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70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

12.05. - 15.05.2019, Würzburg

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Evaluation of 31-P-MR-Spectroscopy in brain metastases correlated to histopathological results

Meeting Abstract

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  • presenting/speaker Johannes Kerschbaumer - Universitätsmedizin Innsbruck, Neurochirurgie, Innsbruck, Austria
  • Ruth Steiger - Universitätsmedizin Innsbruck, Neuroradiologie, Innsbruck, Austria
  • Daniel Pinggera - Universitätsmedizin Innsbruck, Neurochirurgie, Innsbruck, Austria
  • Christian Freyschlag - Universitätsmedizin Innsbruck, Neurochirurgie, Innsbruck, Austria
  • Elke Gizewski - Universitätsmedizin Innsbruck, Neuroradiologie, Innsbruck, Austria
  • Claudius Thomé - Universitätsmedizin Innsbruck, Neurochirurgie, Innsbruck, Austria

Deutsche Gesellschaft für Neurochirurgie. 70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie. Würzburg, 12.-15.05.2019. Düsseldorf: German Medical Science GMS Publishing House; 2019. DocBO-V03

doi: 10.3205/19dgnc027, urn:nbn:de:0183-19dgnc0279

Published: May 8, 2019

© 2019 Kerschbaumer 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: Brain metastases (BM) are well-circumscribed lesions. Still, the amount of edema in these neoplasms suggested either mechanisms of infiltration or defense. A better understanding of the mechanisms within the edema of BM seems reasonable, to preoperatively identify areas of infiltration and resect them.

Modern MR-algorithms may discover areas at high risk by perfusion, diffusion-weighted imaging and spectroscopy.

Representing tumors with high energy-demand and cell-turnover, BMs qualify for preoperative investigation with 31-Phosphorus-MR-Spectroscopy (31PMRS), revealing information about those characteristics.

Methods: 10 patients with a BM in non-eloquent areas, were included in this prospective trial. All underwent preoperative standard MRI, with additional 31PMRS. In all patients, one voxel within the contrast-enhancing tumor (CE+), one at the border (border) and one distant voxel, purely including T2+ areas where determined. A frameless biopsy was performed after craniotomy and the metabolites of the 31PMRS (including contralateral control) were analyzed and compared to the histopathological results.

Ratios, reflecting resynthesis (CE+/border/T2+: 1,109±0,192/1,112±0,158/1,083±0,097), hydrolysis (0,303±0,089/0,360±0,122/0,321±0,089), energy demand (4,227±2,35/3,453±1,284/3,599±0,833) and membrane turnover (1,239±0,2611/3,453±1,284/3,599±0,283 were compared intra-individual with a voxel from the contralateral side (resynthesis/hydrolysis/energy-demand/membrane-turnover: 1,063±0,085/0,335±0,073/3,317±0,7573/0,784±0,186). Resynthesis showed a trend towards higher ratios in CE+ and border biopsies without reaching statistical significances. This trend was also seen concerning energy-demand. Membrane-turnover was significantly higher in CE+, border zone and also in the T2+ areas compared to the control (p<0,001).

Conclusion: 31PMRS in BMs provides information on metabolic changes in CE+, tumor and surrounding edema. There is a proof of enhanced metabolism in tissue without histological tumor manifestation.