MR-spectroscopy guided target delineation for high-grade gliomas

Patterns of Recurrence Analysis in Newly Diagnosed Glioblastoma Multiforme After Three-Dimensional Conformal Radiation Therapy With Respect to Pre–Radiation Therapy Magnetic Resonance Spectroscopic Findings

“…We found significant variations between the two modalities with respect to tumor size and location prior to surgery [14], and after surgery but before RT [15]. These data suggested that MRSI is likely to improve the diagnostic accuracy of the assessment of residual disease for HGG.…”

“…Serial biopsy studies show tumor cells more than 3 cm from the contrast enhancing (CE) region [13]; in addition, some tumors are not contrast-enhancing, and the T2 hyperintensity (T2h) may not distinguish tumor from edema, or normal appearing brain tissue beyond T2h might harbor tumor cells. Previous studies have shown that threedimensional (3D) magnetic resonance spectroscopic imaging (MRSI) is valuable for mapping the spatial extent of brain tumors and this technique is suggested as an adjunct to MRI in delineating the target for radiation therapy in high-grade gliomas (HGG) [14,15].…”

Delineation of Brain Tumor Extent with [11C]l-Methionine Positron Emission Tomography

“…Serial biopsies of patients undergoing craniotomy for malignant gliomas have shown tumor cells at a distance of Ͼ3 cm away from CT contrast enhancement (2,3). Moreover, MRI spectroscopy data also suggest that standard T1-weighted contrast-enhanced MRI may underestimate the volume of metabolically active tumors (4). T2-weighted MRI abnormalities, previously believed to represent edema only, are known to include microscopic disease extension, as verified by biopsy studies by Kelly et al (3).…”

Analysis of Metabolic Indices in Regions of Abnormal Perfusion in Patients with High-Grade Glioma

“…8,39 Parametric maps of elevated peak height, choline, and lactate levels, and abnormal recovery and creatine levels, may be beneficial in treatment planning, including target definition for conformal beam radiation therapy and biopsy guidance to help avoid underestimation of the histologic grading of nonenhancing tumors. [39][40][41] Predicting hypoxic regions would be especially advantageous in determining the most radiosensitive region of the tumor that would respond best to treatment. Future assessment of the role of the combination of these vascular and metabolic parameters as possible indicators of the effectiveness of novel antiangiogenic therapies, as well as their ability to predict survival and regions of recurrence, would be of great interest.…”