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Improved Turnaround Times | Median time to first decision: 12 days

Research ArticlePediatric Neuroimaging

Quantitative Short Echo Time 1H-MR Spectroscopy of Untreated Pediatric Brain Tumors: Preoperative Diagnosis and Characterization

A. Panigrahy, M.D. Krieger, I. Gonzalez-Gomez, X. Liu, J.G. McComb, J.L. Finlay, M.D. Nelson, F.H. Gilles and S. Blüml
American Journal of Neuroradiology March 2006, 27 (3) 560-572;
A. Panigrahy
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M.D. Krieger
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I. Gonzalez-Gomez
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X. Liu
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J.G. McComb
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J.L. Finlay
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M.D. Nelson Jr.
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F.H. Gilles
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S. Blüml
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  • Fig 1.
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    Fig 1.

    1H-MR spectroscopy of medulloblastoma. 1H spectra of a solid-appearing medulloblastoma (A) and of a medulloblastoma with necrotic/cystic areas (B) and corresponding T2-weighted transverse fast spin-echo MR image [repetition time (TR)/echo time (TE), 3500/85 ms; 256 × 192 matrix; 2 signals acquired; echo-train length of 16; acquisition time of 2 minutes 48 seconds] indicating the region of interest. Absolute quantitation included a correction for the different fraction of cystic tissue (6% versus 48%), and spectra are scaled to allow direct comparison of peak areas. A singlet at 3.78 ppm consistent with guanidinoacetate (Gau) is observed, and taurine (Tau) is detected as a complex signal intensity at ≈3.4 ppm. Note the different levels of Tau, creatine (Cr), and glutamate/glutamine (Glu/Gln) signal intensity in the spectra. Spectra also exhibit broad lipid and macromolecule resonances at 0.9 and 1.3 ppm. One peak of the lactate (Lac) doublet at 1.33 ppm is detected as a shoulder of the broad LipMM13 resonance. N-acetylaspartate (NAA) is depleted, and total choline (tCho) is prominent in all spectra of medulloblastoma. The insert in spectrum A shows the spectrum of Tau scaled to the size of the fitted Tau components. Shown are the unfiltered raw data (thin line) and the LCModel fit to the data (thick line).

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    Fig 2.

    1H MR spectroscopy of pilocytic astrocytoma. Short echo time (TE) spectra of a supratentorial (A) and infratentorial (B) pilocytic astrocytoma and corresponding MR images indicating the regions of interest are shown. Pilocytic astrocytoma spectra are noisy because of the low cellularity of the lesions. Absolute quantitation revealed low creatine (Cr) concentrations. High lactate (Lac) and prominent total choline (tCho) and N-acetylaspartate (NAA) relative to creatine were noted.

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    Fig 3.

    Choroid plexus papilloma and choroid plexus carcinoma. Short echo time (TE) MR spectra of a supratentorial (A) and a infratentorial (B) choroid plexus papilloma and of a choroid plexus carcinoma (C) with corresponding MR images indicating the regions of interest. Choroid plexus papilloma shows a prominent myo-inositol peak, whereas creatine (Cr) is hardly detectable. In contrast, more malignant choroid plexus carcinoma shows a prominent choline peak, whereas myo-inositol is not elevated. The insert in spectrum A displays a long TE spectrum obtained from the same region of interest. The long TE spectrum is used to rule out glycine contributing to the mI peak.

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    Fig 4.

    Low-grade astrocytoma and anaplastic astrocytoma. Short echo time (TE) MR spectra of 2 anaplastic astrocytomas (A, -B) and of low-grade astrocytoma (C) with corresponding MR images indicating the regions of interest are shown. The 3 spectra are scaled according to measured concentrations to allow direct comparison. Astrocytomas appear to be quite heterogeneous. Note the striking difference in total choline (tCho) in spectra A and B, tumors of the same diagnostic name. The prominent scyllo-inositol (sI) observed in spectrum C is not representative for all astrocytoma.

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    Fig 5.

    Low-grade ependymoma and anaplastic ependymoma. Short echo time (TE) MR spectra of a low-grade ependymoma (A) and of an anaplastic ependymoma (B) with corresponding MR images indicating the regions of interest. The 2 spectra are scaled according to measured concentration to allow direct comparison. A feature of ependymoma is very low N-acetylaspartate (NAA) signal intensity. In particular, no trace of NAA was found in any of the anaplastic ependymoma. Note that glutamate + glutamine (Glx) relative to creatine (Cr) is more prominent in anaplastic ependymoma.

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    Fig 6.

    Pineal germinoma. Short echo time (TE) MR spectra of a pineal germinoma and MR imaging indicating the region of interest. Taurine (Tau) and guanidinoacetate (Gau) are, as in medulloblastoma, consistently observed in all pineal germinomas.

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    Fig 7.

    Differentiation of common pediatric brain tumors by quantitative 1H-MR spectroscopy. Shown are measured concentrations and concentration ratios of tumors obtained from individual spectra. Labels 1, 2, and 3 in B, C, E, and F indicate data points obtained from individual spectra of the 3 cases presented in more detail in the Results section.

Tables

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    Table 1:

    Patient demographics

    WHO GradeSubjectsS/INo. of SpectraSex (F/M)Age (mean ± SD)
    Study subjects6027/337825/357.22 ± 5.18
        PNET (medulloblastoma)IV140/14166/86.2 ± 3.6
        Anaplastic astrocytomaIII55/052/312.4 ± 6.5
        Low-grade astrocytomaII32/142/15.2 ± 1.6
        Pilocytic astrocytomaI176/11218/96.2 ± 4.9
        Anaplastic ependymomaIII43/152/25.6 ± 3.3
        EpendymomaII50/583/24.7 ± 3.4
        Choroid plexus papillomaI32/160/39.2 ± 6.5
        Choroid plexus carcinomaIV33/041/21.1 ± 1.4
        Germinoma (pineal)—*66/091/514.4 ± 2.4
    • Note:—S indicates supratentorial; I, infratentorial; PNET, primitive neuroectodermal tumor.

    • * There is no WHO grade for germinoma. Germinomas sometimes come mixed with other primitive germ cell components such as endodermal sinus tumor, choriocarcinoma, immature teratoma, and mature teratoma. All germinoma cases included in this study were pure germinomas and responded well to radiation therapy.

    • View popup
    Table 2:

    Absolute concentrations and concentration ratios of untreated pediatric brain tumors

    MedulloblastomaAnaplastic Astrocytoma/AstrocytomaPilocytic AstrocytomaAnaplastic Ependymoma/EpendymomaChoroid Plexus PapillomaChoroid Plexus CarcinomaPineal GerminomaAll Tumors
    Subjects14817933660
    Absolute concentrations (mmol/kg tissue)
        [NAA]0.9 ± 0.82.3 ± 1.51.9 ± 0.80.2 ± 0.4****2.4 ± 1.30.2 ± 0.1*****1.3 ± 1.11.3 ± 1.1
        [Cr]4.7 ± 1.76.2 ± 2.41.0 ± 0.8*****5.3 ± 3.11.3 ± 0.7*1.2 ± 0.7*3.1 ± 0.93.5 ± 2.6
        [tCho]5.1 ± 1.5***3.9 ± 3.12.2 ± 1.1*3.2 ± 1.51.8 ± 0.3***5.1 ± 2.12.2 ± 0.5*3.4 ± 2.0
        [mI]7.4 ± 4.012.3 ± 5.33.8 ± 2.1*****13.1 ± 5.720.4 ± 3.7*4.1 ± 2.05.2 ± 1.1*8.2 ± 5.8
        [Gln]6.3 ± 3.59.51 ± 4.16.4 ± 3.28.4 ± 3.92.6 ± 0.6****2.6 ± 1.54.4 ± 2.66.5 ± 3.7
        [Glu]7.5 ± 4.04.8 ± 2.93.3 ± 1.8*2.9 ± 3.24.2 ± 2.42.7 ± 1.68.7 ± 2.75.0 ± 3.5
        [Glx]†13.8 ± 5.214.4 ± 4.59.7 ± 3.511.3 ± 4.46.8 ± 2.05.4 ± 0.9****13.1 ± 3.111.5 ± 4.7
        [Tau]5.8 ± 2.3****1.7 ± 1.10.4 ± 0.6*****1.5 ± 1.10.8 ± 0.92.5 ± 0.63.0 ± 1.32.3 ± 2.5
        [Glc]1.0 ± 0.82.2 ± 1.12.5 ± 1.80.8 ± 0.71.6 ± 0.83.4 ± 2.60.9 ± 1.01.7 ± 1.5
        [Lac]3.6 ± 1.62.8 ± 3.94.3 ± 2.22.1 ± 2.10.6 ± 0.5**1.5 ± 1.40.9 ± 1.63.0 ± 2.5
        [sI]0.2 ± 0.20.5 ± 0.50.2 ± 0.30.3 ± 0.30.9 ± 0.20.0 ± 0.1***0.3 ± 0.30.3 ± 0.3
        [Ala]2.7 ± 1.2*0.9 ± 0.91.4 ± 0.71.7 ± 1.01.0 ± 0.70.9 ± 1.02.0 ± 0.91.7 ± 1.1
        [Gua]3.7 ± 1.1*1.5 ± 0.5****2.6 ± 1.02.4 ± 1.03.0 ± 1.03.1 ± 0.43.7 ± 1.12.8 ± 1.2
    LipMM09‡16.7 ± 9.77.0 ± 2.6**11.4 ± 5.214.5 ± 6.84.4 ± 1.6**12.5 ± 7.512.0 ± 5.412.3 ± 7.2
    LipMM13‡64.3 ± 73.215.9 ± 13.4*21.8 ± 16.149.6 ± 31.48.3 ± 2.4****61.8 ± 73.963.4 ± 53.940.6 ± 47.9
        [NAA]/[tCho]0.2 ± 0.2***0.9 ± 0.90.9 ± 0.4**0.1 ± 0.2***1.3 ± 0.50.1 ± 0.0*****0.6 ± 0.50.6 ± 0.6
        [Crl]/[tCho]1.0 ± 0.42.1 ± 1.20.5 ± 0.3*****1.8 ± 0.80.7 ± 0.30.3 ± 0.2***1.5 ± 0.51.1 ± 0.8
        [mI]/[tCho]1.5 ± 0.9**4.0 ± 2.01.8 ± 0.7*4.8 ± 2.411.9 ± 3.70.9 ± 0.6*2.5 ± 1.13.0 ± 2.8
        [Gln]/[tCho]1.2 ± 0.6****2.8 ± 1.03.2 ± 1.72.9 ± 1.61.5 ± 0.50.7 ± 0.62.0 ± 1.22.3 ± 1.5
        [Glu]/[tcho]1.5 ± 0.81.8 ± 1.71.7 ± 0.91.3 ± 1.52.3 ± 1.00.6 ± 0.3*4.0 ± 1.1*1.8 ± 1.4
        [Glx]/[tCho]2.8 ± 0.9***4.7 ± 2.24.8 ± 1.74.2 ± 2.63.8 ± 0.51.2 ± 0.7*6.0 ± 0.8**4.1 ± 2.0
        [Tau]/[tCho]1.2 ± 0.5**0.3 ± 0.30.2 ± 0.4*0.5 ± 0.30.5 ± 0.60.6 ± 0.31.4 ± 0.60.6 ± 0.6
        [NAA]/[Cr]0.2 ± 0.2**0.4 ± 0.31.8 ± 1.2**0.1 ± 0.1****1.8 ± 0.40.1 ± 0.1***0.4 ± 0.3*0.7 ± 1.0
        [mI]/[Cr]1.7 ± 0.9*2.0 ± 0.5*3.6 ± 1.92.8 ± 1.416.6 ± 6.67.0 ± 7.31.8 ± 0.5*3.5 ± 4.0
        [Gln]/[Cr]1.3 ± 0.7***1.8 ± 1.05.5 ± 2.5***1.7 ±0.72.0 ± 1.24.1 ± 4.01.3 ± 1.02.7 ± 2.4
        [Glu]/[Cr]1.9 ± 1.50.8 ± 0.5***3.5 ± 2.50.8 ± 1.0*3.1 ± 0.42.7 ± 1.02.9 ± 0.92.2 ± 1.8
        [Glx]/[Cr]3.3 ± 1.62.6 ± 1.1*9.1 ± 4.6**2.5 ± 1.4*5.1 ± 1.17.0 ± 4.84.2 ± 1.14.9 ± 3.8
        [Tau]/[Cr]1.3 ± 0.4*0.2 ± 0.3*0.3 ± 0.4*0.3 ± 0.30.5 ± 0.93.6 ± 2.81.2 ± 0.80.8 ± 1.1
        [Gau]/[Cr]0.9 ± 0.40.3 ± 0.1****2.7 ± 2.30.6 ± 0.3*2.4 ± 0.95.1 ± 4.31.4 ± 0.51.6 ± 1.9
        [Glc]/[Cr]0.2 ± 0.2*0.4 ± 0.22.4 ± 1.50.2 ± 0.2*1.5 ± 1.36.5 ± 7.90.3 ± 0.31.2 ± 2.3
    • Note:—

    • * P < .01,

    • ** P < .001,

    • *** P < .0001,

    • **** P < .00001,

    • ***** P< .000001 versus All Other tumors

    • † [Glx] = [Glu] + [Gln].

    • ‡ Absolute intensity (arbitrary units).

    • View popup
    Table 3:

    Differentiation between different tumor types

    Ana. Astrocytoma/AstrocytomaPilocytic AstrocytomaAna. Ependymoma/EpendymomaChoroid PlexusPapillomaChoroid PlexusCarciomaPineal Germinoma
    Medulloblastoma↑[Tau]/[Cr]*****↑[Tau]****↑[Tau]/[Cr]****↑[tCho]****↑[Glx]***↑[tCho]****
    ↑[Tau]****↓[NAA]/[tCho]****↑[Tau]****[↑[Lac]**↑[Cr]**↓[Glx]/[tCho]****
    ↑[Gua]****↑[Tau]/[Cr]****↑[Tau]/[tCho]**↑[Tau]**↑[Tau]**↑[Tau]*
    Ana. Astro./Astrocytoma↑[Gln]/[Cr]***↑[NAA]*↑[Cr]**↑[Cr]**↓[Glu]/[Cr]*
    ↑[Cr]/[tCho]***↓[Gua]/[Cr]*↓[Glu]/[Cr]**↑[Glx]**↓[Gua]/[Cr]*
    ↑[Cr]**↓LipMM09*↓[Gln]*↓[Gua]*↓[Gua]*
    Pilocytic Astrocytoma[NAA]/[tCho]*****↑[Lac]***↑[NAA]/[tCho]*****↑[Gln]/[Cr]***
    ↑[NAA]*****↑[Gln]**↑[NAA]*****↑[Glc]/[Cr]***
    ↑[Gln]/[Cr]***↑LipMM09**↑[Glx]**↑[tCho]/[Cr]**
    Ana. Epend./Ependymoma↓[Glu]/[Cr]**↑[Cr]/[tCho]**↑[Glu//[tCho]*
    ↑[Gln]*↑[mI]*↓[Glu]/[Cr]*
    ↑LipMM09*↑[Glx]*↑[mI]*
    Choroid↑[mI]*↓[Glx]/[tCho]*
    Plexus↑[tCho]*↓[Glx]*
    Papilloma↑[NAA]/[Cr]*↑[NAA]/[Cr]*
    Choroid Plexus Carcinoma↓[Glu]/[tCho]**
    ↓[Glx]**
    ↓[Cr]/[tCho]*
    • * P < .01,

    • ** P < .001,

    • *** P < .0001,

    • **** P < .00001,

    • ***** P < .000001.

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A. Panigrahy, M.D. Krieger, I. Gonzalez-Gomez, X. Liu, J.G. McComb, J.L. Finlay, M.D. Nelson, F.H. Gilles, S. Blüml
Quantitative Short Echo Time 1H-MR Spectroscopy of Untreated Pediatric Brain Tumors: Preoperative Diagnosis and Characterization
American Journal of Neuroradiology Mar 2006, 27 (3) 560-572;

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Quantitative Short Echo Time 1H-MR Spectroscopy of Untreated Pediatric Brain Tumors: Preoperative Diagnosis and Characterization
A. Panigrahy, M.D. Krieger, I. Gonzalez-Gomez, X. Liu, J.G. McComb, J.L. Finlay, M.D. Nelson, F.H. Gilles, S. Blüml
American Journal of Neuroradiology Mar 2006, 27 (3) 560-572;
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