Liver tumors: follow-up with P-31 MR spectroscopy after local chemotherapy and chemoembolization.

Schilling, A.; Gewiese, B; Berger, G.; Boese-Landgraf, J.; Fobbe, F; Stiller, Detlef; Gallkowski, U.; Wolf, K.-J.

doi:10.1148/radiology.182.3.1311119

Cited by 27 publications

(33 citation statements)

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“…'~' Hyperthermia with intraarterial chemotherapy induced necrotic changes in a melan~ma.~' Chemoembolization caused necrotic changes in liver cancer^^*^^*'^ and in one study a marked early increase in Pi in all 10 responding cancers but no change in the 31P MRS in the 2 non-responders. 166 Intravenous chemotherapy with a nitrosourea caused an early decrease in pH in gliomas, although intra-arterial injection caused an early increase in P H . ~ The role of oxygenation in radiosensitivity is well established in experimental systems and there is some evidence for its role in human cancers although it is only one of several important f a~t 0 r s .…”

Section: Ischemia Hypoxia and Necrosis In Human Cancersmentioning

confidence: 99%

Studies of human tumors by MRS: A review

1992

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The literature describing 31P, 'H, "C, UNa and I%' MRS in vim in human cancers is reviewed. Cancers have typical metabolic characteristics in "P and 'H MRS including high levels of phospholipid metabolites and a cellular pH more alkaline than normal. These alone are not specific for cancer but are diagnostic in appropriate clinical settings. Some metabolic characteristics appear to be prognostic indices and correlation with treatment response is emerging as an important potentially cost-effective use of MRS in oncology. ' (PME) and phosphodiesters (PDE) 1, intracellular pH (pHNMR) and free cellular magnesium concentration (Mg+*). Natural abundance or enriched I3C MRS [Fig. l(b)] provides information about glycolysis, gluconeogenesis, amino acids and lipids. Water-suppressed 'H MRS [ Fig. 2(a)J shows total choline (TCHO), total creatine (TCR), lipids, glutamate, glutamine, inositols, lactate (LAC), and in brain, N-acetyl aspartate (NAA). =Na can be imaged to study its distribution within tissues. F MRS can be used to study pharmacokinetics of 5-fluorouracil(5-FU).Since 1983, when Griffiths et al. ' described 31P MRS of a sarcoma in a hand ( MS, multiple sclerosis; NAA, N-acetyl aspartate; NTP, nucleoside tnphosphate; p c , phosphocholine; PCR, phosphocreatine; PDE, phosphodiester; PE, phosphoethanolamine; PET, positron emission tomography; pHe, extracellular fluid pH; pHNMR, intracellular pH derived from the 3cP NMR spectrum; PI, phosphoinositol; PME, phosphomonoester; PMRFI, phase modulated rotating frame imaging; SE PRESS, spin echo point resolved spectroscopy; STEAM, Stimulated echo acquisition mode; TCHO, totd choline (freeechoh e , phosphocholine and other choline-containing metablltes) In. 'H MRS; TCR, total creatine (CR and PCR) in 'H MRS; TMR, ToPlcal Magnetic Resonance.MRS has been reported in over 200 brain t~m o r s .~* '~ 'H MRS of cancers outside the brain contains large signals from tissue fat making interpretation difficult and in only a few cases has water-suppressed 'H MRS been published.-'H NMR spectra without water suppression are used to examine bone marrow: since normal marrow contains 50% or more fatty tissue the ratio of the water to the methylene 'H peak is a Bottomley et al. in 1983' [Fig. l(b)) Its clinical use was established in diabetic muscle' and a 13C NMR spectrum of the prostate gland was obtained,% but only one cancer (in brain) has been reported.m23Na MRI of brain tumors, described by Feinberg et al. in 1985;' has been reported in ca 40 c a s e~.~' '~ '!T MRS was first used by Wolf er al. in 1987lO4 to examine 5-FU catabolism in the liver, and has been studied in the liver andor tumor of over 50 patients with cancer.'%"* Previous reviews of MRS in human cancers appeared in 1989.11-F'u Recent reviews of related topics include in uitro high-resolution NMR studies of cancer extracts,'= NMR studies of metabolism in tumor cells and perfused organs'24J25 and technical problems affecting reproducibility in clinical MRS.'% This paper reviews the literature of 31P, 'H, 13C, =...

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Section: Ischemia Hypoxia and Necrosis In Human Cancersmentioning

confidence: 99%

Studies of human tumors by MRS: A review

1992

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“…MRS has also been used to evaluate the prostate (14), breast (15, 16), and uterine cervix (17), as well as to evaluate diffuse hepatic disease, such as hepatic steatosis (18), chronic hepatitis (19, 20), and cirrhosis (21, 22). Phosphorus‐31 MRS has been used to assess hepatocellular adenomas (23), a variety of hepatic tumors (24, 25), and for the assessment of the effect of chemoembolization treatment (26). However, in the previous studies, in order to get enough signal‐to‐noise ratios for subsequent spectral analysis, the areas of interest were limited to peripheral locations and close to receiver surface coils.…”

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confidence: 99%

In vivo proton magnetic resonance spectroscopy of large focal hepatic lesions and metabolite change of hepatocellular carcinoma before and after transcatheter arterial chemoembolization using 3.0‐T MR scanner

Kuo

Chen

et al. 2004

Magnetic Resonance Imaging

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Purpose:To investigate the value of in vivo proton magnetic resonance spectroscopy (MRS) in the assessment of large focal hepatic lesions and to measure the metabolite change of hepatocellular carcinoma (HCC) after transcatheter arterial chemoembolization (TACE) using 3.0-T scanner. Materials and Methods:In this prospective study, 43 consecutive patients with large (not less than 3 cm in diameter) hepatic tumors and eight normal volunteer were included. MRS of the lesions in addition to uninvolved liver parenchyma was carried out using a whole-body 3.0-T scanner. Among the patients with proven HCC, eight lesions were evaluated before and two to five days after TACE. The choline-to-lipid (cho/lipid) ratio was measured by dividing the peak area of choline at 3.2 ppm by the peak area of lipid at 1.3 ppm. The sensitivity and specificity profiles of MRS in the diagnosis of malignant hepatic tumors were determined by plotting empirical receiver operating characteristic (ROC) curve. The mean cho/lipid ratios in different groups before and after TACE were also measured. Results:The technical success rate for MRS was 90% (53/ 59). The ROC curve showed proton MRS has moderate discriminating ability in diagnosing malignant hepatic tumors, although the sensitivity was less than 50% while 1-specificity was less than 20%. The area under the curve was 0.71 (P Ͻ 0.05). The mean Ϯ 1 standard error (SE) of cho/lipid ratios for uninvolved liver (N ϭ 8), benign tumor (N ϭ 8), and malignant tumor (N ϭ 21; 19 HCC, one angiosarcoma, and one lymphoma) were 0.06 Ϯ 0.02, 0.02 Ϯ 0.02, and 0.17 Ϯ 0.05, respectively. A significantly statistical difference (ANOVA planned contrast test, P ϭ 0.01 and Games-Howell procedure, P ϭ 0.03) was achieved in the mean cho/lipid ratio between malignant and benign tumors. The mean cho/lipid ratios were significantly decreased from 0.23 Ϯ 0.11 before TACE to 0.01 Ϯ 0.00 after the treatment (t ϭ 2.01, P Ͻ 0.05, one-tail paired t-test; z ϭ -2.37, P Ͻ 0.05, Wilcoxon Signed Ranks Test). Conclusion:In vivo proton MRS is technically feasible for the evaluation of focal hepatic lesions. The technique has potential in the detection of early metabolite change in malignant liver tumors after TACE but limitation still exists in clear differentiation between normal liver and benign and malignant tumor.

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“…9 In another study of 22 patients with lymphomas, a decrease in PME was shown in all but one of the patients who had abnormally high ratios of PME/ATP in their initial spectra. 10 This change was seen as early as one day and as late as two weeks after commencing treatment.…”

Section: P Study Of Human Hepatic Tumoursmentioning

confidence: 92%

Metabolic changes underlying31P MR spectral alterations in human hepatic tumours

Bell

Bhakoo

1998

NMR Biomed.

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Magnetic resonance spectroscopy (MRS) remains the technique of choice for observing tumour metabolism non‐invasively. Although initially 31P MR spectroscopy showed much promise as a non‐invasive diagnostic tool, studies of a wide range of hepatic tumours have conclusively shown that this technique cannot be utilized to distinguish between different tumour types. This lack of specificity and sensitivity appears to be a consequence of the fact that hepatic tumours develop with a range of modalities and not as a single abnormal disease process, and also because of the limited availability of MR detectable metabolic markers. This has led, in recent years, to a re‐evaluation of the role of 31P MR spectroscopy, re‐emerging as a non‐invasive tool to follow the efficacy of the treatment regime. Furthermore, since the principal changes observed in tumours by 31P MRS appear to be an elevation in the concentration of phosphorylcholine (PCho) and phosphoethanolamine (PEth), new research using a combination of MRS and tissue culture of cell lines which carry a combination of known inducible oncogenes, are helping to elucidate some of the metabolic pathways that give rise to these metabolic alterations. © 1998 John Wiley & Sons, Ltd.

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Liver tumors: follow-up with P-31 MR spectroscopy after local chemotherapy and chemoembolization.

Cited by 27 publications

References 0 publications

Studies of human tumors by MRS: A review

Studies of human tumors by MRS: A review

In vivo proton magnetic resonance spectroscopy of large focal hepatic lesions and metabolite change of hepatocellular carcinoma before and after transcatheter arterial chemoembolization using 3.0‐T MR scanner

Metabolic changes underlying31P MR spectral alterations in human hepatic tumours

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