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Magnetic Resonance Spectroscopy Guided Brain Tumor Resection: Differentiation Between Recurrent Glioma and Radiation Change in Two Diagnostically Difficult Cases

Published online by Cambridge University Press:  18 September 2015

Mark C. Preul ,
Richard Leblanc ,
Zografos Caramanos ,
Reza Kasrai ,
Sridar Narayanan  and
Douglas L. Arnold
Mark C. Preul
Affiliation:
Department of Neurology and Neurosurgery, MR Spectroscopy Unit and Neurolmaging Laboratory, Montreal Neurological Hospital and Institute, Montreal
Richard Leblanc*
Affiliation:
Department of Neurology and Neurosurgery, MR Spectroscopy Unit and Neurolmaging Laboratory, Montreal Neurological Hospital and Institute, Montreal
Zografos Caramanos
Affiliation:
Department of Neurology and Neurosurgery, MR Spectroscopy Unit and Neurolmaging Laboratory, Montreal Neurological Hospital and Institute, Montreal
Reza Kasrai
Affiliation:
Department of Neurology and Neurosurgery, MR Spectroscopy Unit and Neurolmaging Laboratory, Montreal Neurological Hospital and Institute, Montreal
Sridar Narayanan
Affiliation:
Department of Neurology and Neurosurgery, MR Spectroscopy Unit and Neurolmaging Laboratory, Montreal Neurological Hospital and Institute, Montreal
Douglas L. Arnold
Affiliation:
Department of Neurology and Neurosurgery, MR Spectroscopy Unit and Neurolmaging Laboratory, Montreal Neurological Hospital and Institute, Montreal
*
Montreal Neurological Institute and Hospital, 3801 University Street, Montreal, Quebec, Canada H3A 2B4
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Abstract:

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Background:

It is often difficult to differentiate a recurrent glioma from the effects of post-operative radiotherapy by means of conventional neurodiagnostic imaging. Proton magnetic resonance spectroscopic imaging (1H-MRSI), that allows in vivo measurements of the concentration of brain metabolites such as choline-containing phospholipids (Cho), may provide in vivo biochemical information helpful in distinguishing areas of tumor recurrence from areas of radiation effect.

Patients and Methods:

Two patients who had undergone resection and post-operative radiotherapy for a cerebral glioma became newly symptomatic. Computed tomographic (CT) and magnetic resonance imaging (MRI) performed after the intravenous infusion of contrast material, and in one case, [18F] fluorodeoxyglucose positron emission tomography (PET), could not differentiate between the possibilities of recurrent glioma and radiation effect. The patients underwent 1H-MRSI prior to reoperation and the 1H-MRSI results were compared to histological findings originating from the same locations.

Results:

A high Cho signal measured by 1H-MRSI was seen in areas of histologicallyproven dense tumor recurrence, while low Cho signal was present where radiation changes predominated.

Conclusions:

The differentiation between the recurrence of a cerebral glioma and the effects of post-operative irradiation was achieved using 1H-MRSI in these two patients whose conventional neurodiagnostic imaging was equivocal for such a distinction. Where these two conditions are present, metabolite images from 1H-MRSI, such as that based on Cho, can be co-registered with other imaging modalities such as MRI and may also be integrated with functional MRI or functional PET within a multimodal imaging-guided surgical navigation system to assure maximal resection of recurrent tumor while minimizing the risk of added neurological damage.

Type
Expedited Publication
Information
Canadian Journal of Neurological Sciences , Volume 25 , Issue 1 , February 1998 , pp. 13 - 22
Copyright
Copyright © Canadian Neurological Sciences Federation 1998

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