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Proton magnetic resonance spectroscopy predicts survival in children with diffuse intrinsic pontine glioma

  • Clinical Study - Patient Study
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Abstract

Patients with diffuse intrinsic pontine glioma (DIPG) face a grim prognosis with limited treatment options. Many patients will enroll on investigational trials though the role of chemotherapy or immunotherapy is unclear. Radiographic changes on conventional MRI are used to evaluate tumor response and progression, but are not predictive of outcome in these patients. More sensitive measures of tumor biology are needed to improve patient management. We evaluated changes in magnetic resonance spectroscopy (MRS) biomarkers in patients with DIPG. Thirty-eight patients were enrolled prospectively on an IRB-approved protocol, which included standard MRI, single voxel spectroscopy (SVS) and multi-slice multi-voxel spectroscopy (MRSI). Scans were performed at multiple time points during each patient’s clinical course, with a total of 142 scans. The prognostic values of Choline:N-acetylaspartate (Cho:NAA), Cho:Creatine (Cho:Cr) and the presence of lactate and lipids (+Lac/Lip) were evaluated. Cho:NAA and variance in Cho:NAA values among different voxels within a tumor were each predictive of shorter survival. This prospective study shows that MRS can be used to identify high-risk patients and monitor changes in tumor metabolism, which may reflect changes in tumor behavior.

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Acknowledgments

The authors thank Dr. Alan Barnett and Dr. Jan Willem van der Veen for their contributions towards the MRSI acquisition and data analysis. This work was presented in part at the ASNR 47th Annual Meeting, Vancouver 2009. Research was supported in part by the Intramural Research Program of the National Institutes of Health, National Cancer Institute, Center for Cancer Research. The views expressed in this article are those of the authors and do not reflect the official policy of the National Institutes of Health, Department of Army, Department of Defense, or U.S. Government.

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Authors and Affiliations

  1. Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Building 10/Room 1-5750, 9000 Rockville Pike, Bethesda, MD, 20892, USA

    Emilie A. Steffen-Smith, Sean J. Hipp, Robyn Bent & Katherine E. Warren

  2. Biometric Research Branch, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD, USA

    Joanna H. Shih

  3. Department of Pediatrics, Walter Reed Army Medical Center, Washington, DC, USA

    Sean J. Hipp

  4. Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA

    Sean J. Hipp

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  1. Emilie A. Steffen-Smith
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Correspondence to Katherine E. Warren.

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Steffen-Smith, E.A., Shih, J.H., Hipp, S.J. et al. Proton magnetic resonance spectroscopy predicts survival in children with diffuse intrinsic pontine glioma. J Neurooncol 105, 365–373 (2011). https://doi.org/10.1007/s11060-011-0601-x

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