Skip to main content

Advertisement

SpringerLink
Log in

Proton magnetic resonance spectroscopy in immunocompetent patients with primary central nervous system lymphoma

  • Clinical Study
  • Published:
Journal of Neuro-Oncology Aims and scope Submit manuscript

Abstract

Background: Magnetic resonance spectroscopy imaging (MRSI) non-invasively evaluates the metabolic profile of normal and abnormal brain tissue. Primary central nervous system lymphoma (PCNSL) is a highly aggressive tumor responsive to high-dose methotrexate based regimens. Patients often have complete responses but relapses are common. We characterized the MR spectra of PCNSL patients, correlated MRSI with MRI and evaluated whether early recurrence could be detected by MRSI.

Methods: Patients with PCNSL had multi-voxel MRSI before, during, and after treatment. The region of interest was defined using axial FLAIR images. Metabolites assessed were N-acetyl-aspartate (NAA), choline (Cho), creatine (Cr), lipid, and lactate. Ratios of Cho/Cr, NAA/Cho, and NAA/Cr were calculated and correlated with MRI. Overall survival (OS), progression free survival (PFS), and relative risks of each of the ratios were determined.

Results: MRSI was performed on 11 men and seven women; median age of 59. Sixty-seven MRSI studies were performed, 17 baseline and 48 follow-up studies. Median ratios in 16 pretreated patients were Cho/Cr-1.90, NAA/Cho-0.39, and NAA/Cr-1.27. Two patients had lipid at baseline, five had lactate and two had both. MRSI correlated with tumor response or progression on MRI; in three patients MRSI suggested disease progression prior to changes on MRI. Univariate analysis of metabolite ratios, lipid, and lactate revealed that none significantly affected PFS or OS. Kaplan–Meier analysis of the presence or absence of lipid, lactate or both revealed a trend for increased PFS.

Conclusion: MRSI and MRI correlate with tumor response or progression and may allow early detection of disease recurrence. The presence or absence of lipid and/or lactate may have prognostic significance. Further research using MRSI needs to be done to validate our findings and determine the role of MRSI in PCNSL.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • MJ Fulham A Bizzi MJ Dietz HH Shih R Raman GS Sobering JA Frank AJ Dwyer JR Alger G Chiro ParticleDi (1992) ArticleTitleMapping of brain tumor metabolites with proton MR spectroscopic imaging: clinical relevance Radiology 185 675–686 Occurrence Handle1:CAS:528:DyaK3sXhsVClt7o%3D Occurrence Handle1438744

    CAS  PubMed  Google Scholar 

  • D Ott J Hennig T Ernst (1993) ArticleTitleHuman brain tumors: assessment with in vivo proton MR spectroscopy Radiology 186 745–752 Occurrence Handle1:STN:280:ByyC2MjlvVI%3D Occurrence Handle8430183

    CAS  PubMed  Google Scholar 

  • WG Negendank R Sauter TR Brown JL Evelhoch A Falini ED Gotsis A Heerschap K Kamada BC Lee MM Mengeot E Moser KA Padavic-Shaller JA Sanders TA Spraggins AE Stillman B Terwey TJ Vogl K Wicklow RA Zimmerman (1996) ArticleTitleProton magnetic resonance spectroscopy in patients with glial tumors: a multicenter study J Neurosurg 84 449–458

    Google Scholar 

  • ME Meyerand JM Pipas A Mamourian TD Tosteson JF Dunn (1999) ArticleTitleClassification of biopsy-confirmed brain tumors using single-voxel MR spectroscopy AJNR Am J Neuroradiol 20 117–123

    Google Scholar 

  • C Dowling AW Bollen SM Noworolski MW McDermott NM Barbaro MR Day RG Henry SM Chang WP Dillon SJ Nelson DB Vigneron (2001) ArticleTitlePreoperative proton MR spectroscopic imaging of brain tumors: correlation with histopathologic analysis of resection specimens AJNR Am J Neuroradiol 22 604–612

    Google Scholar 

  • IM Burtscher G Skagerberg B Geijer E Englund F Stahlberg S Holtas (2000) ArticleTitleProton MR spectroscopy and preoperative diagnostic accuracy: an evaluation of intracranial mass lesions characterized by stereotactic biopsy findings AJNR Am J Neuroradiol 21 84–93

    Google Scholar 

  • MA Heesters RL Kamman EL Mooyaart KG Go (1993) ArticleTitleLocalized proton spectroscopy of inoperable brain gliomas. Response to radiation therapy J Neurooncol 17 27–35

    Google Scholar 

  • MC Preul Z Caramanos JG Villemure G Shenouda R LeBlanc A Langleben DL Arnold (2000) ArticleTitleUsing proton magnetic resonance spectroscopic imaging to predict in vivo the response of recurrent malignant gliomas to tamoxifen chemotherapy Neurosurgery 46 306–318

    Google Scholar 

  • R Tarnawski M Sokol P Pieniazek B Maciejewski J Walecki L Miszczyk T Krupska (2002) ArticleTitle1H-MRS in vivo predicts the early treatment outcome of postoperative radiotherapy for malignant gliomas Int J Radiat Oncol Biol Phys 52 1271–1276

    Google Scholar 

  • X Leclerc TA Huisman AG Sorensen (2002) ArticleTitleThe potential of proton magnetic resonance spectroscopy ((1)H-MRS) in the diagnosis and management of patients with brain tumors Curr Opin Oncol 14 292–298 Occurrence Handle10.1097/00001622-200205000-00007

    Article  Google Scholar 

  • MC Preul R LeBlanc Z Caramanos R Kasrai S Narayanan DL Arnold (1998) ArticleTitleMagnetic resonance spectroscopy guided brain tumor resection: differentiation between recurrent glioma and radiation change in two diagnostically difficult cases Can J Neurol Sci 25 13–22

    Google Scholar 

  • A Pirzkall TR McKnight EE Graves MP Carol PK Sneed WW Wara SJ Nelson LJ Verhey DA Larson (2001) ArticleTitleMR-spectroscopy guided target delineation for high-grade gliomas Int J Radiat Oncol Biol Phys 50 915–928

    Google Scholar 

  • EE Graves SJ Nelson DB Vigneron C Chin L Verhey M McDermott D Larson PK Sneed S Chang MD Prados K Lamborn WP Dillon (2000) ArticleTitleA preliminary study of the prognostic value of proton magnetic resonance spectroscopic imaging in gamma knife radiosurgery of recurrent malignant gliomas Neurosurgery 46 319–326

    Google Scholar 

  • JP Rock D Hearshen L Scarpace D Croteau J Gutierrez JL Fisher ML Rosenblum T Mikkelsen (2002) ArticleTitleCorrelations between magnetic resonance spectroscopy and image-guided histopathology, with special attention to radiation necrosis Neurosurgery 51 912–920

    Google Scholar 

  • LL Wald SJ Nelson MR Day SE Noworolski RG Henry SL Huhn S Chang MD Prados PK Sneed DA Larson WM Wara M McDermott WP Dillon PH Gutin DB Vigneron (1997) ArticleTitleSerial proton magnetic resonance spectroscopy imaging of glioblastoma multiforme after brachytherapy J Neurosurg 87 525–534 Occurrence Handle1:STN:280:ByiH283mtFI%3D Occurrence Handle9322843

    CAS  PubMed  Google Scholar 

  • LE Abrey J Yahalom LM DeAngelis (2000) ArticleTitleTreatment for primary CNS lymphoma: the next step J Clin Oncol 18 3144–3150

    Google Scholar 

  • LM DeAngelis (1990) ArticleTitlePrimary central nervous system lymphoma imitates multiple sclerosis J Neurooncol 9 177–181

    Google Scholar 

  • T Batchelor K Carson A O’Neill SA Grossman J Alavi P New F Hochberg R Priet (2003) ArticleTitleTreatment of primary CNS lymphoma with methotrexate and deferred radiotherapy: a report of NABTT 96–07 J Clin Oncol 21 1044–1049

    Google Scholar 

  • Bottomley P: Selective volume method for performing localized NMR spectroscopy. Patent 4,480,228. 1984.

  • EL Kaplan P Meier (1958) ArticleTitleNonparametric estimation from incomplete observations J Am Stat Assoc 53 457–481

    Google Scholar 

  • PL Lee RG Gonzalez (2000) ArticleTitleMagnetic resonance spectroscopy of brain tumors Curr Opin Oncol 12 199–204

    Google Scholar 

  • IL Simone F Federico C Tortorella CF Andreula GB Zimatore P Giannini G Angarano V Lucivero P Picciola D Carrara A Bellacosa P Livrea (1998) ArticleTitleLocalised 1H-MR spectroscopy for metabolic characterization of diffuse and focal brain lesions in patients infected with HIV J Neurol Neurosurg Psychiatry 64 516–523

    Google Scholar 

  • RJ Chinn ID Wilkinson MA Hall-Craggs MN Paley RF Miller BE Kendall SP Newman MJ Harrison (1995) ArticleTitleToxoplasmosis and primary central nervous system lymphoma in HIV infection: diagnosis with MR spectroscopy Radiology 197 649–654

    Google Scholar 

  • L Chang BL Miller D McBride M Cornford G Oropilla S Buchthal F Chiang H Aronow CK Beck T Ernst (1995) ArticleTitleBrain lesions in patients with AIDS: H-1 MR spectroscopy Radiology 197 525–531

    Google Scholar 

  • I Harting M Hartmann G Jost C Sommer R Ahmadi S Heiland K Sartor (2003) ArticleTitleDifferentiating primary central nervous system lymphoma from glioma in humans using localised proton magnetic resonance spectroscopy Neurosci Lett 342 163–166 Occurrence Handle10.1016/S0304-3940(03)00272-6 Occurrence Handle1:CAS:528:DC%2BD3sXjvFahtbc%3D Occurrence Handle12757890

    Article  CAS  PubMed  Google Scholar 

  • MC Preul Z Caramanos DL Collins JG Villemure R LeBlanc A Olivier R Pokrupa DL Arnold (1996) ArticleTitleAccurate, noninvasive diagnosis of human brain tumors by using proton magnetic resonance spectroscopy Nat Med 2 323–325 Occurrence Handle1:CAS:528:DyaK28XhsVGkt7s%3D Occurrence Handle8612232

    CAS  PubMed  Google Scholar 

  • S Herminghaus U Pilatus W Moller-Hartmann P Raab H Lanfermann W Schlote FE Zanella (2002) ArticleTitleIncreased choline levels coincide with enhanced proliferative activity of human neuroepithelial brain tumors NMR in Biomedicine 15 385–392

    Google Scholar 

  • F Podo (1999) ArticleTitleTumour phospholipid metabolism NMR in Biomedicine 12 413–439

    Google Scholar 

  • RK Gupta TF Cloughesy U Sinha J Garakian J Lazareff G Rubino L Rubino DP Becker HV Vinters JR Alger (2000) ArticleTitleRelationships between choline magnetic resonance spectroscopy, apparent diffusion coefficient and quantitative histopathology in human glioma J Neurooncol 50 215–226

    Google Scholar 

  • H Shimizu T Kumabe R Shirane T Yoshimoto (2000) ArticleTitleCorrelation between choline level measured by proton MR spectroscopy and Ki-67 labeling index in gliomas AJNR Am J Neuroradiol 21 659–665

    Google Scholar 

  • ED Gotsis K Fountas E Kapsalaki P Toulas G Peristeris N Papadakis (1996) ArticleTitleIn vivo proton MR spectroscopy: the diagnostic possibilities of lipid resonances in brain tumors Anticancer Res 16 1565–1567

    Google Scholar 

  • W Negendank R Sauter (1996) ArticleTitleIntratumoral lipids in 1H MRS in vivo in brain tumors: experience of the Siemens cooperative clinical trial Anticancer Res 16 1533–1538

    Google Scholar 

  • M Rijpkema J Schuuring MY Van Der GM Van Der H Bernsen R Boerman A van der Kogel A Heerschap (2003) ArticleTitleCharacterization of oligodendrogliomas using short echo time 1H MR spectroscopic imaging NMR Biomed 16 12–18

    Google Scholar 

  • M Tomoi H Kimura M Yoshida S Itoh Y Kawamura N Hayashi K Yamamoto T Kubota Y Ishii (1997) ArticleTitleAlterations of lactate (+lipid) concentration in brain tumors with in vivo hydrogen magnetic resonance spectroscopy during radiotherapy Invest Radiol 32 288–296

    Google Scholar 

  • A Bizzi B Movsas G Tedeschi CL Phillips P Okunieff JR Alger G Chiro ParticleDi (1995) ArticleTitleResponse of non-Hodgkin lymphoma to radiation therapy: early and long- term assessment with H-1 MR spectroscopic imaging Radiology 194 271–276

    Google Scholar 

  • AC Kuesel KM Briere WC Halliday GR Sutherland SM Donnelly IC Smith (1996) ArticleTitleMobile lipid accumulation in necrotic tissue of high grade astrocytomas Anticancer Res 16 1485–1489

    Google Scholar 

  • KT Holmes CL Lean NH Hunt NJ King (1990) ArticleTitleDevelopment of the “activated” high resolution 1H MR spectrum in murine T cells and B cells occurs in G1 phase of the cell cycle Magn Reson Med 16 1–8

    Google Scholar 

  • PF Agris ID Campbell (1982) ArticleTitleProton nuclear magnetic resonance of intact Friend leukemia cells: phosphorylcholine increase during differentiation Science 216 1325–1327

    Google Scholar 

  • E Braks H Urbach H Pels F Traber W Block HH Schild (2000) ArticleTitlePrimary central nervous system immunocytoma: MRI and spectroscopy Neuroradiology 42 738–741

    Google Scholar 

  • FA Howe SJ Barton SA Cudlip M Stubbs DE Saunders M Murphy P Wilkins KS Opstad VL Doyle MA McLean BA Bell JR Griffiths (2003) ArticleTitleMetabolic profiles of human brain tumors using quantitative in vivo 1H magnetic resonance spectroscopy Magn Reson Med 49 223–232

    Google Scholar 

  • AA Tzika D Zurakowski TY Poussaint L Goumnerova LG Astrakas PD Barnes DC Anthony AL Billett NJ Tarbell RM Scott PM Black (2001) ArticleTitleProton magnetic spectroscopic imaging of the child’s brain: the response of tumors to treatment Neuroradiology 43 169–177

    Google Scholar 

  • CM Segebarth DF Baleriaux DL Arnold PR Luyten JA Hollander Particleden (1987) ArticleTitleMR image-guided P-31 MR spectroscopy in the evaluation of brain tumor treatment Radiology 165 215–219

    Google Scholar 

  • R Lai MK Rosenblum LM DeAngelis (2002) ArticleTitlePrimary CNS lymphoma–A whole-brain disease? Neurology 59 1557–1562

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurology, Feinberg School of Medicine, Northwestern University, Abbott Hall, Room 1123, 710 North Lake Shore Drive, Chicago, IL, USA, 60611

    J. J. Raizer

  2. Department of Medical Physics, Radiology and Medicine, Memorial Sloan-Kettering Cancer Center, USA

    J. A. Koutcher

  3. Department of Neurology, Memorial Sloan-Kettering Cancer Center, USA

    L. E. Abrey & L. M. DeAngelis

  4. Department of Biostatistics, Memorial Sloan-Kettering Cancer Center, USA

    K. S. Panageas

  5. Department of Radiology, Memorial Sloan-Kettering Cancer Center, USA

    E. Lis

  6. Unit on Magnetic Resonance Spectroscopy, National Institute of Mental Health, USA

    S. Xu

  7. Department of Radiology and Medicine, Memorial Sloan-Kettering Cancer Center, USA

    K. L. Zakian

Authors
  1. J. J. Raizer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. A. Koutcher
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. L. E. Abrey
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. K. S. Panageas
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. L. M. DeAngelis
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. E. Lis
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. S. Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. K. L. Zakian
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J. J. Raizer.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Raizer, J.J., Koutcher, J.A., Abrey, L.E. et al. Proton magnetic resonance spectroscopy in immunocompetent patients with primary central nervous system lymphoma. J Neurooncol 71, 173–180 (2005). https://doi.org/10.1007/s11060-004-1360-8

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11060-004-1360-8

Keywords

Search

Navigation