211 Prognostic significance of serial magnetic resonance spectroscopy imaging in patients with malignant glioma undergoing radiotherapy

Alexander, A.; Bistritz, A.; Halls, Steve; Mehta, Vivek; Murray, B.; Roa, Wilson; Riauka, T.; Urtasun, Raul C.; Abdulkarim, Bassam; Fulton, D.

doi:10.1016/s0167-8140(05)80372-x

Cited by 22 publications

(30 citation statements)

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“…For example, a decrease in NAA following radiotherapy is a sign of radiation-induced necrosis even before morphologic changes on conventional MRI images can be detected [89,90]. An increase in choline concentration has been shown to be correlated with markers of cell proliferation (progression) and reduced levels of choline can be seen following radiosurgery [91,92]. Another way of approaching the metabolite levels within tissue is to present the data as a ratio of metabolites.…”

Section: Investigational Imaging Techniques For Distinguishing Progrementioning

confidence: 99%

Postradiation Imaging Changes in the CNS: How can we Differentiate Between Treatment Effect and Disease Progression?

et al. 2014

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A familiar challenge for neuroradiologists and neuro-oncologists is differentiating between radiation treatment effect and disease progression in the CNS. Both entities are characterized by an increase in contrast enhancement on MRI and present with similar clinical signs and symptoms that may occur either in close temporal proximity to the treatment or later in the disease course. When radiation-related imaging changes or clinical deterioration are mistaken for disease progression, patients may be subject to unnecessary surgery and/or a change from otherwise effective therapy. Similarly, when disease progression is mistaken for treatment effect, a potentially ineffective therapy may be continued in the face of progressive disease. Here we describe the three types of radiation injury to the brain based on the time to development of signs and symptoms – acute, subacute and late – and then review specific imaging changes after intensity-modulated radiation therapy, stereotactic radiosurgery and brachytherapy. We provide an overview of these phenomena in the treatment of a wide range of malignant and benign CNS illnesses. Finally, we review the published data regarding imaging techniques under investigation to address this well-known problem.

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Section: Investigational Imaging Techniques For Distinguishing Progrementioning

confidence: 99%

Postradiation Imaging Changes in the CNS: How can we Differentiate Between Treatment Effect and Disease Progression?

et al. 2014

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“…The interruption of global protein synthesis is therefore directly related to decreases in choline resonance observed with 1 H MRS. Results of numerous investigations have shown that choline signal intensity rapidly declines (in as little as 12-24 hours) with effective therapy in a variety of clinical settings [79][80][81][82][83][84] and animal models [85][86][87][88]. Furthermore, 1 H MRS for the assessment of changes in choline signal intensity in response to therapy has been successfully performed with clinical 1.5-and 3-T MRI units and coils not only on the brain but also on the breast, lower extremities, and liver.…”

Section: Assessment Of Mobile Lipids and Choline With Proton Mr Spectmentioning

confidence: 99%

Multimodality Molecular Imaging of Apoptosis in Oncology

Blankenberg

Norfray

2011

American Journal of Roentgenology

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“…Variable changes, such as decrease of NAA, both increase and decrease of Cho, and appearance of Lac and Lip peaks were detected with 1 H-MRS at a distance from the intracranial tumor within several weeks, months and years after conventional fractionated radiotherapy 19,20,[33][34][35][36][37] . While the clinical significance of these findings in humans is still questionable, Figure 9 Dynamics of 1 H-MRS-detected metabolic changes in normal-appearing brain tissue in patients with intracranial metastases treated with radiosurgery.…”

Section: Discussionmentioning

confidence: 99%

Dynamics of Metabolic Changes in Intracranial Metastases and Distant Normal-Appearing Brain Tissue after Stereotactic Radiosurgery: A Serial Proton Magnetic Resonance Spectroscopy Study

et al. 2009

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The present study evaluated the dynamics of metabolic changes in intracranial metastases and distant normal-appearing brain after stereotactic radiosurgery (SRS). Forty neoplasms were evaluated with single-voxel proton magnetic resonance spectroscopy ((1)H-MRS) both before and after treatment. From one to six examinations (median, 3) were done in each individual case during follow-up. At the time of each investigation additional (1)H-MRS was obtained from the normal-appearing brain distant from the radiosurgical target. Investigated metabolites included N-acetylaspartate (NAA), choline-containing compounds (Cho), creatine (Cr), and mobile lipids (Lip). Within the first month after SRS responded tumors showed a statistically significant increase in NAA/Cho ratio, and decrease of Cho content and Lip-to-normal brain Cr (nCr) ratio. By contrast, statistically significant metabolic alterations were not detected in stabilized tumors. Statistically significant volumetric and metabolic changes were not marked between three and 12 months after treatment in non-progressing lesions. Alternatively, decrease of NAA/Cho ratio, NAA content and Cr content, and increase in Lip/nCr ratio and Cho content were evident in progressive neoplasms, and subtle metabolic alterations could be revealed even before the increase in the lesion volume. Metabolic characteristics of normal-appearing brain distant from the radiosurgical target did not show statistically significant changes within the first year after treatment. In conclusion, additional use of serial (1)H-MRS during follow-up after SRS for intracranial metastases permits detailed evaluation of the metabolic tumor response and may be potentially helpful for early prediction of recurrence.

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211 Prognostic significance of serial magnetic resonance spectroscopy imaging in patients with malignant glioma undergoing radiotherapy

Cited by 22 publications

References 0 publications

Postradiation Imaging Changes in the CNS: How can we Differentiate Between Treatment Effect and Disease Progression?

Postradiation Imaging Changes in the CNS: How can we Differentiate Between Treatment Effect and Disease Progression?

Multimodality Molecular Imaging of Apoptosis in Oncology

Dynamics of Metabolic Changes in Intracranial Metastases and Distant Normal-Appearing Brain Tissue after Stereotactic Radiosurgery: A Serial Proton Magnetic Resonance Spectroscopy Study

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