Quantitative measurement of peritumoral concentrations of glutamate, N-acetyl aspartate, and lactate on magnetic resonance spectroscopy predicts glioblastoma-related refractory epilepsy
Quantitative measurement of peritumoral concentrations of glutamate, N-acetyl aspartate, and lactate on magnetic resonance spectroscopy predicts glioblastoma-related refractory epilepsy
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磁共振波谱定量测量瘤周谷氨酸、N-乙酰天冬氨酸和乳酸浓度可预测胶质母细胞瘤相关的难治性癫痫
DOI：
10.1007/s00701-022-05363-y
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发表时间：
2022
影响因子：
2.4
通讯作者：
Kunieda Takeharu
中科院分区：
文献类型：
--
作者：
Nakamura Yawara;Inoue Akihiro;Nishikawa Masahiro;Ohnishi Takanori;Yano Hajime;Kanemura Yonehiro;Ohtsuka Yoshihiro;Ozaki Saya;Kusakabe Kosuke;Suehiro Satoshi;Yamashita Daisuke;Shigekawa Seiji;Watanabe Hideaki;Kitazawa Riko;Tanaka Junya;Kunieda Takeharu
背景细胞外谷氨酸盐的增加是胶质母细胞瘤（GBM）患者癫痫发作的原因。然而，预测癫痫发作是否会难治是困难的。本研究调查是否评估的各种代谢物，包括谷氨酸的水平，可以预测难治性癫痫发作的发生在GBM的代谢物浓度的定量测量磁共振spectroscopy（MRS）.MethodsForty例患者根据相同的治疗方案在爱媛大学医院原发性GBM在2017年4月至2021年7月。在这些患者中，23例接受MRS以通过应用LC模型确定肿瘤周围的代谢物浓度，包括谷氨酸、N-乙酰天冬氨酸、肌酸和乳酸。每种代谢物的浓度表示为与肌酸浓度的比值。将患者分为三组：A型，无癫痫发作的患者; B型，治疗后癫痫发作消失的患者; C型，癫痫发作仍未缓解或治疗后出现（难治性癫痫发作）的患者。结果在23例GBM中，有11例患者出现癫痫发作，其中B型4例，C型7例。癫痫患者（B或C型）的谷氨酸和N-乙酰天冬氨酸值显著高于非癫痫患者（A型）（p < 0.05）。B型和C型之间的谷氨酸或N-乙酰天冬氨酸水平无显著差异。相反，C型患者的乳酸盐浓度显著高于B型患者（p = 0.001）。乳酸肌酸，谷氨酸肌酸，N-乙酰天冬氨酸肌酸比值的截止值为难治性癫痫发作分别为> 1.25，> 1.09，和> 0.88.ConclusionsExtracellular浓度的谷氨酸，N-乙酰天冬氨酸，乳酸在肿瘤周边显着升高GBM患者难治性癫痫发作。测量这些代谢产物的MRS可以预测难治性癫痫患者，并可能是一个指标，继续使用抗癫痫药物。
BackgroundIncreased extracellular glutamate is known to cause epileptic seizures in patients with glioblastoma (GBM). However, predicting whether the seizure will be refractory is difficult. The present study investigated whether evaluation of the levels of various metabolites, including glutamate, can predict the occurrence of refractory seizure in GBM by quantitative measurement of metabolite concentrations on magnetic resonance spectroscopy (MRS).MethodsForty patients were treated according to the same treatment protocol for primary GBM at Ehime University Hospital between April 2017 and July 2021. Of these patients, 23 underwent MRS to determine concentrations of metabolites, including glutamate, N-acetylaspartate, creatine, and lactate, in the tumor periphery by applying LC-Model. The concentration of each metabolite was expressed as a ratio to creatine concentration. Patients were divided into three groups: Type A, patients with no seizures; Type B, patients with seizures that disappeared after treatment; and Type C, patients with seizures that remained unrelieved or appeared after treatment (refractory seizures). Relationships between concentrations of metabolites and seizure types were investigated.ResultsIn 23 GBMs, seizures were confirmed in 11 patients, including Type B in four and Type C in seven. Patients with epilepsy (Type B or C) showed significantly higher glutamate and N-acetylaspartate values than did non-epilepsy patients (Type A) (p < 0.05). No significant differences in glutamate or N-acetylaspartate levels were seen between Types B and C. Conversely, Type C showed significantly higher concentrations of lactate than did Type B (p = 0.001). Cutoff values of lactate-to-creatine, glutamate-to-creatine, and N-acetylaspartate-to-creatine ratios for refractory seizure were > 1.25, > 1.09, and > 0.88, respectively.ConclusionsExtracellular concentrations of glutamate, N-acetylaspartate, and lactate in the tumor periphery were significantly elevated in patients with GBM with refractory seizures. Measurement of these metabolites on MRS may predict refractory epilepsy in such patients and could be an indicator for continuing the use of antiepileptic drugs.
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影响因子：
158.5
作者：
Stupp, R;Mason, WP;Ryan, G
通讯作者：
Ryan, G
影响因子：
4.3
作者：
Dey S;Doddamani RS;Banerjee Dixit A;Tripathi M;Sharma MC;Chandra PS;Banerjee J
通讯作者：
Banerjee J
影响因子：
15.9
作者：
Schiff, David;Lee, Eudocia Q.;Wen, Patrick Y.
通讯作者：
Wen, Patrick Y.
DOI：
10.1006/jmra.1994.1008
发表时间：
1994-01-01
期刊：
JOURNAL OF MAGNETIC RESONANCE SERIES A
影响因子：
--
作者：
SMITH, SA;LEVANTE, TO;ERNST, RR
通讯作者：
ERNST, RR
影响因子：
0.6
作者：
Roesche, J.;Piek, J.;Benecke, R.
通讯作者：
Benecke, R.