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5 - MRS in brain tumors

Published online by Cambridge University Press:  04 August 2010

Peter B. Barker ,
Alberto Bizzi ,
Nicola De Stefano ,
Rao Gullapalli  and
Doris D. M. Lin
Peter B. Barker
Affiliation:
The Johns Hopkins University School of Medicine
Alberto Bizzi
Affiliation:
Istituto Neurologico Carlo Besta, Milan
Nicola De Stefano
Affiliation:
Università degli Studi, Siena
Rao Gullapalli
Affiliation:
University of Maryland, Baltimore
Doris D. M. Lin
Affiliation:
The Johns Hopkins University School of Medicine
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Summary

Key points

  • Imaging of brain tumors has evolved into a multimodal tool providing improved diagnostic and prognostic accuracy, fundamental in disease monitoring and assessing response to therapy.

  • Proton MR spectroscopic imaging (1H-MRSI) combines the spatial localization capabilities of MR imaging with the biochemical information of 1H-MR spectroscopy, and provides a valuable clinical tool for brain tumors by depicting metabolic changes reflective of cellular density, anaplasia, and mitotic index.

  • Choline is elevated in all tumor types due to altered membrane metabolism, and shows correlation with cellular density and indices of cell proliferation. N-acetyl-aspartate (NAA) decreases with tumor infiltration and substitution of normal neural and glial cells. The Cho/NAA ratio is, therefore, a useful parameter particularly in most adult and pediatric primary brain tumors, with a higher ratio correlating with higher cell density and generally associated with a poor prognosis.

  • While 1H-MRS can show different metabolic patterns in different tumor types, it is not used as a primary diagnostic tool.

  • Increasing Cho/NAA and Cho/Cr ratios in serial exams of a primary astrocytoma are suggestive of transformation to a higher grade. By following metabolic changes, 1H-MRS can be useful in monitoring disease progression or response to therapy.

  • 1H-MRSI allows the evaluation of spatial heterogeneity and the macroscopic boundary of a mass, and may provide guidance for targeted biopsy, surgery, or therapy.

  • 1H-MRS studies can also be particularly useful in distinguishing neoplastic from non-neoplastic lesions, and differentiating recurrent tumor from predominantly delayed radiation necrosis.

Type
Chapter
Information
Clinical MR Spectroscopy
Techniques and Applications
 , pp. 61 - 90
Publisher: Cambridge University Press
Print publication year: 2009

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