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In vivo proton MR spectroscopy of primary tumours, nodal and recurrent disease of the extracranial head and neck

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Benign and malignant neoplasms as well as metastatic lymph nodes of 39 patients were examined using localized single voxel magnetic resonance spectroscopy (MRS) [repetition time (TR) 1500, echo time (TE) 135) at 1.5 T. New techniques with simultaneous correction of motion artefacts during the acquisition, three-dimensional saturation pulses, respiratory triggering and smaller volume of interest (VOI) size, were applied. Ratios of peak areas under the choline (Cho) and creatine (Cr) resonances were estimated in all cases and compared with those from samples of normal tissue. Ninety one spectra were acquired in 39 patients, 63 of which were suitable for further evaluation. The smallest VOI was 0.40 cm3. The Cho/Cr ratios in all malignant neoplasms (mean: 5.2, range: 1.7–17.8) were significantly elevated relative to those in the normal muscle structures (mean: 0.9, range: 0.2–1.4), while those in the benign neoplasms were elevated (mean: 24.4, range: 1.4–59.7) with respect to those in the malignant ones. The average Cho/Cr ratio in the metastatic lymph nodes was significantly higher (mean: 4.8, range: 3.3–5.6) than that for benign lymphoid hyperplasia (mean: 2.2, range: 1.0–3.0). MRS measurements were able to differentiate recurrent disease from post-therapeutic tissue changes in 11 out of 13 patients.

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  1. Law M, Hamburger M, Johnson G, Inglese M, Londono A, Golfinos J, Zagzag D, Knopp EA (2004) Differentiating surgical from non-surgical lesions using perfusion MR imaging and proton MR spectroscopic imaging. Technol Cancer Res Treat 3:557–565

    PubMed  Google Scholar 

  2. Bolan PJ, Nelson MT, Yee D, Garwood M (2005) Imaging in breast cancer: Magnetic resonance spectroscopy. Breast Cancer Res 7:149–152

    Article  PubMed  CAS  Google Scholar 

  3. Hanaoka H, Yoshioka Y, Ito I, Niitu K, Yasuda N (1993) In vitro characterization of lung cancers by the use of 1 H nuclear magnetic resonance spectroscopy of tissue extracts and discriminant factor analysis. Magn Reson Med 29:436–440

    Article  PubMed  CAS  Google Scholar 

  4. Wetter A, Hubner F, Lehnert T, Fliessbach K, Vorbuchner M, Roell S, Zangos S, Luboldt W, Vogl TJ (2005) Three-dimensional 1 H-magnetic resonance spectroscopy of the prostate in clinical practice: technique and results in patients with elevated prostate-specific antigen and negative or no previous prostate biopsies. Eur Radiol 15:645–652

    Article  PubMed  Google Scholar 

  5. Cheng LL, Burns MA, Taylor JL, He W, Halpern EF, McDougal WS, Wu CL (2005) Metabolic characterization of human prostate cancer with tissue magnetic resonance spectroscopy. Cancer Res 65:3030–3034

    PubMed  CAS  Google Scholar 

  6. Dowling C, Bollen AW, Noworolski SM, et al (2001) Preoperative proton MR spectroscopic imaging of brain tumours: correlation with histopathological analysis of resection specimens. AJNR Am J Neuroradiol 22:604–612

    PubMed  CAS  Google Scholar 

  7. Rutkowski T, Tarnawski R, Sokol M, Maciejewski B (2003) 1 H-MR spectroscopy of normal brain tissue before and after postoperative radiotherapy because of primary brain tumours. Int J Radiat Oncol Biol Phys 56:1381–1389

    Article  PubMed  Google Scholar 

  8. Star-Lack JM, Adalsteinsson E, Adam MF, et al (2000) In vivo 1 H MR spectroscopy of head and neck lymph node metastasis and comparison with oxygen tension measurements. AJNR Am J Neuroradiol 21:183–193

    PubMed  CAS  Google Scholar 

  9. Mukherji SK, Schiro S, Castillo M, Kwock L, Muller KE, Blackstock W (1997) Proton MR spectroscopy of squamous cell carcinoma of the extracranial head and neck: in vitro and in vivo studies. AJNR Am J Neuroradiol 18:1057–1072

    PubMed  CAS  Google Scholar 

  10. Huang W, Roche P, Shindo M, Madoff D, Geronimo C, Button T (2000) Evaluation of head and neck tumour response to therapy using in vivo 1 H MR spectroscopy: correlation with pathology. Proc Int Soc Magn Reson Med 8:552

    Google Scholar 

  11. Maheshwari SR, Mukherji SK, Neelon B, et al. (2000) The choline/creatine ratio in five benign neoplasms: comparison with squamous cell carcinoma by use in vitro spectroscopy. AJNR Am J Neuroradiol 21:1930–1935

    PubMed  CAS  Google Scholar 

  12. King AD, Yeung DKW, Ahuja AT, Leung SF, Tse GMK, van Hasselt AC (2004) In vivo proton MR spectroscopy of primary and nodal nasopharyngeal carcinoma. AJNR Am J Neuroradiol 25:484–490

    PubMed  Google Scholar 

  13. Adalsteinsson E, Spielman DM, Pauly JM, Terris DJ, Sommer G, Macovski A (1998) Feasibility study of lactate imaging of head and neck tumours. NMR Biomed 11:360–369

    Article  PubMed  CAS  Google Scholar 

  14. Gerstle RJ, Aylward SR, Kromhout Schiro S, Mukherji SK (2000) The role of neural networks in improving the accuracy of MR spectroscopy for the diagnosis of head and neck cancer. AJNR Am J Neuroradiol 21:1133–1138

    PubMed  CAS  Google Scholar 

  15. Sobin LH, Wittekind C (eds) (2002) UICC: TNM classification of malignant tumours, 6th edn. Wiley, New York

  16. Mescher M, Merkle H, Kirsch J, Garwood M, Gruetter R (1998) Simultaneous in vivo spectral editing and water suppression. NMR Biomed 11:266–272

    Article  PubMed  CAS  Google Scholar 

  17. Barker PB, Hearshen DO, Boska MD (2001) Single-voxel proton MRS of the human brain at 1.5 T and 3.0 T. Magn Reson Med 45:765–769

    Article  PubMed  CAS  Google Scholar 

  18. Hurd RE, Freeman DM (1989) Metabolite specific proton magnetic resonance imaging. Proc Natl Acad Sci USA 4402–4406

  19. Russell P, Lean CL, Delbridge L, May GL, Dowd S, Mountford CE (1994) Proton magnetic resonance and human thyroid neoplasia: discrimination between benign and malignant neoplasms. Am J Med 96:383–388

    Article  PubMed  CAS  Google Scholar 

  20. Mountford CE, Lean CL, Hancock R, Dowd S, Mackinnon WB, Tattersall MH, Russell P (1993) Magnetic resonance spectroscopy detects cancer in draining lymph nodes. Invasion Metastasis 13:57–71

    PubMed  CAS  Google Scholar 

  21. MacKinnon WB, Barry PA, Malycha PL, Gillett DJ, Russell P, Lean CL, Doran ST, Barraclough BH, Bilous M, Mountford CE (1997) Fine-needle biopsy specimens of benign lesions distinguished from invasive cancer ex vivo with proton MR spectroscopy. Radiology 204:661–666

    PubMed  CAS  Google Scholar 

  22. Motoori K, Yamamoto S, Ueda T, Nakano K, Muto T, Nagai Y, Ikeda M, Funatsu H, Ito H (2004) Inter- and intratumoural variability in magnetic resonance imaging of pleomorphic adenoma. J Comput Assist Tomogr 28:233–246

    Article  PubMed  Google Scholar 

  23. Majos C, Julia-Sape M, Alonso J, Serralonga M, Aguilera C, Acebes JJ, Arus C, Gili J (2004) Brain tumor classification by proton MR spectroscopy: comparison of diagnostic accuracy at short and long TE. AJNR Am J Neuroradiol 25:1696–1704

    PubMed  Google Scholar 

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Correspondence to Sotirios Bisdas.

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Bisdas, S., Baghi, M., Huebner, F. et al. In vivo proton MR spectroscopy of primary tumours, nodal and recurrent disease of the extracranial head and neck. Eur Radiol 17, 251–257 (2007).

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