Document Detail

Assessing global invasion of newly diagnosed glial tumors with whole-brain proton MR spectroscopy.
MedLine Citation:
PMID:  16219818     Owner:  NLM     Status:  MEDLINE    
BACKGROUND AND PURPOSE: Because of their invasive nature, high-grade glial tumors are uniformly fatal. The purpose of this study was to quantify MR imaging-occult, glial tumor infiltration beyond its radiologic margin through its consequent neuronal cell damage, assessed by the global concentration decline of the neuronal marker N-acetylaspartate (NAA). METHODS: Seventeen patients (10 men; median age, 39 years; age range, 23-79 years) with radiologically suspected (later pathologically confirmed) supratentorial glial neoplasms, and 17 age- and sex-matched controls were studied. Their whole-brain NAA (WBNAA) amounts were obtained with proton MR spectroscopy: for patients on the day of surgery (n = 17), 1 day postsurgery (n = 15), and once for each control. To convert into concentrations, suitable for intersubject comparison, patients' global NAA amounts were divided by their brain volumes segmented from MR imaging. Least squares regression was used to analyze the data. RESULTS: Pre- and postoperative WBNAA (mean +/- SD) of 9.2 +/- 2.1 and 9.7 +/- 1.8 mmol/L, respectively, in patients were indistinguishable (P = .369) but significantly lower than in controls (12.5 +/- 1.4 mmol/L). Mean resected tumor size (n = 15) was approximately 3% of total brain volume. CONCLUSION: The average 26% WBNAA deficit in the patients, which persisted following surgical resection, cannot be explained merely by depletion within the approximately 3% MR imaging-visible tumor volume or an age-dependent effect. Although there could be several possible causes of such widespread decline--perineuronal satellitosis, neuronal deafferentation, Wallerian and retrograde degeneration, vasogenic edema, functional diaschisis, secondary vascular changes--most are a direct or indirect reflection of extensive, MR imaging-occult, microscopic tumor cell infiltration, diffusely throughout the otherwise "normal-appearing" brain.
Benjamin A Cohen; Edmond A Knopp; Henry Rusinek; James S Babb; David Zagzag; Oded Gonen
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  AJNR. American journal of neuroradiology     Volume:  26     ISSN:  0195-6108     ISO Abbreviation:  AJNR Am J Neuroradiol     Publication Date:  2005 Oct 
Date Detail:
Created Date:  2005-10-12     Completed Date:  2005-11-21     Revised Date:  2008-02-14    
Medline Journal Info:
Nlm Unique ID:  8003708     Medline TA:  AJNR Am J Neuroradiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2170-7     Citation Subset:  IM    
Department of Radiology, New York University School of Medicine, New York, NY 10016, USA.
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MeSH Terms
Aspartic Acid / analogs & derivatives,  analysis
Brain / pathology
Brain Chemistry
Glioma / chemistry,  diagnosis,  pathology*,  surgery
Magnetic Resonance Spectroscopy*
Middle Aged
Neoplasm Invasiveness
Supratentorial Neoplasms / chemistry,  diagnosis,  pathology*,  surgery
Grant Support
Reg. No./Substance:
56-84-8/Aspartic Acid; 997-55-7/N-acetylaspartate
Comment In:
AJNR Am J Neuroradiol. 2005 Oct;26(9):2167   [PMID:  16219816 ]

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