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Recognition of anaplastic foci within low-grade gliomas using MR spectroscopy

Publikace na 1. lékařská fakulta, 3. lékařská fakulta |
2014

Tento text není v aktuálním jazyce dostupný. Zobrazuje se verze "en".Abstrakt

The recognition of anaplastic foci within low-grade gliomas is of extreme importance in patients under follow-up for Grade II gliomas. We present the algorithm of MR spectroscopy (MRS)-guided brain biopsy and its correlation with tumour histology.

Methods. Twenty-seven patients harbouring suspected Grade II/III glioma were examined on our 3T MR. 2D PRESS-CSI metabolite images of Choline/Creatine, Creatine/N-acetylaspartate and Choline/N-acetylaspartate were calculated and exported to the DICOM format.

According to these maps, a stereobiopsy was performed at the point of maximum Choline/Creatine ratio prior to tumour resection. In the case of enhancing tumour, a subsequent biopsy was performed from the point of enhancement.

Comparisons were made between the histology of the biopsied specimens and the resected tumours. Results.

Eleven tumours were diagnosed as high-grade and sixteen as low-grade lesions. The correlation between main spectroscopic ratios (Cho/Cr and Cho/NAA) was strongly positive at the points of maximum Cho/Cr.

Similar results were obtained at the points of contrast enhancement. Comparison of histological parameters of biopsy samples at the points of maximum Cho/Cr and histological examination of the completely resected tumours gives a strong correlation of tumour grade, number of mitoses and Ki-67 expression.

The diagnostic accuracy of MRS-guided biopsy was 84%. The absolute value of Cho/NAA was higher in high-grade compared to that of low-grade lesions.

The value of Cho/NAA ratio of 0.9 using MRS produced a sensitivity and specificity of 78% in the differentiation between low-grade and high-grade lesions. Combining MRS with structural MR, the sensitivity increased to 86% and the specificity to 80%.

Conclusions. Strong correlation was demonstrated between Cho/Cr and Ch/NAA ratios. ches