MR Spectroscopy of Bilateral Thalamic Gliomas
François Estève,a,
Sylvie Granda,
Christophe Rubina,
Dominique Hoffmanna,
Basile Pasquiera,
Danielle Graveron-Demillya,
Rachid Mahdjouba and
Jean-François Le Basa
a From the Unité IRM (F.E., S.G., J-F.L.B.), the Unité INSERM 438, University Joseph Fourier (F.E., S.G., C.R., J-F.L.B.), the Service de Neurochirurgie (D.H.), and the Service d'Anatomie Pathologique (B.P.), Centre Hospitalier Universitaire de Grenoble; and the Laboratoire RMN CNRS UPRESA 5012 UCB Lyon (D.G-D., R.M.), France.
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FIG 1. Histopathologic section from biopsy sample obtained in patient 2. A few neuronal cells are visible (arrows), surrounded by astrocytes with hyperchromatic nuclei in a fibrillar eosinophilic background. Immunohistochemical study has shown that the tumoral cells express the GFA protein; the KI-67 index was low. No necrosis or mitotic figures or endothelial proliferation were observed. These elements are consistent with the diagnosis of astrocytoma grade II (WHO, 1993). Scale bar: 60 µm. Hematoxylin erythrosin saffron.
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FIG 2. MR images of the BTG in patient 1.
Upper and Lower Left, T1-weighted MR images of a large tumoral mass, including both thalami. Lateral ventricles are expanded owing to the obstruction of the interventricular foramen.
Upper Right, T2-weighted MR image in axial orientation shows the tumoral mass infiltrating both thalami and the head of the caudate nucleus. The VOI for the proton MR spectroscopic image was located by using the three orientations and included a large amount of tumoral tissue.
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FIG 3. A, MR spectroscopic image of the Cr-PCr interpolated peak area values (see text). The highest level of the Cr-PCr MR spectroscopic signal appears on the right side of the tumor.
B, Tumoral (1) and normal (2) areas used for metabolic analysis are drawn on this T2-weighted MR image obtained from patient 1.
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FIG 4. A–E, Comparison patterns of proton spectrum for both patients with BTG (patient 1, A and B; patient 2, C and D) obtained from voxels in normal areas (A and C) and tumoral areas (B and D) with peak assignments. The Cr peak is higher than the Cho peak in tumoral areas. These unusual patterns are different from that usually observed in a low-grade glioma (E). The 1.3 ppm resonance has been assigned to Lac in all spectra
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FIG 5. A and B, Phosphorus spectrum in single VOI ISIS sequence obtained in patient 2 (A). The PCr peak is higher than in a spectrum obtained under the same conditions in a healthy volunteer (B). PDE indicates phosphodiester; PME, phosphomonoester.
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