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01-07-2011 | Clinical Study – Patient Study

Heterogeneity in malignant gliomas: a magnetic resonance analysis of spatial distribution of metabolite changes and regional blood volume

Authors: Marlies Wagner, Reinhold Nafe, Alina Jurcoane, Ulrich Pilatus, Kea Franz, Johannes Rieger, Joachim P. Steinbach, Elke Hattingen

Published in: Journal of Neuro-Oncology | Issue 3/2011

Abstract

First-pass contrast-enhanced dynamic perfusion imaging provides information about the regional cerebral blood volume (rCBV), an increase of which indicates neovascularization. MR spectroscopic imaging informs about metabolite changes in brain tumors, with elevated choline (Cho) values revealing cell proliferation and density, and the glial metabolite creatine (Cr) representing high-energy storage. This study investigates metabolite changes within the tumor voxel of maximal rCBV value (rCBV_max). Anatomically coregistered parameter maps of rCBV, Cho and Cr were evaluated in 36 patients with primary or recurrent WHO grade III or IV gliomas. Apart from Cho and Cr values within the voxel of rCBV_max (Cho_perf, Cr_perf), the maximal Cho and Cr values of the tumor tissue were recorded (Cho_max, Cr_max). The correlation between these parameters was analyzed with Spearman’s rho test while a binomial test was performed to check whether Cho_max = Cho_perf and Cr_max = Cr_perf. We found that, in 29 of the 36 patients, neither Cho nor Cr had their maxima in the voxel of rCBV_max (Cho_perf, Cr_perf < Cho_max, Cr_max, P < 0.001). However, Cho_perf was highly correlated with Cho_max (r = 0.76, P < 0.001) and Cr_perf with Cr_max (r = 0.47, P < 0.001). Further Cho_perf correlated with Cr_perf (r = 0.55, P < 0.001). Neither of the spectroscopic parameters (Cho_max, Cr_max, Cho_perf, Cr_perf,) correlated with rCBV_max. In conclusion, in WHO grade III and IV gliomas the voxel with maximal rCBV often differs from the voxel with the maximal Cho and Cr, indicating the spatial divergence between neovascularization and tumor cell proliferation, cell density and glial processes. However, tCho and tCr changes within the area of neovascularization are positively correlated with the maximal increase within the tumor tissue. These results demonstrate aspects of regional tumor heterogeneity as characterized by different MR modalities that, apart from histopathological grading might be crucial for neurosurgical biopsy as well as for antiangiogenetic and future molecular therapies.

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Title: Heterogeneity in malignant gliomas: a magnetic resonance analysis of spatial distribution of metabolite changes and regional blood volume
Authors: Marlies Wagner
Reinhold Nafe
Alina Jurcoane
Ulrich Pilatus
Kea Franz
Johannes Rieger
Joachim P. Steinbach
Elke Hattingen
Publication date: 01-07-2011
Publisher: Springer US
Published in: Journal of Neuro-Oncology / Issue 3/2011
Print ISSN: 0167-594X
Electronic ISSN: 1573-7373
DOI: https://doi.org/10.1007/s11060-010-0443-y

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Heterogeneity in malignant gliomas: a magnetic resonance analysis of spatial distribution of metabolite changes and regional blood volume

Abstract

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