title: Quantitative proton magnetic resonance spectroscopy of focal brain lesions.
abstract: The diagnostic value of single-voxel proton magnetic resonance spectroscopy (2 T, stimulated echo acquisition mode, TR = 6,000 ms, TE = 20 ms, 4-5 mL volumes-of-interest) was assessed for a differentiation of focal brain lesions of unknown etiology in 17 patients 1-14 years of age. Absolute metabolite concentrations were compared with age-matched control subjects and an individual control region. Most of the brain tumors were characterized by strongly reduced total N-acetylaspartyl compounds and marked increases of myo-inositol and choline-containing compounds, consistent with a lack of neuroaxonal tissue and a proliferation of glial cells. Lactate was elevated in only four patients. When using this pattern for a metabolic discrimination of brain tumors from other focal lesions, proton spectroscopy correctly identified 14 of 17 abnormalities, as confirmed by histologic examination after neurosurgical intervention. One false-positive tumor diagnosis was a severe reactive gliosis mimicking a typical tumor spectrum. Two inconclusive cases comprised an astrocytoma with moderately elevated myo-inositol but reduced choline-containing compounds and a patient with an abscess leading to a marked reduction of all metabolites but strong contributions from mobile lipids. In summary, quantitative proton spectroscopy has considerable clinical value for preoperative characterization of focal brain lesions.
authors.affiliation: Abteilung Kinderheilkunde, Schwerpunkt Neuropädiatrie, Göttingen, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Wilken
authors.forename: P
authors.initials: P
authors.lastname: Dechent
authors.forename: J
authors.initials: J
authors.lastname: Herms
authors.forename: C
authors.initials: C
authors.lastname: Maxton
authors.forename: E
authors.initials: E
authors.lastname: Markakis
authors.forename: F
authors.initials: F
authors.lastname: Hanefeld
authors.forename: J
authors.initials: J
authors.lastname: Frahm
mesh_terms: D000293:Adolescent; D001224:Aspartic Acid / Q000031:analogs & derivatives / Q000378:metabolism; D014408:Biomarkers, Tumor / Q000032:analysis / Q000378:metabolism*; D001921:Brain / Q000378:metabolism* / Q000473:pathology*; D001922:Brain Abscess / Q000175:diagnosis / Q000378:metabolism; D001927:Brain Diseases / Q000175:diagnosis* / Q000209:etiology / Q000378:metabolism*; D001932:Brain Neoplasms / Q000175:diagnosis / Q000378:metabolism; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D002794:Choline / Q000031:analogs & derivatives / Q000378:metabolism; D003401:Creatine / Q000031:analogs & derivatives / Q000378:metabolism; D003937:Diagnosis, Differential; D005260:Female; D005910:Glioma / Q000175:diagnosis / Q000378:metabolism; D005911:Gliosis / Q000175:diagnosis / Q000378:metabolism; D006801:Humans; D007223:Infant; D007294:Inositol / Q000378:metabolism; D019344:Lactic Acid / Q000378:metabolism; D009682:Magnetic Resonance Spectroscopy / Q000379:methods; D008297:Male; D009103:Multiple Sclerosis / Q000175:diagnosis / Q000378:metabolism; D011237:Predictive Value of Tests
chemical_list: D014408:Biomarkers, Tumor; D001224:Aspartic Acid; D019344:Lactic Acid; D007294:Inositol; D003401:Creatine; D002794:Choline