Proton magnetic resonance spectroscopy imaging in the evaluation of patients undergoing gamma knife surgery for Grade IV glioma

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  • 1 Departments of Radiology, Radiation Oncology, and Neurological Surgery, University of California, San Francisco, California
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Object. The purpose of this study was to assess the differences in spatial extent and metabolic activity in a comparison of a radiosurgical target defined by conventional strategies that utilize the enhancing lesion and a metabolic lesion defined by proton magnetic resonance spectroscopy (MRS) imaging. The authors evaluated whether these differences manifest themselves in the clinical outcome of patients and assessed the value of incorporating 1H-MRS imaging—derived spatial information into the treatment planning process for gamma knife surgery (GKS).

Methods. Twenty-six patients harboring Grade IV gliomas who had previously been treated with external-beam radiation therapy were evaluated by comparing the radiosurgically treated lesion volume with the volume of metabolically active tumor defined on 1H-MRS imaging. The cohort was evenly divided into two groups based on the percentage of overlap between the radiosurgical target and the metabolic lesion volumes. Patients with a percentage of overlap greater than 50% with respect to the metabolic lesion volume were classified as low risk and those with an overlap less than 50% were classified as high risk.

Kaplan—Meier estimators were calculated using time to progression and survival as dependent variables. The metabolite levels within the metabolic lesion were significantly greater than those within the radiosurgical target (p ≤ 0.001). The median survival was 15.7 months for patients in the low-risk group and 10.4 months for those in the highrisk group. This difference was statistically significant (p < 0.01).

Conclusions. Analysis of the results of this study indicates that patients undergoing GKS may benefit from the inclusion of 1H-MRS imaging in the treatment planning process.

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Contributor Notes

Address reprint requests to: Sarah J. Nelson, Dr.rer.nat, Department of Radiology, University of California, San Francisco, 185 Berry Street, Suite 350, San Francisco, California 94107–1739. email: nelson@mrsc.ucsf.edu.
  • 1.

    Alger JR, , Frank JA, & Bizzi A, et al: Metabolism of human gliomas: assessment with H-1 MR spectroscopy and F-18 fluorodeoxyglucose PET. Radiology 177:633641, 1990 Alger JR, Frank JA, Bizzi A, et al: Metabolism of human gliomas: assessment with H-1 MR spectroscopy and F-18 fluorodeoxyglucose PET. Radiology 177:633–641, 1990

    • Search Google Scholar
    • Export Citation
  • 2.

    Coffey RJ, , Lunsford LD, & Flickinger JC: The role of radiosurgery in the treatment of malignant brain tumors. Neurosurg Clin N Am 3:231244, 1992 Coffey RJ, Lunsford LD, Flickinger JC: The role of radiosurgery in the treatment of malignant brain tumors. Neurosurg Clin N Am 3:231–244, 1992

    • Search Google Scholar
    • Export Citation
  • 3.

    Graves EE, , Nelson SJ, & Vigneron DB, et al: A preliminary study of the prognostic value of proton magnetic resonance spectroscopic imaging in gamma knife radiosurgery of recurrent malignant gliomas. Neurosurgery 46:319328, 2000 Graves EE, Nelson SJ, Vigneron DB, et al: A preliminary study of the prognostic value of proton magnetic resonance spectroscopic imaging in gamma knife radiosurgery of recurrent malignant gliomas. Neurosurgery 46:319–328, 2000

    • Search Google Scholar
    • Export Citation
  • 4.

    Gross MW, , Weber WA, & Feldmann HJ, et al: The value of F-18-fluorodeoxyglucose PET for the 3-D radiation treatment planning of malignant gliomas. Int J Radiat Oncol Biol Phys 41:989995, 1998 Gross MW, Weber WA, Feldmann HJ, et al: The value of F-18-fluorodeoxyglucose PET for the 3-D radiation treatment planning of malignant gliomas. Int J Radiat Oncol Biol Phys 41:989–995, 1998

    • Search Google Scholar
    • Export Citation
  • 5.

    Grosu AL, , Feldmann H, & Dick S, et al: Implications of IMT-SPECT for postoperative radiotherapy planning in patients with gliomas. Int J Radiat Oncol Biol Phys 54:842854, 2002 Grosu AL, Feldmann H, Dick S, et al: Implications of IMT-SPECT for postoperative radiotherapy planning in patients with gliomas. Int J Radiat Oncol Biol Phys 54:842–854, 2002

    • Search Google Scholar
    • Export Citation
  • 6.

    Grosu AL, , Weber W, & Feldman HJ, et al: First experience with I-123-alpha-methyl-tyrosine SPECT in the 3-D radiation treatment planning of brain gliomas. Int J Radiat Oncol Biol Phys 47:517526, 2000 Grosu AL, Weber W, Feldman HJ, et al: First experience with I-123-alpha-methyl-tyrosine SPECT in the 3-D radiation treatment planning of brain gliomas. Int J Radiat Oncol Biol Phys 47:517–526, 2000

    • Search Google Scholar
    • Export Citation
  • 7.

    Kelly PJ, , Daumas-Duport C, & Kispert DB, et al: Imaging-based stereotaxic serial biopsies in untreated intracranial glial neoplasms. J Neurosurg 66:865874, 1987 Kelly PJ, Daumas-Duport C, Kispert DB, et al: Imaging-based stereotaxic serial biopsies in untreated intracranial glial neoplasms. J Neurosurg 66:865–874, 1987

    • Search Google Scholar
    • Export Citation
  • 8.

    Kelly PJ, , Daumas-Duport C, & Scheithauer BW, et al: Stereotactic histologic correlations of computed tomography- and magnetic resonance imaging-defined abnormalities in patients with glial neoplasms. Mayo Clin Proc 62:450459, 1987 Kelly PJ, Daumas-Duport C, Scheithauer BW, et al: Stereotactic histologic correlations of computed tomography- and magnetic resonance imaging-defined abnormalities in patients with glial neoplasms. Mayo Clin Proc 62:450–459, 1987

    • Search Google Scholar
    • Export Citation
  • 9.

    Kleihues P, , Burger PC, & Scheithauer BW: The new WHO classification of brain tumours. Brain Pathol 3:255268, 1993 Kleihues P, Burger PC, Scheithauer BW: The new WHO classification of brain tumours. Brain Pathol 3:255–268, 1993

    • Search Google Scholar
    • Export Citation
  • 10.

    Larson DA: Radiation therapy and radiosurgery for brain tumors, in Youmans JR (ed): Neurological Surgery. Philadelphia: Saunders, 1996, p 2913 Larson DA: Radiation therapy and radiosurgery for brain tumors, in Youmans JR (ed): Neurological Surgery. Philadelphia: Saunders, 1996, p 2913

    • Search Google Scholar
    • Export Citation
  • 11.

    Larson DA, , Gutin PH, & McDermott M, et al: Gamma knife for glioma: selection factors and survival. Int J Radiat Oncol Biol Phys 36:10451053, 1996 Larson DA, Gutin PH, McDermott M, et al: Gamma knife for glioma: selection factors and survival. Int J Radiat Oncol Biol Phys 36:1045–1053, 1996

    • Search Google Scholar
    • Export Citation
  • 12.

    Levivier M, , Wikler D Jr, & Massager N, et al: The integration of metabolic imaging in stereotactic procedures including radiosurgery: a review. J Neurosurg 97 (Suppl 5):542550, 2002 Levivier M, Wikler D Jr, Massager N, et al: The integration of metabolic imaging in stereotactic procedures including radiosurgery: a review. J Neurosurg 97 (Suppl 5):542–550, 2002

    • Search Google Scholar
    • Export Citation
  • 13.

    McKnight TR, , Noworolski SM, & Vigneron DB, et al: An automated technique for the quantitative assessment of 3D-MRSI data from patients with glioma. J Magn Reson Imaging 13:167177, 2001 McKnight TR, Noworolski SM, Vigneron DB, et al: An automated technique for the quantitative assessment of 3D-MRSI data from patients with glioma. J Magn Reson Imaging 13:167–177, 2001

    • Search Google Scholar
    • Export Citation
  • 14.

    McKnight TR, , von dem Bussche MH, & Vigneron DB, et al: Histopathological validation of a three-dimensional magnetic resonance spectroscopy index as a predictor of tumor presence. J Neurosurg 97:794802, 2002 McKnight TR, von dem Bussche MH, Vigneron DB, et al: Histopathological validation of a three-dimensional magnetic resonance spectroscopy index as a predictor of tumor presence. J Neurosurg 97:794–802, 2002

    • Search Google Scholar
    • Export Citation
  • 15.

    Nakamura JL, , Verhey LJ, & Smith V, et al: Dose conformity of gamma knife radiosurgery and risk factors for complications. Int J Radiat Oncol Biol Phys 51:13131319, 2001 Nakamura JL, Verhey LJ, Smith V, et al: Dose conformity of gamma knife radiosurgery and risk factors for complications. Int J Radiat Oncol Biol Phys 51:1313–1319, 2001

    • Search Google Scholar
    • Export Citation
  • 16.

    Negendank WG, , Sauter R, & Brown TR, et al: Proton magnetic resonance spectroscopy in patients with glial tumors: a multicenter study. J Neurosurg 84:449458, 1996 Negendank WG, Sauter R, Brown TR, et al: Proton magnetic resonance spectroscopy in patients with glial tumors: a multicenter study. J Neurosurg 84:449–458, 1996

    • Search Google Scholar
    • Export Citation
  • 17.

    Nelson SJ: Analysis of volume MRI and MR spectroscopic imaging data for the evaluation of patients with brain tumors. Magn Reson Med 46:228239, 2001 Nelson SJ: Analysis of volume MRI and MR spectroscopic imaging data for the evaluation of patients with brain tumors. Magn Reson Med 46:228–239, 2001

    • Search Google Scholar
    • Export Citation
  • 18.

    Nelson SJ, , Graves E, & Pirzkall A, et al: In vivo molecular imaging for planning radiation therapy of gliomas: an application of 1H MRSI. J Magn Reson Imaging 16:464476, 2002 Nelson SJ, Graves E, Pirzkall A, et al: In vivo molecular imaging for planning radiation therapy of gliomas: an application of 1H MRSI. J Magn Reson Imaging 16:464–476, 2002

    • Search Google Scholar
    • Export Citation
  • 19.

    Nelson SJ, , Nalbandian AB, & Proctor E, et al: Registration of images from sequential MR studies of the brain. J Magn Reson Imaging 4:877883, 1994 Nelson SJ, Nalbandian AB, Proctor E, et al: Registration of images from sequential MR studies of the brain. J Magn Reson Imaging 4:877–883, 1994

    • Search Google Scholar
    • Export Citation
  • 20.

    Nelson SJ, , Vigneron DB, & Dillon WP: Serial evaluation of patients with brain tumors using volume MRI and 3D 1H MRSI. NMR Biomed 12:123138, 1999 Nelson SJ, Vigneron DB, Dillon WP: Serial evaluation of patients with brain tumors using volume MRI and 3D 1H MRSI. NMR Biomed 12:123–138, 1999

    • Search Google Scholar
    • Export Citation
  • 21.

    Nwokedi EC, , DiBiase SJ, & Jabbour S, et al: Gamma knife stereotactic radiosurgery for patients with glioblastoma multiforme. Neurosurgery 50:4147, 2002 Nwokedi EC, DiBiase SJ, Jabbour S, et al: Gamma knife stereotactic radiosurgery for patients with glioblastoma multiforme. Neurosurgery 50:41–47, 2002

    • Search Google Scholar
    • Export Citation
  • 22.

    Pirzkall A, , McKnight TR, & Graves EE, et al: MR-spectroscopy guided target delineation for high-grade gliomas. Int J Radiat Oncol Biol Phys 50:915928, 2001 Pirzkall A, McKnight TR, Graves EE, et al: MR-spectroscopy guided target delineation for high-grade gliomas. Int J Radiat Oncol Biol Phys 50:915–928, 2001

    • Search Google Scholar
    • Export Citation
  • 23.

    Segebarth CM, , Baleriaux DF, & Luyten PR, et al: Detection of metabolic heterogeneity of human intracranial tumors in vivo by 1H NMR spectroscopic imaging. Magn Reson Med 13:6276, 1990 Segebarth CM, Baleriaux DF, Luyten PR, et al: Detection of metabolic heterogeneity of human intracranial tumors in vivo by 1H NMR spectroscopic imaging. Magn Reson Med 13:62–76, 1990

    • Search Google Scholar
    • Export Citation
  • 24.

    Simmons ML, , Frondoza CG, & Coyle JT: Immunocytochemical localization of N-acetyl-aspartate with monoclonal antibodies. Neuroscience 45:3745, 1991 Simmons ML, Frondoza CG, Coyle JT: Immunocytochemical localization of N-acetyl-aspartate with monoclonal antibodies. Neuroscience 45:37–45, 1991

    • Search Google Scholar
    • Export Citation
  • 25.

    Star-Lack J, , Vigneron DB, & Pauly J, et al: Improved solvent suppression and increased spatial excitation bandwidths for three-dimensional PRESS CSI using phase-compensating spectral/spatial spin-echo pulses. J Magn Reson Imaging 7:745757, 1997 Star-Lack J, Vigneron DB, Pauly J, et al: Improved solvent suppression and increased spatial excitation bandwidths for three-dimensional PRESS CSI using phase-compensating spectral/spatial spin-echo pulses. J Magn Reson Imaging 7:745–757, 1997

    • Search Google Scholar
    • Export Citation
  • 26.

    Tran TK, , Vigneron DB, & Sailasuta N, et al: Very selective suppression pulses for clinical MRSI studies of brain and prostate cancer. Magn Reson Med 43:2333, 2000 Tran TK, Vigneron DB, Sailasuta N, et al: Very selective suppression pulses for clinical MRSI studies of brain and prostate cancer. Magn Reson Med 43:23–33, 2000

    • Search Google Scholar
    • Export Citation

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