phosphocreatine and Meningioma

Of primary central nervous system tumors treated each year, the majority are glioma, followed by meningioma and then pituitary adenoma. While the use of magnetic resonance (MR) and computed tomographic imaging is well established in the diagnosis and management of such tumors, these techniques have a limited role in determining the metabolic state, either prior to or following therapy. Multinuclear MR spectroscopy, on the other hand, provides information on tumor metabolism and the effect of therapy on tumor viability. This paper reviews MR spectroscopic studies performed on patients with central nervous system tumors and discusses the impact that such studies have had on tumor diagnosis and management.

Topics: Adenoma; Adenosine Triphosphate; Adolescent; Adult; Aged; Blood Chemical Analysis; Brain Chemistry; Brain Neoplasms; Child; Child, Preschool; Energy Metabolism; Female; Glioma; Humans; Hydrogen-Ion Concentration; Incidence; Infant; Magnetic Resonance Spectroscopy; Male; Meningeal Neoplasms; Meningioma; Middle Aged; Phosphocreatine; Phospholipids; Pituitary Neoplasms

The ability of magnetic resonance spectroscopy (MRS) to differentiate neoplastic brain cells and their metabolic and structural characteristics is evaluated. We examined 120 patients with brain tumors using a 1.5-tesla MRI unit and MRS. The peak areas of N-acetyl-aspartate (NAA), phosphocreatine-creatine (Pcr-Cr), choline-containing compounds (Cho), lactate, lipids, myoinositol, amino acids and the ratios of NAA/Pcr-Cr, NAA/Cho and Cho/Pcr-Cr were calculated by a standard integral algorithm. In normal brain tissue, the following metabolites were identified: NAA at 2.0 ppm, Pcr-Cr at 3.0 ppm and Cho at 3.2 ppm. The different concentrations of the metabolites examined and their role in the biochemical profile of different types of tumors are discussed. The confidence interval of the MRS versus pathology was between 0.9 and 0.954, while it was between 0.52 and 0.631 for MRI versus pathology. The Cho/Pcr-Cr ratio is a very important malignancy marker for histologic tumor grading of astrocytomas. The greater this ratio, the higher the grade of the astrocytoma. NAA/Pcr-Cr together with Cho/Pcr-Cr help specify the presence or absence of a neoplasm. Proton MRS is a useful and promising diagnostic modality not only in diagnosing but also in grading solid brain tumors.

Topics: Adult; Aged; Amino Acids; Aspartic Acid; Astrocytoma; Brain; Brain Abscess; Brain Neoplasms; Choline; Creatine; Glioblastoma; Humans; Lactates; Lipid Metabolism; Magnetic Resonance Spectroscopy; Meningioma; Middle Aged; Oligodendroglioma; Phosphocreatine; Reference Values

Biopsies of 6 malignant gliomas (grade 3 or 4) and 11 low-grade meningiomas were extracted with perchloric acid or methanol/water, and the fully-relaxed 1H-MRS spectra of the extracts containing water-soluble metabolites and a concentration and chemical shift standard were recorded at 11.4 T. The resonance signals assigned to inositol (Ino), glycerophospho- and phosphocholine (GPC + PC), choline (Cho), creatine and phosphocreatine (Cr + PCr), glutamate (Glu), acetate (Ac), alanine (Ala) and lactate (Lac) were integrated, and analyzed by two methods. First, the concentrations of the aforementioned substances in the bioptates were estimated from their resonance signals in the extracts. Second, these signals were normalized to the Cr + PCr resonance signal. The Mann-Whitney U-test was used to verify statistical significance between the data sets obtained for gliomas and meningiomas. When the first method of analysis was used, the only difference was in the Ala concentration, which in meningiomas was on average 4 times higher than in gliomas (P < 0.01). However, when the second method of analysis was applied, gliomas expressed lower normalized resonance signals of Ala and Glu (P < 0.001, ranges not overlapping), Lac (P < 0.005), as well as Ino and GPC + PC (P < 0.05). In proton MR spectra of brain tumor tissue extracts containing water soluble metabolites, the resonance signals normalized to that of total creatine may provide a very good discrimination between malignant gliomas and low-grade meningiomas.

Topics: Biopsy; Brain; Brain Neoplasms; Creatine; Diagnosis, Differential; Energy Metabolism; Glioma; Humans; Magnetic Resonance Spectroscopy; Meningeal Neoplasms; Meninges; Meningioma; Phosphocreatine; Predictive Value of Tests; Prognosis; Reference Values

Controversy exists about correlations between histological tumor grade and magnetic resonance (MR) spectroscopy data. The authors studied single-voxel proton MR spectroscopy as a noninvasive way to evaluate grade of malignancy in intracranial meningiomas.. The authors compared the results of MR spectroscopy with those derived by the MIB-1 staining index (SI) in 29 meningiomas. Proton MR spectroscopy was performed using stimulated echo acquisition and volume-localized solvent-attenuated proton nuclear MR sequences before surgery or other therapy. Twenty-four tumors were histologically benign (13 meningothelial, three fibrous, four transitional, three angiomatous, and one chordoid); four were atypical (Grade II), and one was papillary (Grade III). The mean MIB-1 SI in the benign group was significantly lower than those in the other groups (p = 0.0041). The mean choline-containing compound (Cho)/ creatine and phosphocreatine (Cr) ratios in the benign and nonbenign groups were 2.56+/-1.26 and 7.85+/-3.23, respectively (p = 0.0002). A significant linear correlation was observed between the Cho/Cr ratio and the MIB-1 SI (r0.05 = 0.74, p<0.001). Necrosis was present histologically in four of the five meningiomas classified either as atypical or papillary. Magnetic resonance spectroscopy revealed a methylene signal in these meningiomas that was not detected in benign meningiomas. Of the five meningiomas in which only a lactate signal was observed, two were benign and the MIB-1 SI in these two benign meningiomas was higher than the mean value for the benign group. Alanine, detected in 12 of 30 meningiomas, did not correlate with either tumor grade or Cho/Cr ratio.. Proton MR spectroscopy is a useful diagnostic method for determining the proliferative or malignant potential of meningiomas according to the Cho/Cr ratio. A lactate and/or methylene signal suggests a high-grade tumor.

Topics: Adult; Aged; Aged, 80 and over; Antigens, Nuclear; Biomarkers, Tumor; Brain; Cell Division; Cell Transformation, Neoplastic; Choline; Creatine; Diagnosis, Differential; Energy Metabolism; Female; Humans; Hydrocarbons; Ki-67 Antigen; Lactic Acid; Magnetic Resonance Imaging; Magnetic Resonance Spectroscopy; Male; Meningeal Neoplasms; Meninges; Meningioma; Methane; Middle Aged; Necrosis; Neoplasm Recurrence, Local; Nuclear Proteins; Phosphocreatine; Prognosis; Reoperation

To test clinical proton MR spectroscopy as a noninvasive method for predicting tumor malignancy.. Water-suppressed single-voxel point resolved spectroscopy in the frontal white matter of 17 healthy volunteers and 25 patients with brain tumors yielded spectra with peaks of N-acetyl aspartate (NAA), choline-containing compounds (Cho), creatine/phosphocreatine (Cre), and lactate. These peak intensities were semiquantitated as a ratio to that of the external reference. The validity of the semiquantitation was first evaluated through phantom and volunteer experiments.. The variation in measurements of the designated region in the volunteers was less than 10%. Normal ranges of NAA/reference, Cho/reference, and Cre/reference were 3.59 +/- 0.68, 1.96 +/- 0.66, and 1.53 +/- 0.64 (mean +/- SD), respectively. In 17 gliomas, the Cho/reference value in high-grade gliomas was significantly higher than in low-grade gliomas. Levels of NAA/reference were also significantly different in low-grade and high-grade malignancy. In eight meningiomas (four newly diagnosed and four recurrent), the level of Cho/reference was significantly higher in recurrent meningiomas than in normal white matter or in newly diagnosed meningiomas.. Higher grades of brain tumors in this study were associated with higher Cho/reference and lower NAA/reference values. These results suggest that clinical proton MR spectroscopy may help predict tumor malignancy.

Topics: Adolescent; Adult; Aged; Aspartic Acid; Brain Neoplasms; Choline; Creatine; Energy Metabolism; Female; Glioma; Humans; Image Processing, Computer-Assisted; Lactates; Lactic Acid; Magnetic Resonance Spectroscopy; Male; Meningioma; Middle Aged; Phantoms, Imaging; Phosphocreatine; Protons; Reference Values; Reproducibility of Results

Phosphorus magnetic resonance spectroscopy has been used noninvasively to determine characteristic spectral parameters for untreated human brain tumors as a prelude to its use in clinical diagnosis.. The spectra, which reflect the relative amounts of phosphorus-containing compounds, and the pH within and surrounding the tumors, were obtained in vivo using the localization technique of one-dimensional chemical shift imaging applied with a surface coil. Phosphorus-31 chemical shift imaging was performed successfully in vivo on 9 volunteers and 27 patients with untreated brain tumors, including 7 with astrocytoma, 4 with glioblastoma, 3 with meningioma, and 11 with metastases. This study provides spectra from within and surrounding the brain tumors, and allows accountability for the heterogeneity of brain tumors by the selection of the maximum data point for each parameter.. The ratios of resonance areas, phosphodiesters over nucleoside triphosphate (NTP), and phosphomonoesters over NTP, were found to be higher in glioblastomas (2.55 +/- 0.22, 1.06 +/- 0.09) and astrocytomas (3.04 +/- 0.36, 1.28 +/- 0.36) than in normal brain (2.00 +/- 0.32, 0.79 +/- 0.22). The ratios of areas due to inorganic phosphate and NTP, and phosphocreatine and NTP, also were higher in astrocytomas (1.16 +/- 0.40, 1.17 +/- 0.41) compared with glioblastomas (0.68 +/- 0.01, 0.88 +/- 0.19) and normal brain (0.61 +/- 0.03, 0.77 +/- 0.03). The pH of brain tumors ranged from alkaline to neutral, with meningiomas consistently having alkaline pH.. These data show that there are statistically significant differences in the magnetic resonance parameters of the affected brain hemispheres of patients with astrocytomas, glioblastomas, meningiomas, and normal brain tissue, and underline the need for a multisite clinical trial to establish clinical criteria for diagnosis.

Topics: Adenosine Triphosphate; Adult; Aged; Astrocytoma; Brain; Brain Neoplasms; Female; Glioblastoma; Humans; Hydrogen-Ion Concentration; Magnetic Resonance Imaging; Magnetic Resonance Spectroscopy; Male; Meningeal Neoplasms; Meningioma; Middle Aged; Organophosphates; Phosphates; Phosphocreatine; Phosphorus; Phosphorus Isotopes; Tomography, X-Ray Computed

We studied the feasibility of characterizing brain tumor tissue by localized proton magnetic resonance spectroscopy (1H-MRS). Twenty-six newly diagnosed tumors were examined by in-vivo 1H-MRS. The NAA (N-acetylaspartate)/Cho (choline) ratio of Grade 2 astrocytoma was higher than that of Grade 4. The Cho/Cr (creatine and phosphocreatine) ratio of meningioma was considerably higher than that of glioma of all grades. We have experienced only two cases of ependymoma and the Cho/Cr ratios of both were lower than that of glioma. It seems likely that 1H-MRS can be used to differentiate Grade 2 from Grade 4 in most cases of astrocytoma based on the NAA/Cho ratio, though a few cases will overlap. Meningioma can be distinguished easily from glioma, and the results of our study suggest that ependymoma shows a characteristic pattern on 1H-MRS, different from those of other brain tumors.

Topics: Aspartic Acid; Astrocytoma; Brain Neoplasms; Choline; Creatine; Ependymoma; Glioma; Humans; Magnetic Resonance Spectroscopy; Meningioma; Phosphocreatine

Magnetic resonance spectroscopy (MRS) may contribute to the characterization of intracranial tumors in vivo. Volume selective water suppressed proton spectroscopy offers the possibility to study a number of metabolites in the brain including choline (CHO), creatinine/phosphocreatinine (CR/PCR), N-acetylaspartate (NAA), and lactate. Using the stimulated echo technique we have studied 17 patients with intracranial tumors. In all cases the tumors were classified based on histologic evaluation. The tumor spectra differed considerably from those obtained in healthy brain tissue. The results indicate a relative decrease in the NAA and CR/PCR content. In many cases a lactate peak could be seen especially in the tumors with malignant growth characteristics. Our preliminary results suggest that proton spectroscopy may contribute to the differentiation of brain tumors with respect to benign or malignant growth. However, further research is warranted before a definite conclusion can be drawn.

Topics: Adult; Aged; Aspartic Acid; Astrocytoma; Brain Neoplasms; Choline; Creatine; Female; Humans; Lactates; Lactic Acid; Magnetic Resonance Spectroscopy; Male; Meningeal Neoplasms; Meningioma; Middle Aged; Oligodendroglioma; Phosphocreatine

Eleven normal volunteers and 17 subjects with brain tumors were studied by phosphorus-31 Magnetic Resonance (MR) spectroscopy. Measurements were performed by FROGS (Fast Rotating Gradient Spectroscopy) saturating nearly skin or muscle by Volume of Interest (VOI). This measurement took about 30 minutes for each case, including the imaging procedure, shimming and the measuring of spectroscopy. In phosphorus-31 MR spectroscopy, pH of the subjects with brain tumors showed a statistically significant elevation compared with that of the volunteers. In the subjects with benign tumors, only the elevation of pH was significant compared with that in volunteers. There was no other difference. This result suggests that benign tumors have an almost normal metabolic mechanism. Malignant brain tumors showed a decrease of PCr and an increase of Pi and PME. The increase of Pi indicates the increase of energy consumption. The increase of PME is connected with the acceleration of cell proliferation, there is a difference between malignant tumors and benign tumors. Phosphorus-31 spectroscopy has the potential to investigate the metabolism in vivo.

Topics: Astrocytoma; Brain Neoplasms; Energy Metabolism; Humans; Hydrogen-Ion Concentration; Magnetic Resonance Spectroscopy; Meningioma; Organophosphates; Phosphocreatine; Phosphorus

A recently developed method for image-selected localized hydrogen-1 magnetic resonance (MR) spectroscopy was assessed in the differential diagnosis of nine primary and secondary cerebral tumors, including four gliomas, two meningiomas, one neurilemoma, one arachnoid cyst, and one metastasis of breast cancer. Well-resolved H-1 MR spectra of these tumors were obtained in vivo with a conventional 1.5-T whole-body MR imaging system. All tumor spectra were remarkably different from spectra from normal brain tissue. Spectra obtained from different tumors exhibited reproducible differences, while histologically similar tumors yielded characteristic spectra with only minor differences. The observed spectral alterations reflect variations in concentrations and relaxation times of the H-1 MR sensitive pool of free (mobile) metabolites within the tissues. In most cases, the concentrations of N-acetyl-aspartate and creatine/phosphocreatine are reduced below detectability, whereas choline-containing compounds are generally enhanced. The spectral differences between the tumors are mainly due to the differing concentrations of lipids, lactic acid, and carbohydrates. Localized H-1 MR spectroscopy may become an important clinical tool for the differentiation of tumors as well as for therapeutic control.

Topics: Adult; Aspartic Acid; Brain Chemistry; Brain Diseases; Brain Neoplasms; Choline; Creatinine; Cysts; Diagnosis, Differential; Female; Glioma; Glutamine; Humans; Inositol; Lactates; Lactic Acid; Magnetic Resonance Spectroscopy; Male; Meningeal Neoplasms; Meningioma; Middle Aged; Neurilemmoma; Phosphocreatine

Topics: Adenosine Diphosphate; Adenosine Monophosphate; Adenosine Triphosphate; Adolescent; Adult; Aged; Brain Neoplasms; Child; Creatine Kinase; Energy Metabolism; Female; Glioma; Glycogen; Humans; Lipids; Male; Meningioma; Middle Aged; Neurilemmoma; Phosphates; Phosphocreatine; Uridine Triphosphate