The diagnostic performance of magnetic resonance spectroscopy in differentiating high-from low-grade gliomas: A systematic review and meta-analysis

Wang, Qun; Zhang, Hui; Zhang, Jiashu; Wu, Chen; Zhu, Weijie; Li, Fangye; Chen, Xiaolei; Xu, Bainan

doi:10.1007/s00330-015-4046-z

Cited by 91 publications

(90 citation statements)

References 49 publications

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“…A potential advantage of MRS lies in the characterisation of grade II oligodendroglioma, which commonly show elevated rCBV, and may be misclassified as high-grade tumour [49]. Otherwise, MRS finds a less prominent application in grading, tumour classification, biopsy planning and characterisation of radiation effects, with a moderate performance shown for the latter indications in research [50–52]. For glioma grading, Cho/Cr and Cho/NAA ratios have most frequently been reported to increase diagnostic accuracy, but in isolation MRS remains inferior to rCBV measurements [47, 53].…”

Section: Discussionmentioning

confidence: 99%

“…For glioma grading, Cho/Cr and Cho/NAA ratios have most frequently been reported to increase diagnostic accuracy, but in isolation MRS remains inferior to rCBV measurements [47, 53]. For various thresholds, quantitative MRS suffers from a mismatch between sensitivity and specificity, therefore a clear diagnostic benefit in grading has only been shown through combination with other techniques [34, 50, 53]. For the differentiation of radiation necrosis and recurrent glioma, a systematic meta-analysis revealed a limited performance for MRS, and strongly recommended its use only in combination with other modalities [51].…”

Section: Discussionmentioning

confidence: 99%

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Glioma imaging in Europe: A survey of 220 centres and recommendations for best clinical practice

et al. 2018

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ObjectivesAt a European Society of Neuroradiology (ESNR) Annual Meeting 2015 workshop, commonalities in practice, current controversies and technical hurdles in glioma MRI were discussed. We aimed to formulate guidance on MRI of glioma and determine its feasibility, by seeking information on glioma imaging practices from the European Neuroradiology community.MethodsInvitations to a structured survey were emailed to ESNR members (n=1,662) and associates (n=6,400), European national radiologists’ societies and distributed via social media.ResultsResponses were received from 220 institutions (59% academic). Conventional imaging protocols generally include T2w, T2-FLAIR, DWI, and pre- and post-contrast T1w. Perfusion MRI is used widely (85.5%), while spectroscopy seems reserved for specific indications. Reasons for omitting advanced imaging modalities include lack of facility/software, time constraints and no requests. Early postoperative MRI is routinely carried out by 74% within 24–72 h, but only 17% report a percent measure of resection. For follow-up, most sites (60%) issue qualitative reports, while 27% report an assessment according to the RANO criteria. A minority of sites use a reporting template (23%).ConclusionClinical best practice recommendations for glioma imaging assessment are proposed and the current role of advanced MRI modalities in routine use is addressed.Key Points• We recommend the EORTC-NBTS protocol as the clinical standard glioma protocol.• Perfusion MRI is recommended for diagnosis and follow-up of glioma.• Use of advanced imaging could be promoted with increased education activities.• Most response assessment is currently performed qualitatively.• Reporting templates are not widely used, and could facilitate standardisation.Electronic supplementary materialThe online version of this article (10.1007/s00330-018-5314-5) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Glioma imaging in Europe: A survey of 220 centres and recommendations for best clinical practice

et al. 2018

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“…Cho/Cr ratio tends to increase as glioma malignancy progresses. In a recent metaanalysis, Cho/NAA ratio showed a sensitivity of 80% and specificity of 76%, higher than Cho/ Cr ratio and NAA/Cr ratio for the differentiation of high-grade from low-grade gliomas [9]. However, both sensitivity and specificity do not enable an accurate diagnosis, thus additional imaging modalities may be needed.…”

Section: Mr Spectroscopymentioning

confidence: 95%

Advanced MR Imaging Techniques in the Diagnosis of Intraaxial Brain Tumors

Zikou¹,

Alexiou²,

Argyropoulou³

2016

Neurooncology - Newer Developments

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Intracranial masses are a significant health problem and present several imaging challenges. The role of imaging is no longer limited to merely providing anatomic details but the advanced MR techniques permit the assessment of the freedom of water molecule movement, the microvascular structure and hemodynamic characteristics, and the chemical makeup of certain metabolites of lesions. In the current chapter, we will discuss the role of the advanced MR imaging techniques, namely perfusion, diffusion-weighted imaging, and MR spectroscopy in the diagnosis and classification of the most frequent brain tumors in adults. We provide a brief description of the advanced MR techniques that are currently used, and we discuss in detail the imaging findings for each lesion. These lesions include gliomas both high and low grade, metastatic lesions, lymphomas, and lesions that may mimic tumors such as tumefactive demyelinating lesions, abscesses, and encephalitis. Our goal is to summarize the diagnostic information that advanced MR imaging techniques offer for establishing a diagnosis and clinical decision making.

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“…For example, the concentrations of Cho (a marker of membrane turnover and cell density) and creatine (Cr, levels of which are related to cellular energy state) can be measured in normal and tumor tissues; they appear to be distinctively distributed in high-grade brain tumors, which have significantly higher Cho/Cr ratios than benign lesions 13,14. Although proton MRS ( 1 H-MRS) imaging of Cho and other metabolites has been used for decades in the diagnosis and staging of gliomas,15 grading of tumors,16,17 and following treatment,18,19 the relationship between biochemical metabolic heterogeneity within gliomas and CSC niches has yet to be established. A recent study reported that 1 H-MRS integrated with the use of a neuronavigation system can facilitate intraoperative planning and maximal resection, based on the metabolic activities of gliomas, leading to a better patient prognosis 20.…”

Section: Introductionmentioning

confidence: 99%

Multivoxel magnetic resonance spectroscopy identifies enriched foci of cancer stem-like cells in high-grade gliomas

Qiu

Wang

et al. 2017

OTT

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ObjectiveThis study investigated the correlation between choline/creatine (Cho/Cr) ratios determined by multivoxel proton magnetic resonance spectroscopy (1H-MRS) and the distribution of cancer stem-like cells (CSLCs) in high-grade gliomas.Patients and methodsSixteen patients with high-grade gliomas were recruited and underwent 1H-MRS examination before surgery to identify distinct tumor regions with variable Cho/Cr ratios. Using intraoperative neuronavigation, tumor tissues were accurately sampled from regions with high and low Cho/Cr ratios within each tumor. The distribution of CSLCs in samples from glioma tissue regions with different Cho/Cr ratios was quantified by neurosphere culture, immunohistochemistry, and Western blot.ResultsThe mean neurosphere formation rate in tissues with high Cho/Cr ratios was significantly increased compared with that in low Cho/Cr ratio tissues (13.94±5.94 per 100 cells vs 8.04±3.99 per 100 cells, P<0.001). Immunohistochemistry indicated that tissues with high Cho/Cr ratios had elevated expression of CD133, nestin, and CD15, relative to low Cho/Cr ratio tissue samples (23.6%±3.8% vs 18.3%±3.3%, 25.2%±4.5% vs 19.8%±2.8%, 24.5%±3.8% vs 17.8%±2.2%, respectively; all P<0.001). Western blot demonstrated that relative CD133 and nestin protein expression in high Cho/Cr ratio regions was significantly higher than that in low Cho/Cr ratio tissue samples (0.50±0.17 vs 0.30±0.08, 0.45±0.13 vs 0.27±0.07, respectively; both P<0.001). The protein expression levels of CD133 and nestin were highly correlated with Cho/Cr ratios (r=0.897 and r=0.861, respectively).ConclusionCho/Cr ratios correlate with the distribution of CSLCs in high-grade gliomas, and this may assist in identifying foci enriched with CSLCs and thus improve the management of high-grade gliomas.

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The diagnostic performance of magnetic resonance spectroscopy in differentiating high-from low-grade gliomas: A systematic review and meta-analysis

Cited by 91 publications

References 49 publications

Glioma imaging in Europe: A survey of 220 centres and recommendations for best clinical practice

Glioma imaging in Europe: A survey of 220 centres and recommendations for best clinical practice

Advanced MR Imaging Techniques in the Diagnosis of Intraaxial Brain Tumors

Multivoxel magnetic resonance spectroscopy identifies enriched foci of cancer stem-like cells in high-grade gliomas

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