The Value of Magnetic Resonance in Differentiation between Brain Glioma and Treatment Induced Injury

Open access

Summary

Introduction. The further therapeutic management decisions in glioma patients after the radiation/chemotherapy may be difficult because the treatment induced brain injury can mimic tumor recurrence clinically and on neuroimaging.

Aim of the Study was to assess the usefulness of magnetic resonance spectroscopy (MRS) and diffusion tensor imaging (DTI) in differentiation between glial tumor recurrence and radiation/chemotherapy-induced changes in the brain.

Material and methods. 73 patients with primary brain gliomas and 77 gliomas patients after combined therapy with possibly treatment induced changes underwent MRS and DTI. Fractional anisotropy (FA) and metabolite ratios were measured in the tumor and pathological signal intensity area adjacent to post-surgical cavity.

Results. Mean choline/creatine (Cho/Cr), myoinositol/creatine (MI/Cr), lactate-lipid/creatine (LL/Cr) ratios of brain gliomas was statistically significant higher and FA values lower than those in the pathological signal intensity area adjacent to post-surgical cavity. No differences were found in mean N-acetyl aspartate/creatine (NAA/Cr) ratios among two groups.

Conclusions. Our study suggests that Cho/Cr, MI/Cr, LL/Cr and FA measures should be recommended as additional highly informative tool to conventional structural magnetic resonance imaging (MRI) when monitoring gliomas patients after combined therapy.

1. Bonicelli C, Bacci A, Agat i R, Leonardi M. Potential of high field functional MRI in the neuroradiological diagnosis of brain tumours // The Neuroradiol J, 2009; 22:534-545

2. Brandsma D, Stalpers L, Taal W, Sminia P, Bent MJ. Clinical features, mechanisms, and management of pseudoprogression in malignant gliomas // Lancet Oncol, 2008; 9:453-461

3. Chaskis C, Neyns B, Michot te A, Ridder M, Everaert H. Pseudoprogression after radiotherapy with concurrent temozolomide for high-grade glioma: clinical observations and working recommendations // Surg Neurol, 2009; 72:423-428

4. Costanzo AD, Scarabino T, Trojsi F, Popolizio T, Catapano D, Giannatempo GM, Bonavita S, Portaluri M, Tosetti M, Angelo VA, Salvolini U, Tedeschi G. Proton MR spectroscopy of cerebral gliomas at 3T: spatial heterogeneity, and tumour grade and extent // Eur Radiol, 2008; 18:1727-1735

5. Dincer A, Isik U, Kosak E, Ozet M. Extrapontine myelinolysis in a child: a rare case with MRI, DWI and MRS follow-up // The Neuroradiology Journal, 2008; 21:527-537

6. Gerstner L, Jellinger K, H eiss WD, Wober G. Morphological changes in anaplastic gliomas treated with radiation and chemotherapy // Acta Neurochir, 1977; 36:117-138

7. Goebell E, Fiehler J, Ding XQ, Paustenbach S, Nietz S, Heese O, Kucinski T, Hagel C, Westphal M, Zeumer H. Disarrangement of fiber tracts and decline of neuronal density correlate in glioma patients - a combined diffusion tensor imaging and 1H-MR spectroscopy study // Am J Neuroradiol, 2006; 27:1427-1431

8. Huang J, Wang AM, Shetty A , Maitz AH, Yan D, Doyle D, Richey K, Park S, Pieper DR, Chen PY, Grills IS. Differentiation between intra-axial metastatic tumor progression and radiation injury following fractionated radiation therapy or stereotactic radiosurgery using MR spectroscopy, perfusion MR imaging or volume progression modeling // Magn Reson Imaging, 2011; 29:993-1001

9. Hygino CJLC, Rodriguez I, Domingues RC, Gasparetto EL, Sorensen AG. Pseudoprogression and pseudoresponse: imaging challenges in the assessment of posttreatment glioma // Am J Neuroradiol, 2011; 32:1978-1985

10. Kallenberg K, Bock H, Helm s G, Jung K, Wrede A, Buhk JH, Giese A, Frahm J, Strik H, Dechent P, Knauth M. Untreated glioblastoma multiforme: increased myo-inositol and glutamine levels in the contralateral cerebral hemisphere at proton MR spectroscopy // Radiology, 2009; 253:805-812

11. Louis DN, Ohgaki H, Wiestl er OD, Cavenee WK, Burger PC, Jouvet A, Scheithauer BW, Kleihues P: The 2007 WHO classification of tumours of the central nervous system // Acta Neuropathol, 2007; 114:97-109

12. Nakajima T, Kumabe T, Kana mori M, Saito R, Tashiro M, Watanabe M, Tominaga T: Differential diagnosis between radiation necrosis and glioma progression using sequential proton magnetic resonance spectroscopy and methionine positron emission tomography // Neurol Med Chir, 2009 49:394-401

13. Nelson SJ. Assessment of t herapeutic response and treatment planning for brain tumors using metabolic and physiological MRI // NMR Biomed, 2011; 24:734-749

14. Oshiro S, Tsugu H, Komatsu F, Abe H, Onishi H, Ohmura T, Iwaasa M, Sakamoto S, Fukushima T. Quantitative assessment of gliomas by proton magnetic resonance spectroscopy // Anticancer Res, 2007; 27:3757-3764

15. Pope WB, Young JR, Ellings on BM. Advances in MRI assessment of gliomas and response to anti- VEGF therapy // Curr Neurol Neurosci Rep, 2011; 11:336-344

16. Principi M, Italiani M, Ot taviano P. Perfusion MRI in the evaluation of cerebral blood volume and mean transit time in untreated and recurrent glioblastomas // The Neuroradiology Journal, 2009 22:48-57

17. Schillaci O, Travascio L, Bruni C, Bazzocchi G, Testa A, Garaci FG, Melis M, Floris R, Simonetti G. Molecular imaging and magnetic resonance imaging in early diagnosis of Alzheimer’s disease // The Neuroradiology Journal, 2008; 21:755-771

18. Smith EA, Carlos RC, Junck LR, Tsien CI, Elias A, Sundgren PC. Developing a clinical decision model: MR spectroscopy to differentiate between recurrent tumor and radiation change in patients with new contrast- enhancing lesions // Am J Roentgenol, 2009 192:45-52

19. Sundgren PC. MR spectrosco py in radiation injury // Am J Neuroradiol, 2009; 30:1469 -1476

20. Sundgren PC, Nagesh V, Eli as A, Tsien C, Junck L, Hassan GDM, Lawrence TS, Chenevert TL, Rogers L, McKeever P, Cao Y. Metabolic alterations: a biomarker for radiation-induced injury of normal brain. An MR spectroscopy study // J Magn Reson Imaging, 2009; 29:291-297

21. Wang YX, King AD, Zhou H, Leung SF, Abrigo J, Chan YL, Hu CW, Yeung DK, Ahuja AT. Evolution of radiation-induced brain injury: MR imaging- based study // Radiology, 2010; 254:210-218

22. Weybright P, Sundgren PC, Maly P, Hassan DG, Nan B, Rohrer S, Junck L. Differentiation between brain tumor recurrence and radiation injury using MR spectroscopy // Am J Roentgenol, 2005; 185:1471- 1476

23. Yaman E, Buyukberber S, Be nekli M, Oner Y, Ugur Coskun U, Akmansu M, Ozturk B, Kaya AO, Uncu D, Yildiz R. Radiation induced early necrosis in patients with malignant gliomas receiving temozolomide // Clin Neurol Neurosur, 2010; 112:662-667

24. Yerli H, Ağıldere AM, Özen O, Geyik E, Atalay B, Elhan AH. Evaluation of cerebral glioma grade by using normal side creatine as an internal reference in multi-voxel 1H-MR spectroscopy // Diagn Interv Radiol, 2007; 13:3-9

Acta Chirurgica Latviensis

The Journal of Riga Stradins University; Latvian Association of Surgeons; Latvian Association of Paediatric Surgeons

Journal Information

Metrics

All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 56 56 8
PDF Downloads 9 9 0