Document Detail


MR Spectroscopy Using Normalized and Non-normalized Metabolite Ratios for Differentiating Recurrent Brain Tumor from Radiation Injury.
MedLine Citation:
PMID:  21820634     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
RATIONALE AND OBJECTIVES: To compare the ability of normalized versus non-normalized metabolite ratios to differentiate recurrent brain tumor from radiation injury using magnetic resonance spectroscopy (MRS) in previously treated patients.
MATERIALS AND METHODS: Twenty-five patients with previous diagnosis of primary intracranial neoplasm confirmed with biopsy/resection, previously treated with radiation therapy (range, 54-70 Gy) with or without chemotherapy and new contrast enhancing lesion on a 1.5 T magnetic resonance imaging at the site of the primary neoplasm participated in this retrospective study. After MRS, clinical, radiological, and histopathology data were used to classify new contrast-enhancing lesions as either recurrent neoplasm or radiation injury. Volume of interest included both the lesion and normal-appearing brain on the contralateral side. Non-normalized metabolic ratios were calculated from choline (Cho), creatine (Cr), and N-acetylaspartate (NAA) spectroscopic values obtained within the contrast-enhancing lesion: Cho/Cr, NAA/Cr, and Cho/NAA. Normalized ratios were calculated using the metabolic values from the contralateral normal side: Cho/normal creatinine (nCr), Cho/normal N-acetylaspartate (nNAA), Cho/normal choline, NAA/nNAA, NAA/nCr, and Cr/nCr. Results were correlated with the final diagnosis by Wilcoxon rank-sum analysis.
RESULTS: Two of three non-normalized ratios, Cho/NAA (sensitivity 86%, specificity 90%) and NAA/Cr (sensitivity 93%, specificity 70%) significantly associated with tumor recurrence even after correcting for multiple comparisons. Of the six normalized ratios, only Cho/nNAA significantly correlated with tumor recurrence (sensitivity 73%, specificity 40%), but did not remain significant after correcting for multiple comparisons.
CONCLUSION: Cho/NAA and NAA/Cr were the two ratios with the best discriminating ability and both had better discriminating ability than their corresponding normalized ratios (Area under the curve = 0.92 versus 0.77, AUC= 0.85 vs. 0.66), respectively.
Authors:
Augusto E Elias; Ruth C Carlos; Ethan A Smith; Dan Frechtling; Bekris George; Pavel Maly; Pia C Sundgren
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Academic radiology     Volume:  18     ISSN:  1878-4046     ISO Abbreviation:  Acad Radiol     Publication Date:  2011 Sep 
Date Detail:
Created Date:  2011-08-08     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9440159     Medline TA:  Acad Radiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1101-8     Citation Subset:  IM    
Copyright Information:
Copyright © 2011 AUR. Published by Elsevier Inc. All rights reserved.
Affiliation:
Department of Radiology, University of Michigan Health Systems, 1500 E. Medical Center Drive, Ann Arbor, MI 48109.
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