Protonová MR spektroskopie umožňuje neinvazivní hodnocení metabolitů vyšetřované tkáně, poskytuje informaci o složení intrakraniálních lézí, zvyšuje specificitu strukturální magnetické rezonance a tudíž ovlivňuje léčbu pacientů a případná rozhodnutí o změně léčebné strategie, jako je tomu například u rozlišení poléčebných změn a recidivy vysokostupňových gliomů po komplexní onkologické léčbě. Biochemické změny intrakraniálních nádorů se mohou lišit v závislosti na histologii a stupni malignity. Výsledky spektroskopie lze využít v neuroonkologii v mnohých klinických indikacích. Při interpretaci těchto závěrů je nutné mít na paměti limitace spektroskopie a nutnost adekvátní zkušenosti provádějícího pracoviště.
Proton MR spectroscopy provides the non-invasive assessment of metabolites in examined tissue, can be used to get intracranial neoplasms structural information, increases the specificity of structural magnetic resonance and may serve as an additional examination for evaluation of the response to treatment and decisions to change the treatment strategy as it is in diferentiation of posttreatment changes and recurrence after comlex oncologic treatment of glioma patients. Biochemic changes in glioma differ according to histology and tumor grading. The results of MR spectroscopy can be used for several indications in neurooncology. However, it is important to remember spectroscopy limitations and the necessity of an adequate institutional experience.
- Klíčová slova
- N-acetylaspartát,
- MeSH
- cholin metabolismus MeSH
- gliom diagnostické zobrazování metabolismus MeSH
- kreatin metabolismus MeSH
- kyselina asparagová analogy a deriváty metabolismus MeSH
- kyselina mléčná metabolismus MeSH
- lidé MeSH
- nádory mozku * diagnostické zobrazování metabolismus MeSH
- protonová magnetická rezonanční spektroskopie * MeSH
- stupeň nádoru MeSH
- Check Tag
- lidé MeSH
OBJECTIVE: To prospectively determine institutional cut-off values of apparent diffusion coefficients (ADCs) and concentration of tissue metabolites measured by MR spectroscopy (MRS) for early differentiation between glioblastoma (GBM) relapse and treatment-related changes after standard treatment. MATERIALS AND METHODS: Twenty-four GBM patients who received gross total resection and standard adjuvant therapy underwent MRI examination focusing on the enhancing region suspected of tumor recurrence. ADC maps, concentrations of N-acetylaspartate, choline, creatine, lipids, and lactate, and metabolite ratios were determined. Final diagnosis as determined by biopsy or follow-up imaging was correlated to the results of advanced MRI findings. RESULTS: Eighteen (75%) and 6 (25%) patients developed tumor recurrence and pseudoprogression, respectively. Mean time to radiographic progression from the end of chemoradiotherapy was 5.8 ± 5.6 months. Significant differences in ADC and MRS data were observed between those with progression and pseudoprogression. Recurrence was characterized by N-acetylaspartate ≤ 1.5 mM, choline/N-acetylaspartate ≥ 1.4 (sensitivity 100%, specificity 91.7%), N-acetylaspartate/creatine ≤ 0.7, and ADC ≤ 1300 × 10(-6) mm(2)/s (sensitivity 100%, specificity 100%). CONCLUSION: Institutional validation of cut-off values obtained from advanced MRI methods is warranted not only for diagnosis of GBM recurrence, but also as enrollment criteria in salvage clinical trials and for reporting of outcomes of initial treatment.
- MeSH
- chemoradioterapie metody MeSH
- dakarbazin analogy a deriváty terapeutické užití MeSH
- glioblastom diagnóza metabolismus terapie MeSH
- hodnocení výsledků zdravotní péče metody MeSH
- lidé středního věku MeSH
- lidé MeSH
- lokální recidiva nádoru diagnóza metabolismus prevence a kontrola MeSH
- molekulární zobrazování metody MeSH
- nádorové biomarkery metabolismus MeSH
- nádory mozku diagnóza metabolismus terapie MeSH
- následné studie MeSH
- prognóza MeSH
- protonová magnetická rezonanční spektroskopie metody MeSH
- reprodukovatelnost výsledků MeSH
- senzitivita a specificita MeSH
- výsledek terapie MeSH
- zobrazování difuzních tenzorů MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- klinické zkoušky MeSH
- práce podpořená grantem MeSH
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.
- MeSH
- cholin metabolismus MeSH
- gliom metabolismus patologie chirurgie MeSH
- inositol metabolismus MeSH
- kreatin metabolismus MeSH
- kyselina asparagová analogy a deriváty metabolismus MeSH
- laktáty metabolismus MeSH
- lidé MeSH
- magnetická rezonanční spektroskopie metody MeSH
- metabolismus lipidů fyziologie MeSH
- nádory mozku metabolismus patologie chirurgie MeSH
- neurochirurgické výkony MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- přehledy MeSH
