Magnetic resonance spectroscopy of atypical diffuse pontine masses.
OBJECTIVE
Diffuse pontine gliomas in children carry a dismal prognosis, with a mean survival of less than 1 year despite therapy. The diagnosis is based on the characteristic changes demonstrated on traditional magnetic resonance (MR) imaging. A few typically MR imaging-appearing pontine masses, however, do not behave in the expected fashion, which calls the original diagnosis into question.


METHODS
The authors conducted a retrospective review of data obtained in 42 children (age 6 months-13 years) in whom diffuse pontine glioma had been diagnosed at their institution. Five of these patients (12%) survived longer than expected (> 18 months). There were no differences in these patients in terms of demographics, presentation, traditional imaging findings, or treatment compared with the group as a whole. Magnetic resonance spectroscopy, however, demonstrated two distinct patterns not seen in typical diffuse pontine gliomas. In two patients elevated lipid and lactate levels were shown, with decreased levels of choline, myoinositol, and N-acetyl-aspartate (NAA). In the other patients strikingly elevated choline/creatinine ratios and myoinositol levels were observed in comparison with typical pontine tumors.


CONCLUSIONS
These MR spectroscopy patterns demonstrated in this retrospective study seem to convey prognostic information and may lead to an expansion of this diagnostic tool.
Krieger
Mark D
MD
Division of Neurosurgery, and Department of Radiology, Childrens Hospital Los Angeles, Los Angeles, California, USA. mkrieger@chla.usc.edu
Blüml
Stefan
S
McComb
J Gordon
JG
D000293:Adolescent; D020295:Brain Stem Neoplasms / Q000175:diagnosis* / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D005260:Female; D005910:Glioma / Q000175:diagnosis* / Q000401:mortality; D006801:Humans; D007223:Infant; D009682:Magnetic Resonance Spectroscopy / Q000379:methods*; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate