In Vivo Proton Spectroscopy of Giant Cell Tumor of the Bone

Abstract

The results of this study indicate that GCT of bone may show raised choline levels on proton MR spectroscopy. This finding is not an indicator of malignancy in these tumors.

Musculoskeletal Tumors: How to Use Anatomic, Functional, and Metabolic MR Techniques

“…Cholinecontaining compounds are constituents of the phospholipid metabolism of cell membranes that reflect cell membrane turnover, a feature of malignancy. Whereas proton MR spectroscopy has been a more routine part of a tumor imaging protocol in the brain, it has recently been explored in the musculoskeletal system (49)(50)(51)(52)(53)(54)(55)(56)(57)(58)(59).…”

“…A description of MR spectroscopy techniques along with their challenges and limitations is beyond the scope of this article; however, the literature thus far has supported the use of MR spectroscopy in the characterization of musculoskeletal tumors for malignancy, preferably with quantitative rather than qualitative approaches to the assessment of choline content in a lesion (51,52,54,(56)(57)(58)(59). The authors of musculoskeletal MR spectroscopy studies have been sity with successively heavier diffusion weighting.…”

“…In fact, in the brain, changes on the DW images are visible before they can be seen on a T2-weighted image (48). Thus, although not fully established in the current literature at this time, there is a suggestion that DW imaging with ADC mapping can impart valuable information when attempting to assess a musculoskeletal tumor, es-mostly qualitative in their assessment of choline content, using choline peaks or qualitative ratios (51,52,(57)(58)(59) rather than absolutely quantitative measurements (53,56), a problem given that choline is elevated in malignant as well as benign tumors (49)(50)(51)(52)(53)(54)(55)(56)(57)(58)(59). Because MR spectroscopic measurements are affected by many imaging-related factors, qualitative imaging is limited in its reproducibility and its ability to provide a generalized solution (54).…”

“…A systematic review of the literature in which a pooled analysis of 122 untreated musculoskeletal lesions reported in the literature was analyzed reveals that using the presence of detectable choline within a lesion has a sensitivity of 88% and specificity of 68% for malignancy (51,52,54,(56)(57)(58)(59), while the use of a quantitative approach to MR spectroscopy results (measurement of choline concentration) carried a specificity between 90% and 100%, depending on the threshold concentration that was used (54,56). At this time, the utility of MR spectroscopy lies with its high negative predictive value: If no choline is detectable in a tumor, it is likely to be benign.…”

Magnetic resonance spectroscopy in cancer diagnostics

“…Several chemical resonances contribute to the choline peak, including phosphocholine (PC), glycerophosphocholine, and free choline. Choline-containing compounds have been widely established as one of the most characteristic of cancer cells and have been shown to be present in breast, prostate, musculoskeletal, and different types of brain tumors [12,16,17]. These contributions can be divided in ex vivo and in vivo MRS studies, but in in vivo evaluations, the resonances are broader and appear as a single peak, referred to as total choline containing compounds (tCho).…”