Use of proton magnetic resonance spectroscopy of the brain to differentiate gliomatosis cerebri from low-grade glioma.
OBJECTIVE
Gliomatosis cerebri (GC), a rare entity characterized by a widespread infiltration of brain by tumor, lacks objective and quantitative diagnostic criteria. Single-voxel spectroscopy and chemical shift imaging (two-dimensional proton magnetic resonance [MR] spectroscopy) were performed using both short (20- or 22-msec) and long (135-msec) echo times in nine patients suffering from GC, nine patients with low-grade gliomas (LGGs), and 25 healthy volunteers to establish the precise metabolic pattern of this uncommon brain neoplasm.


METHODS
The gliomatosis infiltration was characterized by markedly elevated levels of creatine-phosphocreatine (Cr) and mvo-inositol (Ins), a reduced level of N-acetyl aspartate (NAA), and a moderately elevated level of choline-containing compounds (Cho). This pattern differs strikingly from LGGs, which are characterized by elevated levels of Cho and Ins, markedly reduced levels of NAA, and low-to-normal Cr concentrations. Although the distinction between GC and LGG, based on histological and MR imaging criteria, is a matter of debate, MR spectroscopy produces valuable information for the differentiation between these two entities and, hence, the choice of therapeutic strategy. It also provides new insight into the pathophysiology of GC because elevated Cr and Ins levels may be related to proliferation of glial elements or, more probably, activation of normal glia. Elevated levels of Cho reflect cellular proliferation and reduced NAA corresponds to reversible neuronal injury and/or focal invasion by the tumor process.


CONCLUSIONS
Owing to the unfavorable clinical outcome associated with GC compared with that associated with LGG, the findings of this study illustrate the diagnostic and prognostic value of proton MR spectroscopy in the characterization of infiltrating gliomas.
Galanaud
Damien
D
Centre de Resonance Magnétique Biologique et Médicale, Unité Mixte de Recherche, Centre National de Recherche Scientifique 6612, Faculté de Médecine, Université de la Méditerranée, and Hôpital de La Timone, Marseille, France.
Chinot
Olivier
O
Nicoli
François
F
Confort-Gouny
Sylviane
S
Le Fur
Yann
Y
Barrie-Attarian
Maryline
M
Ranjeva
Jean-Philippe
JP
Fuentès
Stéphane
S
Viout
Patrick
P
Figarella-Branger
Dominique
D
Cozzone
Patrick J
PJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D001921:Brain / Q000378:metabolism* / Q000473:pathology* / Q000503:physiopathology; D001932:Brain Neoplasms / Q000378:metabolism* / Q000473:pathology* / Q000503:physiopathology; D003937:Diagnosis, Differential; D005260:Female; D005910:Glioma / Q000378:metabolism* / Q000473:pathology* / Q000503:physiopathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D008875:Middle Aged; D018302:Neoplasms, Neuroepithelial / Q000378:metabolism* / Q000473:pathology* / Q000503:physiopathology; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013997:Time Factors