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Myo-inositol concentration in MR spectroscopy for differentiating high grade glioma from primary central nervous system lymphoma

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Abstract

It is sometimes difficult to distinguish gliomas from other tumors on routine imaging. In this study, we assessed whether 3-T magnetic resonance spectroscopy (MRS) with LCModel software might be useful for discriminating glioma from other brain tumors, such as primary central nervous system lymphomas (PCNSLs) and metastatic tumors. A total of 104 cases of brain tumor (66 gliomas, 20 PCNSLs, 6 metastatic tumors, 12 other tumors) were preoperatively investigated with short echo time (35 ms) single-voxel 3-T MRS. LCModel software was used to evaluate differences in the absolute concentrations of choline, N-acetylaspartate, N-acetylaspartylglutamate, glutamate + glutamine, myo-inositol (mIns), and lipid. mIns levels were significantly increased in high-grade glioma (HGG) compared with PCNSL (p < 0.001). In multivariate logistic regression analysis, mIns was the best marker for differentiating HGG from PCNSL (p < 0.0001, odds ratio 1.9927, 95% confidence interval 1.3628–3.2637). Conventional MRS detection of mIns resulted in a high diagnostic accuracy (sensitivity, 64%; specificity, 90%; area under the receiver operator curve, 0.80) for HGG. The expression of inositol 3-phosphate synthase (ISYNA1) was significantly higher in gliomas than in PCNSLs (p < 0.05), suggesting that the increased level of mIns in glioma is due to high expression of ISYNA1, the rate-limiting enzyme in the mIns-producing pathway. In conclusion, noninvasive analysis of mIns using single-voxel MRS may be useful in distinguishing gliomas from other brain tumors, particularly PCNSLs.

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Abbreviations

Cr:

Creatine

FWHM:

Full width at half maximum

Gln:

Glutamine

Glu:

Glutamate

Glx:

Glutamine + glutamate

HGG:

High-grade glioma

IDH:

Isocitrate dehydrogenase

ISYNA1:

Inositol 3-phosphate synthase

Lip:

Lipid

mIns:

Myo-inositol

MRI:

Magnetic resonance imaging

MRS:

Magnetic resonance spectroscopy

NAA:

N-Acetylaspartate

NAAG:

N-Acetylaspartylglutamate

PCNSL:

Primary central nervous system lymphoma

SNR:

Signal-to-noise ratio

2HG:

2-Hydroxyglutarate

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Acknowledgements

We appreciate those at the Brain Tumor Translational Resource at Kobe University for access to biospecimens and for biorepository support.

Funding

K. Tanaka is supported by grants from the Japanese Ministry of Education, Culture, Sports, Science and Technology (26462181), Takeda Science Foundation and Mochida Memorial Foundation for Medical and Pharmaceutical Research. T. Sasayama, K. Hosoda and E. Kohmura are supported by grants from the Japanese Ministry of Education, Culture, Sports, Science and Technology (25462258, 15K10302 and 25293309, respectively).

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Kobe University Graduate School of Medicine and Kobe University Hospital, Kobe, 650-0017, Japan

    Hiroaki Nagashima, Takashi Sasayama, Kazuhiro Tanaka, Naoko Sato, Masahiro Maeyama, Masaaki Kohta, Junichi Sakata, Yusuke Yamamoto, Kohkichi Hosoda & Eiji Kohmura

  2. Center for Radiology and Radiation Oncology, Kobe University Graduate School of Medicine and Kobe University Hospital, Kobe, 650-0017, Japan

    Katsusuke Kyotani

  3. Department of Diagnostic Pathology, Kobe University Graduate School of Medicine and Kobe University Hospital, Kobe, 650-0017, Japan

    Tomoo Itoh

  4. Division of Radiation Oncology, Kobe University Graduate School of Medicine and Kobe University Hospital, Kobe, 650-0017, Japan

    Ryohei Sasaki

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  1. Hiroaki Nagashima
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Corresponding author

Correspondence to Takashi Sasayama.

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The authors declare that they have no conflict of interest.

Research involving human participants and/or animals

This study was approved by the ethics review boards of our institutions (approval numbers: #1497 for MRS; #1579 for use of tumor samples).

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Informed consent was obtained from all patients prior to their inclusion in this study.

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Nagashima, H., Sasayama, T., Tanaka, K. et al. Myo-inositol concentration in MR spectroscopy for differentiating high grade glioma from primary central nervous system lymphoma. J Neurooncol 136, 317–326 (2018). https://doi.org/10.1007/s11060-017-2655-x

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