BACKGROUND: MR spectroscopy (MRS) measurements are common practice in the preoperative diagnostic regimen, but no evidence exists concerning their value in intraoperative MRI (iMRI) setting. We sought to examine the feasibility of intraoperative MRS and to assess the clinical value of the method in optimizing the gliomas resection. METHODS: Forty-five patients with low- and high-grade gliomas underwent iMRI-assisted surgery, including pre- and intraoperative MRS measurements. During the intraoperative control scan, MRS was performed at the resection margin. Peak areas under the major metabolites (N-acetyl-aspartate: NAA; choline: Cho; and creatine: Cr) resonances were estimated, and their ratios entered in the statistical analysis. RESULTS: Concerning preoperative MRS imaging, mean Cho/NAA and Cho/Cr ratios in low-grade gliomas were 2.3 and 1.2, respectively. The average Cho/NAA and Cho/Cr ratios in the high-grade gliomas were 3.9 and 2.3, respectively. In 12 out of 20 cases with low-grade gliomas, intraoperative conventional MR imaging showed suspected tumor remnant and MRS diagnosed correctly the tissue signal alterations in 10 out of those 12 cases. MRS could characterize gadolinium-enhancing or non-enhancing tumor remnants in all cases with high-grade tumors. Thus, it could help achieve total tumor resection unless the latter was contraindicated due to increased risk of neurological complications. CONCLUSIONS: MR spectroscopy (MRS) in an iMRI setting is feasible, facilitating preoperative glioma staging as well as satisfactory characterization of suspected tumor remnants. Thus, it may be helpful tool for an extended tumor resection.
BACKGROUND: MR spectroscopy (MRS) measurements are common practice in the preoperative diagnostic regimen, but no evidence exists concerning their value in intraoperative MRI (iMRI) setting. We sought to examine the feasibility of intraoperative MRS and to assess the clinical value of the method in optimizing the gliomas resection. METHODS: Forty-five patients with low- and high-grade gliomas underwent iMRI-assisted surgery, including pre- and intraoperative MRS measurements. During the intraoperative control scan, MRS was performed at the resection margin. Peak areas under the major metabolites (N-acetyl-aspartate: NAA; choline: Cho; and creatine: Cr) resonances were estimated, and their ratios entered in the statistical analysis. RESULTS: Concerning preoperative MRS imaging, mean Cho/NAA and Cho/Cr ratios in low-grade gliomas were 2.3 and 1.2, respectively. The average Cho/NAA and Cho/Cr ratios in the high-grade gliomas were 3.9 and 2.3, respectively. In 12 out of 20 cases with low-grade gliomas, intraoperative conventional MR imaging showed suspected tumor remnant and MRS diagnosed correctly the tissue signal alterations in 10 out of those 12 cases. MRS could characterize gadolinium-enhancing or non-enhancing tumor remnants in all cases with high-grade tumors. Thus, it could help achieve total tumor resection unless the latter was contraindicated due to increased risk of neurological complications. CONCLUSIONS: MR spectroscopy (MRS) in an iMRI setting is feasible, facilitating preoperative glioma staging as well as satisfactory characterization of suspected tumor remnants. Thus, it may be helpful tool for an extended tumor resection.
Authors: Radhika Srinivasan; Joanna J Phillips; Scott R Vandenberg; Mei-Yin C Polley; Gabriela Bourne; Alvin Au; Andrea Pirzkall; Soonmee Cha; Susan M Chang; Sarah J Nelson Journal: Neuro Oncol Date: 2010-07-20 Impact factor: 12.300
Authors: Isabelle Catalaa; Roland Henry; William P Dillon; Edward E Graves; Tracy R McKnight; Ying Lu; Daniel B Vigneron; Sarah J Nelson Journal: NMR Biomed Date: 2006-06 Impact factor: 4.044
Authors: A Stadlbauer; C Nimsky; S Gruber; E Moser; T Hammen; T Engelhorn; M Buchfelder; O Ganslandt Journal: AJNR Am J Neuroradiol Date: 2007-03 Impact factor: 3.825
Authors: Christian Senft; Elke Hattingen; Ulrich Pilatus; Kea Franz; Anne Schänzer; Heinrich Lanfermann; Volker Seifert; Thomas Gasser Journal: Neurosurgery Date: 2009-11 Impact factor: 4.654
Authors: Mustafa Aziz Hatiboglu; Jeffrey S Weinberg; Dima Suki; Ganesh Rao; Sujit S Prabhu; Komal Shah; Ed Jackson; Raymond Sawaya Journal: Neurosurgery Date: 2009-06 Impact factor: 4.654
Authors: Juan M García-Gómez; Jan Luts; Margarida Julià-Sapé; Patrick Krooshof; Salvador Tortajada; Javier Vicente Robledo; Willem Melssen; Elies Fuster-García; Iván Olier; Geert Postma; Daniel Monleón; Angel Moreno-Torres; Jesús Pujol; Ana-Paula Candiota; M Carmen Martínez-Bisbal; Johan Suykens; Lutgarde Buydens; Bernardo Celda; Sabine Van Huffel; Carles Arús; Montserrat Robles Journal: MAGMA Date: 2008-11-07 Impact factor: 2.310