title: Proton magnetic resonance chemical shift imaging (1H CSI)-directed stereotactic biopsy.
abstract: BACKGROUND
  To add metabolic information during stereotactic biopsy target selection, the authors adopted proton chemical shift imaging (1H CSI)-directed stereotactic biopsy. Currently, proton single voxel spectroscopy (SVS) technique has been reported in stereotactic biopsy. We performed 1H CSI in combination with a stereotactic headframe and selected targets according to local metabolic information, and evaluated the pathological results.
  
  
  METHODS
  The 1H CSI-directed stereotactic biopsy was performed in four patients. 1H CSI and conventional Gd-enhancement stereotactic MRI were performed simultaneously after the fitting of a stereotactic frame. After reconstructing the metabolic maps of N-acetylaspartate (NAA)/phosphocreatine (Cr), phosphocholine (Cho)/Cr, and Lactate/Cr ratios, focal areas of increased Cho/Cr ratio and Lac/Cr ratios were selected as target sites in the stereotactic MR images.
  
  
  RESULTS
  1H CSI is possible with the stereotactic headframe in place. No difficulty was experienced performing 1H CSI or making a diagnosis. Pathological samples taken from areas of increased Cho/Cr ratios and decreased NAA/Cr ratios provided information upon increased cellularity, mitoses and cellular atypism, and facilitated diagnosis. Pathological samples taken from areas of increased Lac/Cr ratio showed predominant feature of necrosis.
  
  
  CONCLUSIONS
  1H CSI was feasible with the stereotactic headframe in place. The final pathological results obtained were concordant with the local metabolic information from 1H CSI. We believe that 1H CSI-directed stereotatic biopsy has the potential to significantly improve the accuracy of stereotactic biopsy targeting.
authors.affiliation: Department of Neurosurgery, Kangnam St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
authors.forename: B C
authors.initials: BC
authors.lastname: Son
authors.forename: M C
authors.initials: MC
authors.lastname: Kim
authors.forename: B G
authors.initials: BG
authors.lastname: Choi
authors.forename: E N
authors.initials: EN
authors.lastname: Kim
authors.forename: H M
authors.initials: HM
authors.lastname: Baik
authors.forename: B Y
authors.initials: BY
authors.lastname: Choe
authors.forename: S
authors.initials: S
authors.lastname: Naruse
authors.forename: J K
authors.initials: JK
authors.lastname: Kang
mesh_terms: D000328:Adult; D001224:Aspartic Acid / Q000031:analogs & derivatives / Q000378:metabolism; D001707:Biopsy, Needle / Q000295:instrumentation*; D001921:Brain / Q000473:pathology; D001932:Brain Neoplasms / Q000473:pathology*; D003401:Creatine / Q000378:metabolism; D003937:Diagnosis, Differential; D004734:Energy Metabolism / Q000502:physiology*; D005260:Female; D005909:Glioblastoma / Q000473:pathology*; D005910:Glioma / Q000473:pathology*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D019344:Lactic Acid / Q000378:metabolism; D008279:Magnetic Resonance Imaging / Q000295:instrumentation*; D009682:Magnetic Resonance Spectroscopy / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D010725:Phosphocreatine / Q000378:metabolism; D010767:Phosphorylcholine / Q000378:metabolism; D013238:Stereotaxic Techniques / Q000295:instrumentation*
chemical_list: D010725:Phosphocreatine; D010767:Phosphorylcholine; D001224:Aspartic Acid; D019344:Lactic Acid; C000179:N-acetylaspartate; D003401:Creatine