Proton magnetic resonance spectroscopy predicts proliferative activity in diffuse low-grade gliomas

Abstract

The aim of the study was to investigate the ability of (1)HMRS to reflect proliferative activity of diffuse low-grade gliomas (WHO grade II). Between November 2002 and March 2007, a prospective study was performed on consecutive patients with suspected supratentorial hemispheric diffuse low-grade tumors. All the patients underwent MR examination using uniform procedures, and then surgical resection or biopsy within 2 weeks of the MR examination. Proliferative activity of the tumors was assessed by Ki-67 immunochemistry (Mb-1) on paraffin embedded tumor sections. Spectroscopic data was compared with Ki-67 labeling index and other histologic data such as histological subtype, cellular atypia, cellular density using univariate and multivariate analysis. 82 of 97 consecutive patients had histologically confirmed WHO grade 2 gliomas. Ki-67 proliferation index (PI) was correlated with specific spectral patterns: (1) low PI (<4%) was associated with increased Cho/Cr and absence of both free lipids or lactates; (2) intermediate PI (4-8%) was associated with resonance of lactates; and (3) high PI (>8%) was characterized by a resonance of free lipids. On multivariate analysis, resonance of lactates and resonance of free lipids appeared as independent predictors of intermediate PI (P < 0.001) and high PI (P < 0.001), respectively; moreover, free lipids resonance was correlated with cellular atypia (P < 0.05). This study suggests that (1)HMRS is a reliable tool to evaluate the proliferation activity of WHO grade 2 glioma and to identify potentially more aggressive clinical behavior.

Proton MR spectroscopic imaging of human glioblastomas at 1.5 Tesla

“…In previous study it was reported that the 45% increase of tCho indicates tumor progression, while an increase of up to 35% indicates its stable status (Pinker et al 2012). The direct correlation was also declared between the tCho/tNAA, tCho/tCr and the proliferation marker Ki-67 (Guillevin et al 2008;Toyooka et al 2008) which is a predictor of aggressive clinical tumor manifestation (Horska and Barker 2010;Kao et al 2013). In this study, in addition to elevated values of tCho/tCr and tCho/tNAA decreased levels of tNAA/tCr were also observed in glioblastoma-affected brain tissue compared to the healthy areas.…”

“…However, it is possible to spectroscopically measure precursors of their synthesis and products of their degradation as the tCho signal contributors (Solivera and Law 2009;Ha et al 2013). Since the level of tCho particularly reflects the concentration of phosphocholine which is more than twice increased in highgrade gliomas (Lupo et al 2007;McKnight and Wladman 2010), tCho is suitable for monitoring tumor carcinogenesis (Guillevin et al 2008;Housni and Boujraf 2013). In previous study it was reported that the 45% increase of tCho indicates tumor progression, while an increase of up to 35% indicates its stable status (Pinker et al 2012).…”

“…To the tCho signal mainly phosphocholine contributes, and in a lesser extent glycerophosphocholine, free choline, and acetylcholine (Horska and Barker 2010;McKnight and Wladman 2010). Since the phosphocholine is the precursor of membrane phospholipids synthesis (Solivera et al 2009;Ha et al 2013), tCho is considered to be the most useful MRS parameter reflecting higher cellular proliferation and tumor carcinogenesis (Guillevin et al 2008;Housni and Boujraf 2013). The concentration of free creatine and phosphocreatine, detected as a joint peak tCr, has the most stable value among 1 H MRS detectable metabolites and thus it is usually used as a reference for relative metabolite quantification (Soares and Law 2009;Barker 2010).…”

Comparison of Multiple Parameters Obtained on 3T Pulsed Arterial Spin-Labeling, Diffusion Tensor Imaging, and MRS and the Ki-67 Labeling Index in Evaluating Glioma Grading

“…19 According to the previous literature, this index is correlated with various advanced MR imaging parameters. 8,20,21 In this study, we performed a comparative review of multiple parameters obtained with pulse sequences evaluated by using 3T MR imaging and glioma grading in newly diagnosed patients with glioma. Our purpose was to evaluate whether the parameters provide useful, complementary information and whether this combination of parameters shows the best performance for grading cerebral gliomas.…”

Proton MR spectroscopy in predicting the increase of perfusion MR imaging for WHO grade II gliomas

“…rCBV has also been correlated with glucose uptake and tumor angiogenesis in human gliomas (22,23). In a previous study we demonstrated a correlation between different Ki-67 values and specific spectral profiles, eg, the resonance of lactate was an independent predictive factor of Ki-67 values that are greater than 4% (16). Moreover, we have previously shown a correlation between the resonance of free lipids and the presence of cellular atypia.…”