Format

Send to

Choose Destination
World Neurosurg. 2019 Mar 13. pii: S1878-8750(19)30667-9. doi: 10.1016/j.wneu.2019.03.041. [Epub ahead of print]

Results of 31-P-MR-spectroscopy for brain metastases correlates with histopathological results.

Author information

1
Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria. Electronic address: johannes.kerschbaumer@tirol-kliniken.at.
2
Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria.
3
Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria.
4
Institute of Neurology, Medical University Vienna, Vienna, Austria.
5
Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Innsbruck, Austria.

Abstract

BACKGROUND:

Brain metastases (BM) are classically well-circumscribed lesions. Still, the amount of edema in these neoplasms suggested either mechanisms of infiltration or defense. A better understanding of the mechanisms within the edema of BM seems reasonable, to preoperatively identify areas of potential infiltration and resect them.

AIM:

BM represent tumors with high energy-demand and cell-turnover, therefore they qualify for preoperative investigation with 31-Phosphorus-MR-Spectroscopy (31PMRS), revealing information about those characteristics.

METHODS:

10 patients with BMs were included in this trial. All underwent preoperative standard MRI, with additional 31PMRS. In all patients, one voxel within the contrast-enhancing tumor (CE+), one voxel at the border (including CE+ areas and surrounding T2-hyperintensive (T2+)) and one distant voxel, purely including T2+ areas where determined by a neuroradiologist and a neurosurgeon. A frameless stereotactic biopsy was performed after craniotomy and subsequently, the metabolites of the 31PMRS were analyzed and compared to the histopathological results.

RESULTS:

Ratios, reflecting resynthesis (CE+/border/T2+: 1,109±0,192/1,112±0,158/1,083±0,097), hydrolysis (0,303±0,089/0,360±0,122/0,321±0,089), energy demand (4,227±2,35/3,453±1,284/3,599±0,833) and membrane turnover (1,239±0,2611/3,453±1,284/3,599±0,283 were calculated and compared intra-individual with a voxel from the contralateral side (resynthesis/hydrolysis/energy-demand/membrane-turnover: 1,063±0,085/0,335±0,073/3,317±0,7573/0,784±0,186). Resynthesis showed a trend towards higher ratios in CE+ and border biopsies without reaching statistical significances. This trend was also seen concerning energy-demand. Membrane-turnover was significantly higher in CE+, border zone and also in the T2+ areas compared to the control (p>0,001).

CONCLUSION:

31PMRS in BMs provides information on metabolic changes in tumor and surrounding edema. There is a proof of enhanced metabolism in tissue without histological tumor manifestation.

KEYWORDS:

31-P-MRS; biopsy; brain metastases; infiltration; spectroscopy

PMID:
30878742
DOI:
10.1016/j.wneu.2019.03.041

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center