurements with surface coils are implemented by using a B1-insensitive inversion pulse in the inversion recovery sequence. The quantitative reproducibility of localized 31P NMR spectra was verified. Absolute metabolite concentration can be determined after a suitable calibration of the 31P NMR spectrum. Localized shimming is required to obtain localized 31P NMR spectra of excellent spectral resolution. This is done by monitoring the 1H NMR signal from water by a single-shot localization technique. The techniques discussed can be applied to obtain spectra of brain, liver, heart, and other organs. 31P NMR spectra of intracranial tumors demonstrate its applicability in the examination of patients.

Application of MR spectroscopy to the study of tumor biology

Though MR spectroscopy has long been used to analyze the structure of organic compounds in solution, interest in applying it to the study of biologic systems has been slow in evolving because of past problems with spectral resolution in solids and gels. Renewed interest in this area has been stimulated both by the rapid growth of MR imaging as a clinical tool as well as by improvements in MR spectrometer design and use of sophisticated pulse sequences which have greatly improved the analysis of molecular composition. This review specifically focuses on the application of MR spectroscopy to studying the biology of malignant cells. The bulk of MR studies in this area to date have involved either 1H or 31P spectroscopy. Several investigators have now demonstrated that 1H spectra can be used to distinguish both animal and human tumors of differing metastatic properties. Preliminary data suggest that these spectral differences result in part from differences in cell surface glycoproteins and/or glycolipids between cells of low and high metastatic potential. Many of these molecules can absorb cell water potentially affecting T1 of cell water by their relative concentrations. Prolonged T2 relaxation times have been associated with some spectral peaks which distinguish cells of differing metastatic potential. The findings may partly explain why tumors have the prolonged T1 and T2 relaxation times seen in proton MR imaging. Other 1H MR spectroscopic studies suggest that there are detectable differences in plasma lipids in patients with a variety of malignancies compared to normal controls, suggesting possible utility as a screening test.(ABSTRACT TRUNCATED AT 250 WORDS)

Phospholipid and energy metabolism of cancer cells monitored by 31P magnetic resonance spectroscopy: possible clinical significance

31P magnetic resonance spectroscopy (MRS) has been established as an excellent noninvasive procedure for studying metabolism in cancer cells. For a full understanding of the results of in vivo MRS studies of metabolism, it is necessary to be able to conduct controlled experiments on the same intact functioning cells in a perfusion apparatus. The specific techniques used for this purpose are described, and the applications to cancer cell bioenergetics and phospholipid metabolism in drug-resistant and drug-sensitive breast cancer cells are illustrated. Spectra of the same cell line grown in a "model tumor" in natural basement membrane gel and in nude mice in vivo are compared. The results indicate a potential for the use of 31P MRS in a clinical setting for monitoring therapy and for diagnosis.

Impact of hyperthermic regional perfusion therapy on cell metabolism of malignant melanoma monitored by 31P MR spectroscopy

For the first time, the influence of hyperthermic regional perfusion therapy on tumor cell metabolism has been monitored by means of 31P MR spectroscopy. Shortly after treatment, a complete depletion of high energy phosphates, a significant increase of inorganic phosphate, phosphomono- and phosphodiester resonances and a decrease of pH have been observed. Healthy muscle tissue showed only minor effects caused by this aggressive therapy. The time course of the transient variation of phosphate metabolite concentrations is explained in the framework of a simple pathophysiological model. The results demonstrate that the imediate effect of chemotherapy on tumor tissue can be detected by 31P MRS before any clinical signs of tumor response are visible.

Preliminary results on phosphorus-31 nuclear magnetic resonance evaluation of human uveal melanoma in enucleated eyes

Clinical evaluation of uveal melanomas by nuclear magnetic resonance (NMR) techniques depends on ascertaining how these tumors characteristically appear in NMR images and spectra. The authors have determined NMR characteristics of suspected uveal melanomas by phosphorus-31 (31P) NMR spectroscopy of freshly enucleated human eyes. Nuclear magnetic resonance examination was performed at 8.45 Tesla within 90 minutes after enucleation. Enucleated eyes were maintained at 4 degrees C in tissue culture medium during the 30 minutes required for transport. Nuclear magnetic resonance spectra were obtained within 10 minutes, a clinically acceptable time, using a two-turn 31P surface coil. Spectral parameters included 10-kHz spectral width, 1024 data points, and 0.5-second recycle delay. Phosphorus-31 NMR spectroscopy allowed differentiation of choroidal melanomas from normal ocular structures. Differentiating features include significant peaks in tumor spectra due to the phosphodiesters glycerol 3-phosphoryl ethanolamine (GPE) and glycerol 3-phosphorylcholine (GPC), and the phosphomonoesters phosphorylethanolamine (PE) and phosphorylcholine (PC). These preliminary data are encouraging and suggest that clinical trials at the lower magnetic field strengths available in NMR imaging systems seem feasible and warrant investigation.

[Bone and soft tissue tumors--progress in this decade]

Conventional plain film roentgenography is the basic examination of bone tumors. Modern digital roentgenography offers technical innovations but no fundamental new diagnostic dimensions. Computerized and magnetic resonance-tomography allow a far better delineation of the tumor spread (staging). These new imaging methods together with ultrasound have revolutionized the diagnosis of soft tissue neoplasms, not visible on plain film roentgenograms except lipomas and calcifications.

31P in-vivo spectroscopic study by high-field whole-body MR system--an application to a case with arteriosclerosis obliterans

31P in-vivo spectroscopy was performed by a 1.5-tesla whole-body MR system. The 31P spectrum for the calf muscle in a patient with arteriosclerosis obliterans having intermittent claudication was obtained every two minutes. When the spectrum after the workload was compared with that at rest, an increase in inorganic phosphate (Pi) and a decrease in phosphocreatine (PCr) were observed, resulting in a strong decrease in the PCr/Pi ratio. This method can measure the ischemic and recovery stages of energy metabolism in skeletal muscle noninvasively and continuously in addition to magnetic resonance imaging.