High-grade glioma and solitary metastasis: differentiation by spectroscopy and advanced magnetic resonance techniques

Springer Science and Business Media LLC
Alejandra Arévalo-Sáenz1, Gregorio Rodríguez-Boto Amago2, Manuel Pedrosa Sánchez3
1Division of Neurosurgery, Neurosurgery Department, Hospital Clinico San Carlos, Hospital QuironSalud, C / Profesor Martín Lagos S/N, 28040, Madrid, Spain
2Department of Neurosurgery, Puerta de Hierro University Hospital, C / Joaquín Rodrigo, 1, 28222, Majadahonda, Madrid, Spain
3Department of Neurosurgery, Hospital Universitario de La Princesa, Hospital Sanitas La Moraleja, Hospital Sanitas La Zarzuela, C / Diego de León 62, 28006, Madrid, Spain

Tóm tắt

Abstract Background The differentiation by means of magnetic resonance between high-grade gliomas and intracranial solitary single metastasis is of the utmost importance since they condition both surgical and complementary treatment. Results Retrospective study that analyzes the parameters of advanced magnetic resonance imaging: spectroscopy, diffusion and perfusion, specifically focused on the differences in the coefficients of the metabolites Cho/Cr, Cho/NAA and NAA/Cr in peritumoral edema between high-grade gliomas and metastases. The data have been statistically analyzed using ROC (receiver operating characteristic) curves, and cutoff values were obtained. A total of 79 patients with histologically analyzed tumors were analyzed: 49 high-grade gliomas (40 multiform glioblastomas and 9 anaplastic astrocytomas) and 30 metastases. A statistically significant mean difference was obtained in the three metabolite ratios. The area under the curve for the Cho/NAA ratio was 0.958 (CI: 0.903–1), for Cho/Cr 0.922 (CI: 0.859–0.985) and for NAA/Cr 0.163 (CI: 0.068–0.258; p < 0.001). The cutoff values were 1.115 for Cho/NAA (sensitivity 93.87%, specificity 93.33%, global precision 93.67%); 1.18 for the Cho/Cr ratio (sensitivity 89.79%, specificity 93.33% and precision 91.13%) and 1.155 for the NAA/Cr ratio (sensitivity 67.34%, specificity 93.33%, global precision 44.30%). Conclusion The results of the study support the premise that spectroscopy at the level of peritumoral edema is able to differentiate between high-grade gliomas and metastases by showing tumor infiltration in peritumoral edema.

Từ khóa


Tài liệu tham khảo

Nguyen TD, DeAngelis LM. Brain metastases. Neurol Clin. 2007;25:1173–92. https://doi.org/10.1016/s0733-8619(02)00035-x.

Landis SH, Murray T, Bolden S, Wingo PA. Cancer statistics 1999. CA Cancer J Clin. 1999;49:8–31. https://doi.org/10.3322/canjclin.49.1.8.

Bulakbsi N, Kocaogly M, Ors F, Tayfun C, Ucoz T. Combination of single-voxel proton MR spectroscopy and apparent diffusion coefficient calculation in the evaluation of common brain tumors. AJNR Am J Neuroradiol. 2003;24(2):225–33 (PMID: 12591638).

Knopp EA, Cha S, Johnson G, et al. Glial neoplasms: dynamic contrast enhanced T2-weighted MR imaging. Radiology. 1999;211:791–8. https://doi.org/10.1148/radiology.211.3.r99jn46791.

Brandao LA, Domingues RC. Intracranial neoplasms. En: MR spectroscopy of the brain. Capitulo 10, LWW, Philadelphia, USA. 2004; p. 130–67.

Hollingworth W, Medina LS, Lenkinski RE, Shibata DK, Bernal B, Zurakowski D, et al. A systematic literature review of magnetic resonance spectroscopy for the characterization of brain tumors. AJNR. 2006;27:1404–11.

Zhang M, Olsson Y. Hematogenous metastases of the human brain-characteristics of peritumoral brain changes: a review. J Neurooncol. 1997;35:81–9. https://doi.org/10.1023/a:1005799805335.

Shibata S, Fukushima M, Inone M, Tsutsumi K, Mori K. Ultrastructure of capillary permeability in human brain tumors. Part 1: gliomas associated with cerebral edema (low density areas). No Shinkei Geka. 1985;13(3):275–81.

Bertossi M, Virgintino D, Maiorano E, Occhiogrosso M, Roncali L. Ultrastructural and morphometric investigation of human brain capillaries in normal and peritumoral tissues. Ultrastruct Pathol. 1997;2:41–9. https://doi.org/10.3109/01913129709023246.

Cha S, Lupo JM, Chen MH, Lamborn KR, McDermott MW, Berger MS, et al. Differentiation of glioblastoma multiforme and single brain metastases by peak height and percentage of signal intensity recovery derived from dynamic susceptibility-weighted contrast-enhanced perfusion MR imaging. Am J Neuroradiol. 2007;28:1078–84. https://doi.org/10.3174/ajnr.A0484.

Poptani H, Gupta RK. Characterization of intracranial mass lesions. Within vivo proton MR spectroscopy. AJNR Am J Neuroradial. 1995;16:1593–603.

Moller-Hartmann W, Herminghaus S, Krings T. Clinical application of proton magnetic resonance spectroscopy in the diagnosis of intracranial mass lesion. Neuroradiology. 2002;44:371–81. https://doi.org/10.1007/s00234-001-0760-0.

Chiang IC, Kuo YT. Distinction between high-grade gliomas and solitary metastases using peritumoral 3T magnetic resonance spectroscopy, diffusion, and perfusion imaging. Neuroradiology. 2004;46:619–27. https://doi.org/10.1007/s00234-004-1246-7.

Law M, Cha S, Knopp EA, Johnson G, Arnett J, Litt AW. High-grade gliomas and solitary metastases: differentiation by using perfusion and proton spectroscopic MR imaging. Radiology. 2002;222:715–21. https://doi.org/10.1148/radiol.2223010558.

Server A, Josefsen R, Kulle B, Maehlen J, Schellhorn TR, Gadmar O, et al. Proton magnetic resonance spectroscopy in the distinction of high-grade cerebral gliomas from single metastatic brain tumors. Acta Radiol. 2010;51:316–25. https://doi.org/10.3109/02841850903482901.

Weber MA, Zoubaa S, Schlieter M, Jüttler E, Huttner HB, Geletneky K, et al. Diagnostic performance of spectroscopic and perfusion MRI for distinction of brain tumors. Neurology. 2006;66:1899–906. https://doi.org/10.1212/01.wnl.0000219767.49705.9c.

Knopp EA, Cha S, Johnson G, Mazumdar A, Golfinos JG, Zagzag D, et al. Glial neoplasms: dynamic contrast-emhanced T2 weighted MR imaging. Radiology. 1999;211:791–8. https://doi.org/10.1148/radiology.211.3.r99jn46791.

Zhang M, Olsson Y. Hematogenous metastases of the human brain: characteristics of peritumoral brain changes- a review. J Neurooncol. 1997;35:81–9.

Möller-Hartmann W, Herminghaus S, Krings T, Marquardt G, Lanfermann H, Pilatus U, et al. Clinical application of proton magnetic resonance spectroscopy in the diagnosid of intracranial mass lessions. Neuroradiology. 2022;44:371–438. https://doi.org/10.1007/s00234-001-0760-0.

Nelson SJ. Multivoxel magnetic resonance spectroscopy of brain tumors. Mol Cancer Ther. 2003;2:497–507.

Shimaru H, Morikawa M, Iwanaga S, Kaminogo M, Ochi M, Hayashi K. Differentiation between high-grade glioma and metastatic brain tumor using single-voxel proton MR spectroscopy. Eur Radiol. 2001;11:1784–91. https://doi.org/10.1007/s003300000814.

Sijens PE, Knopp MV, Brunetti A, Wicklow K, Alfano B, Bachert P, et al. 1 HMR spectroscopy in patients with metastatic brain tumors: a multicenter study. Magn Reson Med. 1995;33:818–26. https://doi.org/10.1002/mrm.1910330612.

Opstad KS, Murphy MM, Wilkins PR, Bell BA, Griffiths JR, Howe FA. Differentiation of metastases from high-grade gliomas using short echo time 1 H spectroscopy. J Magn Reson Imaging. 2004;20:187–92. https://doi.org/10.1002/jmri.20093.

Al-Okaili RN, Krejza J, Woo JH, Wolf RL, O’Rourke DM, Judy KD, et al. Intraaxial brain masses: MR imaging-based diagnostic strategy—initial experience. Radiology. 2007;243:539–50. https://doi.org/10.1148/radiol.2432060493.

Cai J-Z, Cao D, Li Y, et al. The clinical value of PROBE-P 3D CSI of 1H-MRS in peritumoral region in differentiating highgrade primary gliomas and solitary metastasis. Chin J CT MRI. 2009;2:7–10.

Wong CS, Chu TYC, Ma JKF. Peri-tumoral magnetic resonance spectroscopy to differentiate solitary primary intra-axial high-grade glioma and brain metastasis: a pilot study. J Hong Kong Coll Radiol. 2010;13:195–8.

Chawla S, Zhang Y, Wang S, Chaudhary S, Chou C, O’Rourke DM, et al. Proton magnetic resonance spectroscopy in differentiating glioblastomas from primary cerebral lymphomas and brain metastases. J Comput Assist Tomogr. 2010;34:836–41. https://doi.org/10.1097/RCT.0b013e3181ec554e.

Thông tin
Thông tin xuất bản

Springer Science and Business Media LLC

Thông tin tác giả