Imaging of Brain Tumors: MR Spectroscopy and Metabolic Imaging

Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287, USA.
Neuroimaging Clinics of North America (Impact Factor: 1.53). 08/2010; 20(3):293-310. DOI: 10.1016/j.nic.2010.04.003
Source: PubMed


The utility of magnetic resonance spectroscopy (MRS) in diagnosis and evaluation of treatment response to human brain tumors has been widely documented. The role of MRS in tumor classification, tumors versus nonneoplastic lesions, prediction of survival, treatment planning, monitoring of therapy, and post-therapy evaluation is discussed. This article delineates the need for standardization and further study in order for MRS to become widely used as a routine clinical tool.

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    • "Both PET and MRS have been used clinically for evaluating tumor metabolism. Although MRS is capable of detecting metabolic dysfunction in tissue that otherwise appears normal on structural imaging, most clinical applications are limited to a small region with single-voxel or multi-voxel acquisitions due to long acquisition time or SNR limitations [10]. In contrast, 18 F-FDG-PET can quickly outline potential metabolic abnormalities throughout the body, but may yield false positive results associated with inflammation, etc. "
    [Show abstract] [Hide abstract] ABSTRACT: The primary objective of this study was to develop and validate simultaneous PET/MRI-MRS as a novel biological image-guided approach to neoadjuvant radiotherapy (RT) and/or chemoradiation (chemoRT) in soft tissue sarcomas (STS). A patient with sarcoma of the right thigh underwent PET/MRI scan before and after neoadjuvant (preoperative) radiotherapy. The Magnetic Resonance Imaging (MRI) and 2-deoxy-2-[fluorine-18]-fluoro-D-glucose-Positron Emission Tomography ((18)F-FDG-PET) scans were performed simultaneously. In the post-radiation scan, Magnetic Resonance Spectroscopy (MRS) was subsequently acquired with volume of interest positioned in a residual hyper-metabolic region detected by PET. Post-radiation PET/MRI showed a residual T2-hyperintense mass with significantly reduced (18)F-FDG-uptake, compatible with near complete response to radiotherapy. However, a small region of residual high (18)F-FDG uptake was detected at the tumor margin. MRS of this region had similar metabolite profile as normal tissue, and was thus considered false positive on PET scan. Pathology results were obtained after surgery for confirmation of imaging findings.
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    • "In a follow-up survey we performed six years after the conduction of the original work so to provide a more thorough knowledge of any changes in practice patterns by hospitals to keep up with field advancements, we found that MRS was started to become a standard service in most hospitals. This finding conformed to some extent with observations by contemporary works expressing the beginning of its acceptance, though not universally , as routine clinical procedure [39]. On the contrary, fMRI was still unrecognized as it was during the initial earlier survey. "
    [Show abstract] [Hide abstract] ABSTRACT: Functional magnetic resonance imaging “fMRI” and magnetic resonance spectroscopy “MRS” are two crucial milestones that were introduced apart from one another into brain imaging and their implementation in major local cities is eventual step. Thus, the purpose of this study was to compare those techniques in terms of their clinical utilization in patient care delivery among the major governmental and private hospitals within Jeddah city. The study initially included eighteen hospitals to identify whether they were utilizing fMRI and MRS in their clinical practice. Out of the 18 hospitals under study only one hospital (5.6%) had both fMRI and MRS software; 7 (38.9%) had MRS but not fMRI; 4 (22.2%) did not have fMRI or MRS; and 6 (33.3%) hospitals had no MRI machine at all. Out of the eight hospitals applying MRS with one being excluded, the starting date of application was 2002 in 4 (57.1%) hospitals, 2004 in 1 (14.3%) hospital, and 2006 in 2 (28.6%) hospitals. The frequency of doing MRS was once a week in 2 (28.6%) hospitals, 2-3 cases/week in 3 (42.9%) hospitals, 5-10 cases/week in 1 (14.3%) hospital, and once every 6 months in 1 (14.3%) hospital. On the other hand, fMRI was applied only by one hospital starting in 2000 and was soon dismissed due to its time consumption and the inability of patients to accurately follow given instructions. It was concluded that MRS was more widely utilized compared to fMRI. Later on, a follow-up survey in the year of 2014 demonstrated that MRS has started to become a standard service in most hospitals whereas fMRI was still being unrecognized.
    Full-text · Article · Sep 2015 · Open Journal of Medical Imaging
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    • "Additional metabolites of interest include lipid and lactate peaks at approximately 1.3 ppm and myo-inositol at approximately 3.5 ppm. Lipids and lactate are considered markers of necrosis and hy-poxia, respectively, and myo-inositol is considered to be related to astrocytic integrity and regulation of brain osmosis131132133134. The MRS profile of gliomas is generally considered elevated Cho and decreased NAA135136137 . "
    [Show abstract] [Hide abstract] ABSTRACT: The imaging and clinical management of patients with brain tumor continue to evolve over time and now heavily rely on physiologic imaging in addition to high-resolution structural imaging. Imaging remains a powerful noninvasive tool to positively impact the management of patients with brain tumor. This article provides an overview of the current state-of-the art clinical brain tumor imaging. In this review, we discuss general magnetic resonance (MR) imaging methods and their application to the diagnosis of, treatment planning and navigation, and disease monitoring in patients with brain tumor. We review the strengths, limitations, and pitfalls of structural imaging, diffusion-weighted imaging techniques, MR spectroscopy, perfusion imaging, positron emission tomography/MR, and functional imaging. Overall this review provides a basis for understudying the role of modern imaging in the care of brain tumor patients.
    Full-text · Article · Apr 2015
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