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AJNR - American Journal of Neuroradiology

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Relationship of MR-Derived Lactate, Mobile Lipids, and Relative Blood Volume for Gliomas in Vivo

Xiaojuan Li^a,b, Daniel B. Vigneron^a,b, Soonmee Cha^b, Edward E. Graves^d, Forrest Crawford^a,b, Susan M. Chang^c and Sarah J. Nelson^a,b

^a Center of Functional and Molecular Imaging, University of California, San Francisco
^b Department of Radiology, University of California, San Francisco
^c Department of Neurological Surgery, University of California, San Francisco
^d Department of Radiation Oncology, Stanford University, Palo Alto, CA

View larger version (104K): [in a new window]   FIG 1. Spatial distribution of elevated Lac and Lip presented as contours overlaid on contrast-enhanced T1-weighted images in presurgical patients with the following tumors: grade II glioma with Lac within the T2 hyperintensity but out of the contrast enhancement (A), nonenhancing grade III glioma with only elevated Lac (B), enhancing grade III glioma with elevated Lac and Lip (C), grade IV glioma with only elevated Lac (D), grade IV glioma with only elevated Lip (E), grade IV glioma without macronecrosis but with elevated Lac and Lip (F), and grade IV glioma with ring enhancement and a necrotic core with elevated Lac and Lip (G). Blue = Lac contours, red = Lip contours, yellow = PRESS box.

View larger version (65K): [in a new window]   FIG 2. Spatial distribution of elevated Lac and Lip presented as contours overlaid on contrast-enhanced T1-weighted images in postsurgical patients with the following tumors: grade II glioma with Lip within the resection cavity and Lac within the contrast enhancement (A), grade II glioma with Lac and Lip within the nonenhancing region (B), grade IV glioma with Lip within the resection cavity and contrast enhancement and Lac in the enhancement and extended to the nonenhancing region (C), and grade IV glioma with Lac within the resection cavity and Lip partly in the resection cavity and mainly in the contrast enhancement (D). Blue = Lac contours, red = Lip contours, yellow = PRESS box.

View larger version (50K): [in a new window]   FIG 3. Images in a 59-year-old woman with nonenhancing infiltrative grade III glioma in the right frontal lobe with a highly elevated Lac level and increased rCBV before surgery: post-contrast T1-weighted image with an overlying PRESS box and voxel grid (A); difference spectra showing huge, elevated Lac peaks (B); Lac image overlaid on the post-contrast T1-weighted image (C), and rCBV (color) overlaid on the post-contrast T1-weighted image (D). White = PRESS box, blue = Lac contour.

View larger version (40K): [in a new window]   FIG 4. Mean, SD, and maximal (Max) rCBV in regions of elevated Lac but no Lip (within Lac) and in regions with elevated Lip but no Lac (within Lip) for six presurgical grade IV tumors with both elevated Lac and Lip. Both mean and maximal rCBV within Lac were significantly lower than those within Lip.

View larger version (78K): [in a new window]   FIG 5. Images in a 49-year-old man with grade IV glioma in the left frontal lobe. Presurgical data show increased mean and maximal rCBV within regions having elevated Lac but no Lip and within regions having elevated Lip but no Lac: contrast-enhanced T1-weighted images with PRESS box (yellow) and part of the voxel grid (white) (A); spectra showing the summed spectra for Cho, Cr, NAA, and elevated Lip (left) and difference spectra showing elevated Lac (right) (B); resampled metabolic images show Lac (upper left), Lip (lower left), and the color overlays (right) for elevated Lac only (green), Lip only (red), and both (yellow) (C); Lac and Lip overlaid on T1-weighted images (D); and rCBV overlaid on T2-weighted images with contours for significantly elevated Lac (blue) and Lip (red) (E).

View larger version (98K): [in a new window]   FIG 6. Images in a 45-year-old man with enhancing grade III glioma involving the splenium of the corpus callosum. Presurgical data show elevated Lip in the center of the region with elevated Lac: T1-weighted image showing contrast enhancement but no macronecrosis (A); resampled Lac (upper) and Lip (lower) images (B); Lac (green), Lip (red), and both (yellow) overlaid on a T1-weighted image (C); rCBV overlaid on a T2-weighted image with contours for elevated Lac (blue) and Lip (red) (D); and rCBV curves for voxels in the contrast enhancement (E). Dynamic signal intensity curves for voxels (red square) suggest necrosis, which is consistent with elevated Lip peaks.