gms | German Medical Science

60th Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Benelux countries and Bulgaria

German Society of Neurosurgery (DGNC)

24 - 27 May 2009, Münster

Multimodal imaging of tumor heterogeneity in cerebral gliomas

Meeting Abstract

  • A. Grams - Abteilung für Neuroradiologie, Klinikum rechts der Isar der TU München
  • F. Ringel - Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar der TU München
  • A. Förschler - Abteilung für Neuroradiologie, Klinikum rechts der Isar der TU München
  • J. Gempt - Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar der TU München
  • S. Astner - Klinik und Poliklinik für Strahlentherapie, Klinikum rechts der Isar der TU München
  • A. Drzezga - Nuklearmedizinische Klinik und Poliklinik, Klinikum rechts der Isar der TU München
  • B. Meyer - Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar der TU München

Deutsche Gesellschaft für Neurochirurgie. 60. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit den Benelux-Ländern und Bulgarien. Münster, 24.-27.05.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. DocP04-05

DOI: 10.3205/09dgnc285, URN: urn:nbn:de:0183-09dgnc2854

Published: May 20, 2009

© 2009 Grams et al.
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Outline

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Objective: MRIis the gold standard in the imaging of brain gliomas. However, with anatomical MRI alone it is not possible todeterminethe heterogeneity of a tumor and its “true” borders. A combination of additional imaging modalities, such as MR-spectroscopy (MRS), MR-perfusion-weighted imaging (PWI) andPET may provide more detailed information.

Methods: 12 patients with cerebral gliomas (WHO grades II–IV) underwent anatomical MRI-, 3D-MRS-, T2*-PWI-, and 18FET-PET-studies. 5 MRS voxels of interest wereevaluated in each individual patient concerning Cho/Cr ratio and regional NAA concentration. Then regional FET-uptake as well as regional cerebral blood volume was measured in these areas in comparison to the healthy hemisphere.

Results: In high grade gliomas we found 6 different components with specific multimodal characteristics which we named “true edema”, “cellular proliferation”, “vascular proliferation”, “infiltration”, “tumor” and “necrosis”. In low grade gliomas 4 different components could be described: “true edema”, “cellular infiltration”, “proliferation” and “tumor”.

Conclusions: With multimodal imaging cerebral high‑ and low-grade gliomas can be differentiated into heterogeneous components. Especially in “edema-appearing” areas this might be a method for differentiation between edema and infiltration areas and thus determine tumor-borders. This knowledge might play a role in the planning of resection or radiation of a tumor; furthermore, interesting or especially “active” tumor areas can be detected to determine biopsy sites.