In vivo single-voxel proton MR spectroscopy in brain lesions with ring-like enhancement

被引:91
作者
Kimura, T
Sako, K
Gotoh, T
Tanaka, K
Tanaka, T
机构
[1] Asahikawa Med Coll, Dept Neurosurg, Asahikawa, Hokkaido 0788510, Japan
[2] Asahikawa Med Coll, Dept Radiol, Asahikawa, Hokkaido 0788510, Japan
[3] Asahikawa Med Coll, Cent Lab Res & Educ, Asahikawa, Hokkaido 0788510, Japan
关键词
proton MR spectroscopy; ring-like enhanced lesion; choline; lactate; lipid; necrosis;
D O I
10.1002/nbm.711
中图分类号
Q6 [生物物理学];
学科分类号
071011 ;
摘要
It is often difficult to make a correct diagnosis of ring-like enhanced lesions on Gd-enhanced MR brain images. To differentiate these lesions using proton MR spectroscopy (H-1-MRS), we retrospectively evaluated the correlation between the H-1-MR spectra and histopathological findings. We evaluated proton MR spectra obtained from the lesions in 45 patients, including metastasis (n = 19), glioblastoma (n = 10), radiation necrosis (n = 7), brain abscess (n = 5), and cerebral infarction (n = 4). The rate of misdiagnosis was found to be lowest at the threshold level of 2.48 for the (choline containing compounds)/(creatine and phosphocreatine) ratio (Cho/Cr) obtained from the whole lesions, which include the enhanced rim and the non-enhanced inner region. That is, the positively predictive values of a Cho/Cr greater than 2.48 for diagnosing metastasis or glioblastoma was 88.9 and 60.0%, respectively, and the positively predictive value of a Cho/Cr less than 2.48 for diagnosing radiation necrosis or cerebral infarction was 71.4 and 100%, respectively. For further differentiating between metastasis and glioblastoma, information about the presence and absence of an N-acetyl-aspartate (NAA) peak and lipid- or lactate-dominant peak was found to be useful. In 73.7% of metastasis cases a lipid-dominant peak was observed in the whole lesion without an NAA peak in the inner region, whereas the same pattern was observed in only 10% of the glioblastoma cases. Correlation with the histopathological findings showed that a high Cho signal is suggestive of neoplasm. Lipid signal in the non-enhanced central region was correlated to necrosis. Lactate signals were often observed in glioblastoma, abscess and sometimes metastasis, presumably reflecting the anaerobic glycolysis by the living cells in the ring-like enhanced rim. Single-voxel proton MR spectroscopy may serve as a potential tool to provide useful information of differentiation of ring-like enhanced lesions that cannot be diagnosed correctly using enhanced MR images alone. Copyright (C) 2001 John Wiley & Sons, Ltd.
引用
收藏
页码:339 / 349
页数:11
相关论文
共 22 条
  • [1] METABOLISM OF HUMAN GLIOMAS - ASSESSMENT WITH H-1 MR SPECTROSCOPY AND F-18 FLUORODEOXYGLUCOSE PET
    ALGER, JR
    FRANK, JA
    BIZZI, A
    FULHAM, MJ
    DESOUZA, BX
    DUHANEY, MO
    INSCOE, SW
    BLACK, JL
    VANZIJL, PCM
    MOONEN, CTW
    DICHIRO, G
    [J]. RADIOLOGY, 1990, 177 (03) : 633 - 641
  • [2] Arnold D L, 1990, NMR Biomed, V3, P184, DOI 10.1002/nbm.1940030407
  • [3] Role of in vivo proton magnetic resonance spectroscopy in the diagnosis and management of brain abscesses
    Dev, R
    Gupta, RK
    Poptani, H
    Roy, R
    Sharma, S
    Husain, M
    [J]. NEUROSURGERY, 1998, 42 (01) : 37 - 42
  • [4] MAPPING OF BRAIN-TUMOR METABOLITES WITH PROTON MR SPECTROSCOPIC IMAGING - CLINICAL RELEVANCE
    FULHAM, MJ
    BIZZI, A
    DIETZ, MJ
    SHIH, HHL
    RAMAN, R
    SOBERING, GS
    FRANK, JA
    DWYER, AJ
    ALGER, JR
    DICHIRO, G
    [J]. RADIOLOGY, 1992, 185 (03) : 675 - 686
  • [5] Furuya S, 1997, NMR BIOMED, V10, P25, DOI 10.1002/(SICI)1099-1492(199701)10:1<25::AID-NBM445>3.0.CO
  • [6] 2-M
  • [7] HENRIKSEN O, 1991, ACTA RADIOL, V32, P95
  • [8] HOUKIN K, 1995, NEURORADIOLOGY, V37, P99
  • [9] Kamada Kyousuke, 1997, Neurologia Medico-Chirurgica, V37, P250, DOI 10.2176/nmc.37.250
  • [10] MOBILE LIPIDS AND METABOLIC HETEROGENEITY OF BRAIN-TUMORS AS DETECTABLE BY EX-VIVO H-1 MR SPECTROSCOPY
    KUESEL, AC
    DONNELLY, SM
    HALLIDAY, W
    SUTHERLAND, GR
    SMITH, ICP
    [J]. NMR IN BIOMEDICINE, 1994, 7 (04) : 172 - 180