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In Vivo 3-T MR Spectroscopy in the Distinction of Recurrent Glioma versus Radiation Effects: Initial Experience¹

¹ From the Nuclear Magnetic Resonance Center (P.L.L., R.G.G.) and Departments of Radiology (J.D.R., R.G.G.), Pathology (D.N.L.), Neurosurgery (F.G.B., G.R.C., E.A.C.), Radiation Therapy (A.F.T., J.S.L.), and Neurology (J.W.H.), Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Gray 2, Boston, MA 02114; and Department of Neurosurgery, Stanford Medical Center, Calif (G.R.H.). Received June 4, 2001; revision requested July 12; final revision received May 7, 2002; accepted May 29. Supported in part by National Institutes of Health grants 1R21CA80113 and 1R01CA83159. Address correspondence to J.D.R. (e-mail: jrabinov@partners.org).

View larger version (81K): [in a new window]   Figure 1. Patient 3. Upper right: Transverse T1-weighted gadolinium-enhanced 1.5-T fast spin-echo MR image. Arrow indicates a focus of enhancement. Upper left: Transverse T2-weighted 3-T fast spin-echo MR image shows the location of the voxels corresponding to the biopsy site (b; middle, left spectrum) and normal tissue (n; middle, right spectrum). The intensity of the two spectra is displayed on the same (arbitrary) vertical scale. The horizontal frequency scale is in parts per million (PPM) relative to the magnet frequency (3 T = 126 MHz). In the lesion, Chob is elevated and Crb is decreased in relation to Chon and Crn levels. Dotted lines indicate peaks. No NAA is detected in the lesion. Bottom left: Histopathologic specimen shows a hypercellular oligodendroglioma with anaplastic features consistent with recurrent tumor. (Hematoxylin-eosin stain; original magnification, x250.) Bottom right: MIB-1 stain shows a proliferation index of greater than 10%, which is consistent with rapid tumor growth. (Original magnification, x250.)

View larger version (72K): [in a new window]   Figure 2. Patient 13. Upper right: Transverse T1-weighted gadolinium-enhanced 1.5-T fast spin-echo MR image. Arrow indicates a focus of enhancement. Upper left: Transverse T2-weighted 3-T fast spin-echo MR image shows the location of the voxels corresponding to the biopsy site (b; middle, left spectrum) and normal tissue (n; middle, right spectrum). The intensity of the two spectra is displayed on the same (arbitrary) vertical scale. The horizontal frequency scale is in parts per million (PPM) relative to the magnet frequency (3 T = 126 MHz). Chob is not elevated in relation to Crn. Bottom: Histopathologic specimen of the biopsy sample shows sparse cellularity with reactive glial cells and vascular fibrosis consistent with radiation effects. (Original magnification, x400.)

View larger version (70K): [in a new window]   Figure 3. Patient 9. Upper right: Transverse T1-weighted gadolinium-enhanced 1.5-T fast spin-echo MR image. Arrow indicates a focus of enhancement. Upper left: Transverse T2-weighted 3-T fast spin-echo MR image shows the location of the voxels corresponding to the biopsy site (b; middle, left spectrum) and normal tissue (n; middle, right spectrum). The intensity of the two spectra is displayed on the same (arbitrary) vertical scale. The horizontal frequency scale is in parts per million (PPM) relative to the magnet frequency (3 T = 126 MHz). The overall SNR in the lesion is low compared with that of the normal tissue. Chob is not elevated in relation to Crn, although Chob/Crb is greater than 1.0. Bottom: Histopathologic sample shows reactive glial cells consistent with radiation effect. There were a few mitoses, one of which is shown by the arrow, indicating a small focus of viable glioma. (Hematoxylin-eosin stain; original magnification, x400.)

View larger version (24K): [in a new window]   Figure 4a. Plots show Cho/Cr for all biopsy samples plotted as a function of histopathologic findings. The height of the error bar represents the average value. Error bars represent the SD. (a) Plot demonstrates that Chob/Crb is not significantly different between the two histopathologic groups (P < .4). (b) Plot demonstrates that Chob/Crn shows a significant difference (P < .002) between the two groups. Chon/Crn is also shown. and = individual cases.

View larger version (27K): [in a new window]   Figure 4b. Plots show Cho/Cr for all biopsy samples plotted as a function of histopathologic findings. The height of the error bar represents the average value. Error bars represent the SD. (a) Plot demonstrates that Chob/Crb is not significantly different between the two histopathologic groups (P < .4). (b) Plot demonstrates that Chob/Crn shows a significant difference (P < .002) between the two groups. Chon/Crn is also shown. and = individual cases.