Use of proton magnetic resonance spectroscopy of the brain to differentiate gliomatosis cerebri from low-grade glioma
Use of proton magnetic resonance spectroscopy of the brain to differentiate gliomatosis cerebri from low-grade glioma
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DOI：
10.3171/jns.2003.98.2.0269
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发表时间：
2003-02-01
影响因子：
4.1
通讯作者：
Cozzone, PJ
中科院分区：
文献类型：
--
作者：
Galanaud, D;Chinot, O;Cozzone, PJ
Object.脑胶质瘤病（GC）是一种罕见的实体，其特点是广泛的脑肿瘤浸润，缺乏客观和定量的诊断标准。在9例GC患者、9例低级别胶质瘤（LGGs）患者和25名健康志愿者中，采用短（20或22毫秒）和长（135毫秒）回波时间进行单体素光谱和化学位移成像（二维质子磁共振[MR]光谱），以建立这种罕见脑肿瘤的精确代谢模式。神经胶质瘤浸润的特点是肌酸磷酸肌酸（Cr）和肌醇（Ins）水平显著升高，N-乙酰天冬氨酸（NAA）水平降低，含胆碱化合物（Cho）水平中度升高。这种模式明显不同于LGG，其特征在于Cho和Ins水平升高，NAA水平显著降低，Cr浓度低至正常。虽然GC和LGG之间的区别，基于组织学和MR成像标准，是一个有争议的问题，MR波谱产生有价值的信息，这两个实体之间的区分，因此，治疗策略的选择。它也提供了新的见解GC的病理生理学，因为铬和Ins水平升高可能与胶质细胞的增殖元素，或更可能的是，正常胶质细胞的激活。Cho水平升高反映了细胞增殖，NAA水平降低对应于可逆的神经元损伤和/或肿瘤过程的局灶性浸润。由于与LGG相关的临床结果相比，GC相关的临床结果不利，本研究的结果说明了质子MR波谱在浸润性胶质瘤特征描述中的诊断和预后价值。
Object. Gliomatosis cerebri (GC), a rare entity characterized by a widespread infiltration of brain by tumor, lacks objective and quantitative diagnostic criteria. Single-voxel spectroscopy and chemical shift imaging (two-dimensional proton magnetic resonance [MR] spectroscopy) were performed using both short (20- or 22-msec) and long (135-msec) echo times in nine patients suffering from GC, nine patients with low-grade gliomas (LGGs), and 25 healthy volunteers to establish the precise metabolic pattern of this uncommon brain neoplasm.Methods. The gliomatosis infiltration was characterized by markedly elevated levels of creatine-phosphocreatine (Cr) and myo-inositol (Ins), a reduced level of N-acetyl aspartate (NAA), and a moderately elevated level of choline-containing compounds (Cho). This pattern differs strikingly from LGGs, which are characterized by elevated levels of Cho and Ins, markedly reduced levels of NAA, and low-to-normal Cr concentrations. Although the distinction between GC and LGG, based on histological and MR imaging criteria, is a matter of debate, MR spectroscopy produces valuable information for the differentiation between these two entities and, hence, the choice of therapeutic strategy. It also provides new insight into the pathophysiology of GC because elevated Cr and Ins levels may be related to proliferation of glial elements or, more probably, activation of normal glia. Elevated levels of Cho reflect cellular proliferation and reduced NAA corresponds to reversible neuronal injury and/or focal invasion by the tumor process.Conclusions. Owing to the unfavorable clinical outcome associated with GC compared with that associated with LGG, the findings of this study illustrate the diagnostic and prognostic value of proton MR spectroscopy in the characterization of infiltrating gliomas.