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1H-MRS is useful to reinforce the suspicion of primary central nervous system lymphoma prior to surgery

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Abstract

Objectives

To assess whether 1H-MRS may be useful to reinforce the radiological suspicion of PCNSL.

Methods

In this retrospective study, we included 546 patients with untreated brain tumours in which single-voxel spectroscopy at TE 30 ms and 136 ms had been performed. The patients were split into two subgroups: “training set” and “test set.” Differences between PCNSL and five other types of intracranial tumours were assessed in the test set of patients using the Mann-Whitney U nonparametric test and cut-off values for pair-wise comparisons defined by constructing receiver operating characteristic curves. These thresholds were used to construct classifiers for binary comparison between PCNSL and non-PCNSL. The performance of the obtained classifiers was assessed in the independent test set of patients.

Results

Significant differences were found between PCNSL and the other groups evaluated. All bilateral comparisons performed in the test set obtained accuracy values above 70 % (71–89 %). Lipids were found to be useful to discriminate between PCNSL and glioblastoma/metastasis at short TE. Myo-inositol resonance was found to be very consistent for discriminating between PCNSL and astrocytomas at short TE.

Conclusions

1H-MRS is useful to reinforce diagnostic suspicion of PCNSL on MRI.

Key Points

• 1 H-MRS can be used to reinforce the diagnostic suspicion of PCNSL.

• Lipids can be used to discriminate between PCNSL and GB/MET.

• Myo-inositol resonance can be used to discriminate between PCNSL and astrocytomas.

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Abbreviations

PCNSL:

Primary central nervous system lymphoma

MEN:

Meningioma

LGA:

Low-grade astrocytoma

AA:

Anaplastic astrocytoma

GB:

Glioblastoma

MET:

Metastases

Glx:

Glutamate/glutamine

ALA:

Alanine

TAU:

Taurine

Cr:

Creatine

Cho:

Choline

mIns:

Myo-inositol

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Acknowledgments

The scientific guarantor of this publication is Carlos Majós MD, PhD. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. This study has received funding in part by MARESCAN (Ministerio de Educación y Ciencia SAF 2011-23870), and by CIBER-BBN, which is an initiative funded by the VI National R&D&I Plan 2008–2011, Iniciativa Ingenio 2010, Consolider Program, CIBER Actions, and financed by the Instituto de Salud Carlos III, with assistance from the European Regional Development Fund, Spain. One of the authors has significant statistical expertise. This retrospective study was included in a research project that had local ethics committee approval. Written informed consent for routine MR imaging studies was obtained from all patients in this study. Some study subjects or cohorts have been previously reported in:

Majós C, Julià-Sapé M, Alonso J, et al. (2004) Brain Tumor Classification by Proton MR Spectroscopy: Comparison of Diagnostic Accuracy at Short and Long TE. AJNR Am J Neuroradiol 25:1696-1704

Majós C, Aguilera C, Alonso J, et al. (2009) Proton MR Spectroscopy Improves Discrimination between Tumor and Pseudotumoral Lesion in Solid Brain Masses. AJNR Am J Neuroradiol 30: 544-551

Majós C, Aguilera C, Cos M, et al. (2009) In vivo proton magnetic resonance spectroscopy of intraventricular tumours of the brain. Eur Radiol 19:2049-2059

Majós C, Bruna J, Julià-Sapé M, et al. (2011) Proton MR Spectroscopy Provides Relevant Prognostic Information in High-Grade Astrocytomas. AJNR Am J Neuroradiol 32:74-80

Methodology: retrospective diagnostic or prognostic study, performed at one institution.

Author information

Authors and Affiliations

  1. Department of Radiology, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Spain

    Paloma Mora, Paloma Mora & Amadeo Muntané

  2. Department of Radiology, Institut de Diagnòstic per la Imatge (IDI), Centre Bellvitge, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Spain

    Carles Majós, Sara Castañer, Juan J. Sánchez & Carles Aguilera

  3. Centro de Investigación en Red en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Cerdanyola del Vallès, Spain

    Carles Majós, Carles Aguilera & Carles Arús

  4. Department of Neurosurgery, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Spain

    Andreu Gabarrós

  5. Department de Bioquímica i Biologia Molecular, Unitat de Bioquímica de Biociències, Universitat Autònoma de Barcelona, Cerdanyola del Vallés, Spain

    Carles Arús

  6. Institut de Biotecnologia i de Biomedicina, Universitat Autònoma de Barcelona, Edifici C, 08193, Cerdanyola del Vallès, Spain

    Carles Arús

Authors
  1. Paloma Mora
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  2. Carles Majós
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  3. Sara Castañer
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  4. Juan J. Sánchez
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  7. Carles Aguilera
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Corresponding author

Correspondence to Paloma Mora.

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Mora, P., Majós, C., Castañer, S. et al. 1H-MRS is useful to reinforce the suspicion of primary central nervous system lymphoma prior to surgery. Eur Radiol 24, 2895–2905 (2014). https://doi.org/10.1007/s00330-014-3308-5

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  • DOI: https://doi.org/10.1007/s00330-014-3308-5

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