Ll. Wald et al., SERIAL PROTON MAGNETIC-RESONANCE SPECTROSCOPY IMAGING OF GLIOBLASTOMA-MULTIFORME AFTER BRACHYTHERAPY, Journal of neurosurgery, 87(4), 1997, pp. 525-534
The utility of three-dimensional (3-D) proton magnetic resonance spect
roscopy (H-1-MRS) imaging for detecting metabolic changes after brain
tumor therapy was assessed in a serial study of 58 total examinations
of 12 patients with glioblastoma multiforme (GBM) who received brachyt
herapy. Individual proton spectra from the 3-D array of spectra encomp
assing the lesion showed dramatic differences in spectral patterns ind
icative of radiation necrosis, recurrent or residual tumor, or normal
brain. The H-1-MRS imaging data demonstrated significant differences b
etween suspected residual or recurrent tumor and contrast-enhancing ra
diation-induced necrosis. Regions of abnormally high choline (Cho) lev
els, consistent with viable tumor, were detected beyond the regions of
contrast enhancement for all 12 gliomas. Changes in the serial H-1-MR
S imaging data were observed, reflecting an altered metabolism followi
ng treatment. These changes included the significant reduction in Cho
levels after therapy, indicating the transformation of tumor to necrot
ic tissue. For patients who demonstrated subsequent clinical progressi
on, an increase in Cho levels was observed in regions that previously
appeared either normal or necrotic. Several patients showed regional v
ariations in response to brachytherapy as evaluated by H-1-MRS imaging
. This study demonstrates the potential of noninvasive 3-D H-1-MRS ima
ging to discriminate between the formation of contrast-enhancing radia
tion necrosis and residual or recurrent tumor following brachytherapy.
This modality may also allow better definition of tumor extent prior
to brachytherapy by detecting the presence of abnormal metabolite leve
ls in nonenhancing regions of solid tumor.