gms | German Medical Science

66th Annual Meeting of the German Society of Neurosurgery (DGNC)
Friendship Meeting with the Italian Society of Neurosurgery (SINch)

German Society of Neurosurgery (DGNC)

7 - 10 June 2015, Karlsruhe

Article

Send article

Diagnostic value of proton magnetic resonance spectroscopic imaging in patients with cerebral gliomas

Meeting Abstract

Search Medline for

  • Iwona Krzyzanowska - Neurochirurgische Klinik und Poliklinik
  • Jens Gempt - Neurochirurgische Klinik und Poliklinik
  • Thomas Pyka - Nuklearmedizinische Klinik, Klinikum rechts der Isar, Technische Universität München
  • Tobias Boeckh-Behrens - Abteilung für Neuroradiologie
  • Bernhard Meyer - Neurochirurgische Klinik und Poliklinik
  • Florian Ringel - Neurochirurgische Klinik und Poliklinik

Deutsche Gesellschaft für Neurochirurgie. 66. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Karlsruhe, 07.-10.06.2015. Düsseldorf: German Medical Science GMS Publishing House; 2015. DocDI.18.06

doi: 10.3205/15dgnc200, urn:nbn:de:0183-15dgnc2007

Published: June 2, 2015

© 2015 Krzyzanowska et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

Objective: Today anatomic MRI is the method of choice for the detection and diagnosis of intrinsic brain tumors. The main limiting factor of the conventional MRI is the lack of metabolic information. Proton MR spectroscopy (MR-S) on the other hand provides metabolic information, though clinical value of the information regarding tumor grading and survival in patients with cerebral gliomas is controversial. With this study we aim to assess the value of MR-S concerning tumor grading and survival.

Method: Patients harboring gliomas who received a MR-S and tumor resection or biopsy were included in this study. 3D 1H-MR spectroscopy (PRESS, TR: 1669 ms, TE: 288 ms, FOV: 200 (ap) x 176 (rl) x 72 (fh) mm, 10 mm isovoxel, acquisition time: 15:55 min) covered the tumor, the peritumoral edema and the contralateral healthy hemisphere. Post-processing was performed on an extended MR workspace workstation (Philips Medical, the Netherlands). Residual water subtraction, apodization filtering, zero filling, and fusion with the anatomical data were done with the software, SpektroView (Philips Medical Systems). All metabolite ratios were described as regional ratios in comparison with healthy contralateral hemispheres. Clinical data, tumor entity, further therapy, extent of resection and overall survival were recorded. Mann-Whitney U test and ROC analysis were used for assessing the usefulness for tumor grading. Univariate and multivariate cox regression were conducted for survival analysis.

Results: 103 patients were included (WHO II = 16, WHO III = 18, WHO IV = 69, 44 = f, 59 =m). Mean age was 55 years (22 to 83 years). 49 patients received a complete tumor resection, 32 patients a resection > 90%, 10 patients > 50% and 11 patients a biopsy only. NAA/Cr-ratios significantly correlated with tumor grade (III vs. IV; p<0.02). For the differentiation of low-grade vs. high-grade gliomas the Cho/Cr-ratio proved to be statistically significant (p<0.01). The NAA/Cr-, Cho/Cr-, and Cho/NAA-ratios were statistical significant concerning the overall survival in univariate analysis. Regarding the multivariate analysis and overall survival age, extent of resection, preoperative KPS and Cho/NAA ratio (maximum) proved to be significant (p=0.05).

Conclusions: Proton magnetic resonance spectroscopic imaging enables grading of cerebral gliomas and has a predictive value regarding the overall survival of patients harboring cerebral gliomas.

Note: Iwona Krzyzanowska and Jens Gempt contributed equally.