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Improving the utility of 1H-MRS for the differentiation of glioma recurrence from radiation necrosis

Journal of Neuro-Oncology volume 133, pages 97–105 (2017)Cite this article

Abstract

Proton magnetic resonance spectroscopy (1H-MRS) has shown promise in distinguishing recurrent high-grade glioma from posttreatment radiation effect (PTRE). The purpose of this study was to establish objective 1H-MRS criteria based on metabolite peak height ratios to distinguish recurrent tumor (RT) from PTRE. A retrospective analysis of magnetic resonance imaging and 1H-MRS data was performed. Spectral metabolites analyzed included N-acetylaspartate, choline (Cho), creatine (Cr), lactate (Lac), and lipids (Lip). Quantitative 1H-MRS criteria to differentiate RT from PTRE were identified using 81 biopsy-matched spectral voxels. A receiver operating characteristic curve analysis was conducted for all metabolite ratio combinations with the pathology diagnosis as the classification variable. Forward discriminant analysis was used to identify ratio variables that maximized the correct classification of RT versus PTRE. Our results were applied to 205 records without biopsy-matched voxels to examine the percent agreement between our criteria and the radiologic diagnoses. Five ratios achieved an acceptable balance [area under the curve (AUC) ≥ 0.700] between sensitivity and specificity for distinguishing RT from PTRE, and each ratio defined a criterion for diagnosing RT. The ratios are as follows: Cho/Cr > 1.54 (sensitivity 66%, specificity 79%), Cr/Cho ≤ 0.63 (sensitivity 65%, specificity 79%), Lac/Cho ≤ 2.67 (sensitivity 85%, specificity 58%), Lac/Lip ≤ 1.64 (sensitivity 54%, specificity 95%), and Lip/Lac > 0.58 (sensitivity 56%, specificity 95%). Application of our ratio criteria in prospective studies may offer an alternative to biopsy or visual spectral pattern recognition to distinguish RT from PTRE in patients with gliomas.

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Abbreviations

AUC:

Area under the curve

Cho:

Choline

Cr:

Creatine

FLAIR:

Fluid attenuation inversion recovery

GBM:

Glioblastoma multiforme

1H-MRS:

Proton magnetic resonance spectroscopy

Lac:

Lactate

Lip:

Lipids

MRI:

Magnetic resonance imaging

NAA:

N-acetylaspartate

PTRE:

Posttreatment radiation effect

RT:

Recurrent tumor

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Funding

Funds from Newsome United Kingdom Chair in Neurosurgery Research held by Dr. Preul.

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Author notes

    Affiliations

    1. Department of Neurology, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USA

      Ian D. Crain

    2. Department of Neurosurgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USA

      Petra S. Elias, Kristina Chapple & Mark C. Preul

    3. Neuro-Oncology Research, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USA

      Adrienne C. Scheck

    4. Department of Neuroradiology, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USA

      John P. Karis

    Authors
    1. Ian D. Crain
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    2. Petra S. Elias
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    6. Mark C. Preul
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    Correspondence to Mark C. Preul.

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    Additional information

    Ian D. Crain and Petra S. Elias have contributed equally to this work.

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    Crain, I.D., Elias, P.S., Chapple, K. et al. Improving the utility of 1H-MRS for the differentiation of glioma recurrence from radiation necrosis. J Neurooncol 133, 97–105 (2017). https://doi.org/10.1007/s11060-017-2407-y

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    • DOI: https://doi.org/10.1007/s11060-017-2407-y

    Keywords

    • 1H-MRS
    • Posttreatment radiation effect
    • Proton magnetic resonance spectroscopy
    • Radiation necrosis
    • Recurrent glioma
    • Tumor recurrence