title: Clinical value of proton magnetic resonance spectroscopy for differentiating recurrent or residual brain tumor from delayed cerebral necrosis.
abstract: OBJECTIVE
  Delayed cerebral necrosis (DN) is a significant risk for brain tumor patients treated with high-dose irradiation. Although differentiating DN from tumor progression is an important clinical question, the distinction cannot be made reliably by conventional imaging techniques. We undertook a pilot study to assess the ability of proton magnetic resonance spectroscopy (1H MRS) to differentiate prospectively between DN or recurrent/residual tumor in a series of children treated for primary brain tumors with high-dose irradiation.
  
  
  METHODS
  Twelve children (ages 3-16 years), who had clinical and MR imaging (MRI) changes that suggested a diagnosis of either DN or progressive/recurrent brain tumor, underwent localized 1H MRS prior to planned biopsy, resection, or other confirmatory histological procedure. Prospective 1H MRS interpretations were based on comparison of spectral peak patterns and quantitative peak area values from normalized spectra: a marked depression of the intracellular metabolite peaks from choline, creatine, and N-acetyl compounds was hypothesized to indicate DN, and median-to-high choline with easily visible creatine metabolite peaks was labeled progressive/recurrent tumor. Subsequent histological studies identified the brain lesion as DN or recurrent/residual tumor.
  
  
  RESULTS
  The patient series included five cases of DN and seven recurrent/residual tumor cases, based on histology. The MRS criteria prospectively identified five out of seven patients with active tumor, and four out of five patients with histologically proven DN correctly. Discriminant analysis suggested that the primary diagnostic information for differentiating DN from tumor lay in the normalized MRS peak areas for choline and creatine compounds.
  
  
  CONCLUSIONS
  Magnetic resonance spectroscopy shows promising sensitivity and selectivity for differentiating DN from recurrent/progressive brain tumor. A novel diagnostic index based on peak areas for choline and creatine compounds may provide a simple discriminant for differentiating DN from recurrent or residual primary brain tumors.
authors.affiliation: Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, TN 38105-2794, USA.
authors.forename: J S
authors.initials: JS
authors.lastname: Taylor
authors.forename: J W
authors.initials: JW
authors.lastname: Langston
authors.forename: W E
authors.initials: WE
authors.lastname: Reddick
authors.forename: P B
authors.initials: PB
authors.lastname: Kingsley
authors.forename: R J
authors.initials: RJ
authors.lastname: Ogg
authors.forename: M H
authors.initials: MH
authors.lastname: Pui
authors.forename: L E
authors.initials: LE
authors.lastname: Kun
authors.forename: J J
authors.initials: JJ
authors.lastname: Jenkins
authors.forename: G
authors.initials: G
authors.lastname: Chen
authors.forename: J J
authors.initials: JJ
authors.lastname: Ochs
authors.forename: R A
authors.initials: RA
authors.lastname: Sanford
authors.forename: R L
authors.initials: RL
authors.lastname: Heideman
mesh_terms: D000293:Adolescent; D001921:Brain / Q000473:pathology*; D001932:Brain Neoplasms / Q000175:diagnosis* / Q000532:radiotherapy; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D009336:Necrosis; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis*; D018365:Neoplasm, Residual; D011878:Radiotherapy / Q000009:adverse effects*; D012680:Sensitivity and Specificity