Long-term cerebral metabolite changes on proton magnetic resonance spectroscopy in patients cured of acute lymphoblastic leukemia with previous intrathecal methotrexate and cranial irradiation prophylaxis

Chan, Y. L.; Roebuck, Derek J.; Yuen, Man-pan; Yeung, K.W.; Lau, Kam-ying; Li, Chi Kong; Chik, Ki Wai

doi:10.1016/s0360-3016(01)01513-9

Cited by 35 publications

(40 citation statements)

References 19 publications

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“…During the present study, in patients with CNS leukemia MRS consistently demonstrated an increase in Cho, and a decrease in or absence of NAA. The Cr peak was consistent with previous data from the literature (36,37). This indicates the 'exogenous' features of the tumor, which possibly aid the differentiation of CNS leukemia from other lesions.…”

Section: Discussionsupporting

confidence: 90%

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Lesions of the central nervous system in leukemia: Pathological and magnetic resonance imaging features at presentation in 14 patients

et al. 2017

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Abstract. The present study aimed to characterize the specific pathology and magnetic resonance imaging (MRI) findings observed in patients with leukemia with central nervous system (CNS) lesions, and to determine their value in the management of such patients. Lesions of the CNS were observed during and following treatment of leukemia. The data from stereotactic biopsy-proven pathology (12 patients) and MRI examinations (14 patients) were retrospectively evaluated. Proton-magnetic resonance-spectroscopy was performed in three patients. Factors that predisposed to lesions of the CNS were reviewed from the patient medical records. Among the 14 patients, eight had CNS leukemia, four had a CNS infection and two had a neurodegenerative disorder (one leukoencephalopathy and one glial cell hyperplasia). The clinical diagnosis based on clinical symptoms, signs and MRI features was not consistent with the pathological diagnosis in two patients. In one patient, the clinical diagnosis was a CNS infection; however, the patient's pathological diagnosis was CNS leukemia. In the other patient, the clinical diagnosis was CNS leukemia, but the pathological diagnosis was glial cell hyperplasia. CNS lesions in leukemia have a wide range of causes. Apart from the relapse of leukemia in the CNS, there are treatment-associated neurotoxicities and infections that are caused by immunocompromised states.As numerous leukemia-associated CNS lesions are treatable, early diagnosis is essential.

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Section: Discussionsupporting

confidence: 90%

“…The novel imaging technique 1 H-MRS is important in the diagnosis of CNS leukemia, and in differentiating it from other brain lesions in patients with leukemia. This is particularly vital when the characteristic imaging findings that usually appear on traditional images are absent (37)(38)(39)(40)(41).…”

Section: Discussionmentioning

confidence: 99%

Lesions of the central nervous system in leukemia: Pathological and magnetic resonance imaging features at presentation in 14 patients

et al. 2017

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“…41 Observations of decreases in both the Cho and the Cho compounds and a decrease in the Cho/ Creatine (Cr) ratio have been reported in irradiated brain. 36,37,42,43 A third large metabolite present in the normal spectra is Cr. Cr is a marker of energy metabolism and is commonly considered to be fairly stable under most conditions and, therefore, is often used as the denominator in metabolic ratio calculations, even if some reports question the stability of Cr in tumors, hypoxia, and other confounding factors.…”

Section: Effects Of Radiation On Normal Brainmentioning

confidence: 99%

“…[41][42][43]47,48,50,51,59 Measurements of Metabolites and Ratio Calculations One of the major problems when reviewing the literature and comparing existing MR spectroscopy data is the use of various ways of calculating metabolite ratios. Several different methods have been used when trying to differentiate recurrent tumor from radiation-induced injury, and there is currently no consensus in the literature on which type of differently calculated ratios can best differentiate tumor recurrence from radiation change.…”

Section: Mr Spectroscopy In Radiation Injurymentioning

confidence: 99%

MR Spectroscopy in Radiation Injury

Sundgren¹

2009

AJNR Am J Neuroradiol

122

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SUMMARY:Detecting a new area of contrast enhancement in or in the vicinity of a previously treated brain tumor always causes concern for both the patient and the physician. The question that immediately arises is whether this new lesion is recurrent tumor or a treatment effect. The differentiation of recurrent tumor or progressive tumor from radiation injury after radiation therapy is often a radiologic dilemma regardless the technique used, CT or MR imaging. The purpose of this article was to review the utility of one of the newer MR imaging techniques, MR spectroscopy, to distinguish recurrent tumor from radiation necrosis or radiation injury. N ew contrast enhancing lesions discovered on routine follow-up brain imaging at or near the site of previously treated primary brain tumor present a diagnostic dilemma. Posttreatment imaging features are often non-specific and the differentiation between recurrent tumor and radiation injury is often difficult. In attempts by investigators to improve local tumor control and the overall clinical outcome and survival for patients with primary brain tumor, new, more aggressive treatment protocols are implemented or tested. These protocols include different schemes of dosages of various chemotherapeutic agents but also different schemes of locally administered high doses of radiation.Although these new radiation schemes have resulted in improved outcome, they have also been associated with a significant incidence of radiation injury to the brain. It is well documented that there is a relationship between increased survival and increased total dose. 1 The risk of late effects that can lead to devastating functional deficits several months to years after brain irradiation limits the total dose that can safely be administrated to patients. Recent data suggest that progressive dementia occurs in approximately 20%-50% of patients with brain tumor who are long-term survivors after treatment with large-field partial-or whole-brain irradiation. 2The differentiation of recurrent tumor or progressive tumor from radiation injury after radiation therapy is often a radiologic dilemma, regardless of the technique used, CT or MR imaging. Most of these brain neoplasms have been subjected to radiation and/or chemotherapy, and many of the tumors do not have specific imaging characteristics that will enable the neuroradiologist to discriminate tumor recurrence from the inflammatory or necrotic change that can result from treatment with radiation and/or chemotherapy. Both entities typically demonstrate contrast enhancement. It is, therefore, often the clinical course, a brain biopsy, or imaging over a lengthy follow-up interval that enables the distinction of recurrent tumor from a treatment-related lesion, not the specific imaging itself.3 A noninvasive tool that could differentiate these entities when a new enhancing lesion is first identified would be invaluable. MR spectroscopy might be well suited for this purpose, provided that spectra of diagnostic quality can be obtained. This noninvasi...

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“…Proton MRS is a noninvasive technique to, (i) interrogate metabolic distributions in the brain (Gillies and Morse 2005;Hoehn et al 2001), (ii) differentiate radiation necrosis from brain tumor progression (Chong et al 2002;Schlemmer et al 2002), and (iii) serve as a indicator of neurotoxicity following experimental (Chan et al 2009;Herynek et al 2004) and clinical brain irradiation (Chan et al 2001;Esteve et al 1998;Lee et al 2004;Virta et al 2000;Walecki et al 1999). Metabolites detected in brain tissue include choline-containing compounds, creatine, glutamate, lactate, N-acetylaspartate (NAA), myoinositol (mI), and taurine.…”

Section: Mr Proton Spectroscopymentioning

confidence: 99%

Quantitative/Objective Analyses of RT-Induced Late Normal Tissue Injury Using Functional Imaging

Nam

Robbins

Marks

2013

ALERT - Adverse Late Effects of Cancer Treatment

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Long-term cerebral metabolite changes on proton magnetic resonance spectroscopy in patients cured of acute lymphoblastic leukemia with previous intrathecal methotrexate and cranial irradiation prophylaxis

Cited by 35 publications

References 19 publications

Lesions of the central nervous system in leukemia: Pathological and magnetic resonance imaging features at presentation in 14 patients

Lesions of the central nervous system in leukemia: Pathological and magnetic resonance imaging features at presentation in 14 patients

MR Spectroscopy in Radiation Injury

Quantitative/Objective Analyses of RT-Induced Late Normal Tissue Injury Using Functional Imaging

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