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European Radiology
Published in: European Radiology 5/2012

01-05-2012 | Musculoskeletal

In vivo characterisation of soft tissue tumours by 1.5-T proton MR spectroscopy

Authors: F. Russo, S. Mazzetti, G. Grignani, G. De Rosa, M. Aglietta, G. C. Anselmetti, M. Stasi, D. Regge

Published in: European Radiology | Issue 5/2012

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Abstract

Objectives

To determine whether proton magnetic resonance spectroscopy (1H-MRS) can help differentiate between benign and malignant soft tissue lesions, and to assess if there is a correlation between 1H-MRS data and the mitotic index.

Methods

MR measurements were performed in 43 patients with soft tissue tumours >15 mm in diameter. Six cases were excluded for technical failure. Examinations were performed at 1.5 T using a single-voxel point resolved spectroscopy sequence (PRESS) with TR/TE = 2000/150 ms. The volume of interest was positioned within the lesion avoiding inclusion of necrotic regions. In all patients, a histological diagnosis was obtained and the corresponding mitotic index was also computed. 1H-MRS results and histopathological findings were compared using the chi-squared test and correlation coefficient.

Results

Choline was detected in 18/19 patients with malignant tumours and in 3/18 patients with benign lesions. The three benign lesions included one desmoid tumour, one ossificans myositis and one eccrine spiradenoma. Choline was not detected in 15 patients with benign lesions or in one patient with dermatofibrosarcoma protuberans. Resulting 1H-MRS sensitivity and specificity were 95% and 83% respectively.

Conclusions

Absence of choline peak is highly predictive of benign tumours suggesting that 1H-MRS can help to differentiate malignant from benign tumours.

Key Points

• 1H-MRS may allow differentiation between benign and malignant soft tissue lesions
• Absence of choline peak is highly predictive of benign soft tissue lesions
• Malignant tumours with a mitotic index >2/10 HPF had a positive choline peak
• A choline peak may still be identified in some benign tumours
Literature
1.
Weiss SW, Goldblum JR (2001) Enzinger and Weiss’s soft tissue tumors, 4th edn. Mosby-Harcourt Brace Company, St. Louis, MO, USA
2.
Papagelopoulos PJ, Mavrogenis AF, Badekas A et al (2003) Foot malignancies: a multidisciplinary approach. Foot Ankle Clin 8:751–763PubMedCrossRef
3.
Moulton JS, Blebea JS, Dunco DM et al (1995) MR imaging of soft-tissue masses: diagnostic efficacy and value of distinguishing between benign and malignant lesions. AJR Am J Roentgenol 164:1191–1199PubMed
4.
Campanacci M (1999) Bone and soft tissue tumors: clinical features, imaging, pathology and treatment, 2nd edn. Springer-Verlag, New York
5.
Berquist TH, Ehman AL, Richardson ML (1987) Magnetic resonance of the musculoskeletal system. Raven, New York
6.
Wetzel LH, Levine E (1990) Soft tissue tumors of the foot: value of MR imaging for specific diagnosis. AJR Am J Roentgenol 155:1025–1030PubMed
7.
Berquist TH, Ehman RL, King BF et al (1990) Value of MR imaging in differentiating benign from malignant soft-tissue masses: study of 95 lesions. AJR Am J Roentgenol 155:1251–1255PubMed
8.
Arkun R, Memis A, Akalin T et al (1997) Liposarcoma of soft tissue: MRI findings with pathologic correlation. Skeletal Radiol 26:167–172PubMedCrossRef
9.
Crim JR, Seeger LL, Yao L et al (1992) Diagnosis of soft-tissue masses with MR imaging: can benign masses be differentiated from malignant ones? Radiology 185:581–586PubMed
10.
Verstraete KL, De Deene Y, Roels H et al (1994) Benign and malignant musculoskeletal lesions: dynamic contrast-enhanced MR imaging-parametric “first-pass” images depict tissue vascularization and perfusion. Radiology 192:835–843PubMed
11.
Fletcher BD, Reddick WE, Taylor JS et al (1996) Dynamic MR imaging of musculoskeletal neoplasms. Radiology 200:869–872PubMed
12.
Verstraete KL, Van der Woude HJ, Hogendoorn PC et al (1996) Dynamic contrast-enhanced MR imaging of musculoskeletal tumors: basic principles and clinical applications. J Magn Reson Imaging 6:311–321PubMedCrossRef
13.
Verstraete KL, Van der Woude HJ (2001) Dynamic contrast-enhanced magnetic resonance imaging. In: De Schepper AM (ed) Imaging of soft tissue tumors, 2nd edn. Springer, Berlin, pp 83–104
14.
Van Rijswijk CSP, Geirnaerdt MJA, Hogendoorn PCW et al (2004) Soft-tissue tumors: value of static and dynamic gadopentetate dimeglumine-enhanced MR imaging in prediction of malignancy. Radiology 233:493–502PubMedCrossRef
15.
Verstraete KL, Dierick A, De Deene Y et al (1994) First-pass images of musculoskeletal lesions: a new and useful diagnostic application of dynamic contrast-enhanced MRI. Magn Reson Imaging 12:687–702PubMedCrossRef
16.
Payne GS, Leach MO (2006) Applications of magnetic resonance spectroscopy in radiotherapy treatment planning. Br J Radiol 79:S16–S26PubMedCrossRef
17.
Gupta RK, Cloughesy TF, Sinha U et al (2000) Relationships between choline magnetic resonance spectroscopy, apparent diffusion coefficient and quantitative histopathology in human glioma. J Neuro-Oncol 50:215–226CrossRef
18.
Doganay S, Altinok T, Alkan A et al (2011) The role of MRS in the differentiation of benign and malignant soft tissue and bone tumors. Eur J Radiol 79:e33–e37PubMedCrossRef
19.
Wang CK, Li CW, Hsieh TJ et al (2004) Characterization of bone and soft-tissue tumors with in vivo 1H MR spectroscopy: initial results. Radiology 232:599–605PubMedCrossRef
20.
Delorme S, Weber MA (2006) Applications of MRS in the evaluation of focal malignant brain lesions. Cancer Imaging 6:95–99PubMedCrossRef
21.
Swindle P, McCredie S, Russell P et al (2003) Pathologic characterization of human prostate tissue with proton MR spectroscopy. Radiology 228:144–151PubMedCrossRef
22.
Cheng LL, Burns MA, Taylor JL et al (2005) Metabolic characterization of human prostate cancer with tissue magnetic resonance spectroscopy. Cancer Res 65:3030–3034PubMed
23.
Ronen SM, Leach MO (2001) Breast imaging technology: imaging biochemistry - applications to breast cancer. Breast Cancer Res 3:36–40PubMedCrossRef
24.
Katz-Brull R, Seger D, Rivenson-Segal D et al (2002) Enhanced choline metabolism and reduced choline-ether-phospholipid synthesis. Cancer Res 62:1966–1970PubMed
25.
Fayad LM, Bluemke DA, McCarthy EF et al (2006) Musculoskeletal tumors: use of proton MR spectroscopic imaging for characterization. J Magn Reson Imaging 23(1):23–28PubMedCrossRef
26.
Fayad LM, Barker PB, Jacobs MA et al (2007) Characterization of musculoskeletal lesions on 3-T proton MR spectroscopy. AJR Am J Roentgenol 188:1513–1520PubMedCrossRef
27.
World Medical Association (2000) Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Subjects, 5th rev. Edinburgh, Scotland
28.
Bartella L, Morris EA, Dershaw DD et al (2006) Proton MR spectroscopy with choline peak as malignancy marker improves positive predictive value for breast cancer diagnosis: preliminary study. Radiology 239:686–692PubMedCrossRef
29.
Sardanelli F, Fausto A, Di Leo G et al (2009) In vivo proton MR spectroscopy of the breast using the total choline peak integral as a marker of malignancy. AJR Am J Roentgenol 192:1608–1617PubMedCrossRef
30.
Fayed N, Olmos S, Morales H et al (2006) Physical basis of magnetic resonance spectroscopy and its application to central nervous system diseases. Am J Appl Sci 3:1836–1845CrossRef
31.
Sijens PE, van den Bent MJ, Nowak PJ et al (1997) 1H chemical shift imaging reveals loss of brain tumor choline signal after administration of Gd-contrast. Magn Reson Med 37:222–225PubMedCrossRef
32.
Roebuck JR, Cecil KM, Schnall MD et al (1998) Human breast lesions: characterization with proton MR spectroscopy. Radiology 209:269–275PubMed
33.
Baek HM, Chen JH, Yu HJ et al (2008) Detection of choline signal in human breast lesions with chemical-shift imaging. J Magn Reson Imaging 27:1114–1121PubMedCrossRef
34.
Huang W, Fisher PR, Dulaimy K et al (2004) Detection of breast malignancy: diagnostic MR protocol for improved specificity. Radiology 232:585–591PubMedCrossRef
35.
WHO Classification of Tumours (2002) Pathology & genetics—Tumours of soft tissue and bone. IARC, Lyon
36.
Newcombe RG (1998) Two-sided confidence intervals for the single proportion: comparison of seven methods. Statist Med 17:857–872CrossRef
37.
Royal College of Obstetricians and Gynaecologists (2002) The investigation and management of the small-for-gestational-age fetus, guideline no.31. RCOG, London
38.
Dowdy S, Weardon S, Chilko D (2004) Statistics for research, 3rd edn. Wiley, New JerseyCrossRef
39.
Hashimoto K, Brownstein MH, Jakobiec FA (1974) Dermatofibrosarcoma protuberans. A tumor with perineural and endoneural cell features. Arch Dermatol 110:874–885PubMedCrossRef
40.
Brenner W, Schaefler K, Chhabra H et al (1975) Dermatofibrosarcoma protuberans metastatic to a regional lymph node. Report of a case and review. Cancer 36:1897–1902PubMedCrossRef
41.
Herminghaus S, Pilatus U, Möller-Hartmann W et al (2002) Increased choline levels coincide with enhanced proliferative activity of human neuroepithelial brain tumors. NMR Biomed 15:385–392PubMedCrossRef
42.
Krouwer HGJ, Kim TA, Rand SD et al (1998) Single-voxel proton MR spectroscopy of nonneoplastic brain lesions suggestive of a neoplasm. AJNR Am J Neuroradiol 19:1695–1703PubMed
43.
Bitsch A, Bruhn H, Vougioukas V et al (1999) Inflammatory CNS demyelination: histopathologic correlation with in vivo quantitative proton MR spectroscopy. AJNR Am J Neuroradiol 20:1619–1627PubMed
44.
Parikh J, Hyare H, Saifuddin A (2002) The imaging features of post-traumatic Myositis Ossificans, with emphasis on MRI. Clin Radiol 57:1058–1066PubMedCrossRef
45.
Manaster BJ, May DA, Disler DG (2007) Musculoskeletal Imaging, 3rd edn. Mosby Elsevier, Philadelphia
46.
47.
Qayyum A (2009) MR spectroscopy of the liver: principles and clinical applications. RadioGraphics 29:1653–1664PubMedCrossRef
48.
Erturk SM, Alberich-Bayarri A, Herrmann KA et al (2009) Use of 3.0-T MR imaging for evaluation of the abdomen. RadioGraphics 29:1547–1563PubMedCrossRef
49.
Ricci E, Pitt A, Keller PJ et al (2000) Effect of voxel position on single-voxel MR spectroscopy findings. AJNR Am J Neuroradiol 21:367–37PubMed
50.
Bolan PJ, Nelson MT, Yee D et al (2005) Imaging in breast cancer: magnetic resonance spectroscopy. Research 7:149–152
51.
Li BSY, Regal J, Gonen O (2001) SNR versus resolution in 3D 1H MRS of the human brain at high magnetic fields. Magn Reson Med 46:1049–1053PubMedCrossRef
52.
Usenius JPR, Kauppinen RA, Vainio PA et al (1994) Quantitative metabolite patterns of human brain tumors: detection by 1H NMR spectroscopy in vivo and in vitro. J Comput Assist Tomo 18:705–713CrossRef
53.
Manton DJ, Lowry M, Blackband SJ et al (1995) Determination of proton metabolite concentrations and relaxation parameters in normal human brain and intracranial tumours. NMR Biomed 8:104–112PubMedCrossRef
Metadata
Title
In vivo characterisation of soft tissue tumours by 1.5-T proton MR spectroscopy
Authors
F. Russo
S. Mazzetti
G. Grignani
G. De Rosa
M. Aglietta
G. C. Anselmetti
M. Stasi
D. Regge
Publication date
01-05-2012
Publisher
Springer-Verlag
Published in
European Radiology / Issue 5/2012
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-011-2350-9

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