title: Magnetic resonance spectroscopic detection of lactate is predictive of a poor prognosis in patients with diffuse intrinsic pontine glioma.
abstract: Diffuse brainstem glioma has a poor prognosis, and there are few long-term survivors. We looked for clinical, conventional magnetic resonance (MR), and MR spectroscopic (MRS) findings predictive of the prognosis of patients with brainstem glioma. Our institutional review board approved this retrospective study of 23 patients with diffuse intrinsic pontine or diffuse medullary brainstem glioma treated during the period 2000-2009. To evaluate prognostic values, we performed a Kaplan-Meier survival analysis (log-rank test) that incorporated the patients' age and sex, symptom duration, the presence or absence of cranial nerve palsy, long tract sign, ataxia, and cysts, the chemotherapeutic regimen, Gd enhancement, longitudinal and cerebellar extension, basilar artery encasement, and MRS parameters. Of the 23 diffuse brainstem gliomas, 19 were located at the pons (ratio of male to female patients, 1.1:1). The mean age of the 23 patients was 15.9 years (range, 4-50 years); 16 were aged <20 years. The duration of overall survival was 19.7 months; in patients with diffuse intrinsic pontine glioma, it was 16.6 months, and in patients aged <20 years, it was 11.8 months. Clinical and conventional MR findings at presentation were not predictive of the prognosis in children with diffuse intrinsic pontine glioma. In addition, a patient age <20 years and the detection of lactate by MRS were poor prognostic factors. The MRS detection of lactate is a prognostic factor in patients with diffuse intrinsic pontine glioma. Additional studies of larger patient populations using other imaging modalities are needed.
authors.affiliation: Department of Neurosurgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.
authors.forename: Fumiyuki
authors.initials: F
authors.lastname: Yamasaki
authors.forename: Kaoru
authors.initials: K
authors.lastname: Kurisu
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Kajiwara
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Watanabe
authors.forename: Takeshi
authors.initials: T
authors.lastname: Takayasu
authors.forename: Yuji
authors.initials: Y
authors.lastname: Akiyama
authors.forename: Taiichi
authors.initials: T
authors.lastname: Saito
authors.forename: Ryosuke
authors.initials: R
authors.lastname: Hanaya
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Sugiyama
mesh_terms: D000293:Adolescent; D000328:Adult; D020295:Brain Stem Neoplasms / Q000175:diagnosis* / Q000378:metabolism* / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D019344:Lactic Acid / Q000378:metabolism*; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D008875:Middle Aged; D011149:Pons; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D055815:Young Adult
chemical_list: D019344:Lactic Acid