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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.

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Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria. Electronic address:
Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria.
Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria.
Institute of Neurology, Medical University Vienna, Vienna, Austria.
Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Innsbruck, Austria.



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.


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.


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.


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).


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.


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


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