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Brain spectroscopy to assist in tumor evaluation

Case Study
Jissendi Tchofo, Patrice, MD Brussels, Erasme Hospital Belgium
de Kok, Wendy Philips Healthcare Philips Global

Patient history:

A 9-year-old female patient was referred to ULB Erasme in Brussels, Belgium, for an MR-examination of the brain.

 

The conventional MR-images revealed a tumor located in the fourth ventricle. MR-spectroscopy was performed to assist in the evaluation of the space-occupying lesion.

MR examination:

The examination was performed on a 3.0T Achieva scanner.

The 8-channel SENSE Head coil was used for imaging.

 

The comprehensive brain examination consisted of:

  • sagittal T1-weighted FFE
  • axial T2-weighted TSE
  • axial T2-weighted FLAIR
  • axial T1-weighted SE
  • axial SSh-diffusion weighted sequence with high SENSE reduction factor
  • T1-weighted 3D FFE sequence, after contrast injection

 

The images revealed a space-occupying lesion, originating from the fourth ventricle.

sagittal T1W_FFE 30 slices 4.0 mm, pixel size 0.6x0.75 mm, TR/TE 323/4.6 ms, scan time 3:28 min.Axial T2W_TSE 34 slices 4.0 mm, pixel size 0.6x0.75 mm, TR/TE 4000/80 ms, scan time 2:24 min.Axial SSh_DWI 60 slices 2.5 mm, pixel size 2.0x2.0 mm, TE 62 ms, b=1000, SENSE factor 3, scan time 1:39 min.
sagittal T1W_FFE
Axial T2W_TSE
Axial SSh_DWI
30 slices 4.0 mm, pixel size 0.6x0.75 mm, TR/TE 323/4.6 ms, scan time 3:28 min.
34 slices 4.0 mm, pixel size 0.6x0.75 mm, TR/TE 4000/80 ms, scan time 2:24 min.
60 slices 2.5 mm, pixel size 2.0x2.0 mm, TE 62 ms, b=1000, SENSE factor 3, scan time 1:39 min.

 

Based on the morphology in the images, and on the patient's history, the space-occupying was diagnosed to be probably an ependymoma or maybe a medulloblastoma.

 

Contrast agent was injected, after which a T1-weighted 3D-FFE sequence was performed, to study the enhancement behaviour of the lesion:

 

T1W_3D_FFE 130 slices 1.3 mm, pixel size 1.0x1.0 mm, TR/TE 25/2.1 ms, SENSE factor 2, scan time 3:21 min
T1W_3D_FFE
130 slices 1.3 mm, pixel size 1.0x1.0 mm, TR/TE 25/2.1 ms, SENSE factor 2, scan time 3:21 min

 

A nodular and slightly irregular enhancement pattern was detected. Part of the lesion showed strong enhancement.

 

It was decided to perform MR-spectroscopy to assist in the evaluation of the tumor.

MR spectroscopy examination:

The patient was repositioned in the T/R-Head coil for improved volume definition in spectroscopy.

A survey and a fast T2-weighted TSE in the axial plane were acquired, after which a single voxel spectroscopy scan was planned. (Selected preset procedure: Head_CNS/Brain/1VOI_30_exc):

 

  • PRESS volume size ~ 21 x 23 x 24 mm to fit in the lesion
  • repetition time 2000 ms, for sufficient T1-relaxation
  • echo time = 30 ms, for visualisation of short-T2 metabolites
  • Bandwidth 2000 Hz, nr. of samples 1024 (zerofilled to 2048) = spectral resolution ~ 2 Hz
  • 128 measurements: scan time = 4:55 min

 

The spectrum was processed using SpectroView:

SVS, TE = 30 ms
SVS, TE = 30 ms

 

The screen capture of the processed spectrum shows that the NAA-level is reduced and lactate/lipids are present. The choline/creatine ratio is slightly increased.

Increased signal is seen at 3.45 ppm, probably caused by a rise of taurine.

 

Script parameters:

  • initial baseline subtraction = no
  • analysis range = 4.35 - -1.0 ppm
  • baseline terms = 5
  • Gaussian percentage = 90
  • real signal aspect
  • lock relative frequencies / widths = no

Diagnosis:

Diagnosis was made on the outcome of both conventional MRI findings and MR spectroscopy findings.

 

Based on the finding of increased signal at 3.45 ppm, probably due to taurine, it was most likely that the space-occupying lesion was a medulloblastoma.

 

The post-operative diagnosis was medulloblastoma.



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Mar 2, 2006

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Case Study
Achieva 3.0T
Release 1
Quasar Dual
Brain, Neuro, Spectroscopy
 

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