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Spectroscopy in glioblastoma

Case Study
Raininko, Raili Uppsala University Hospital Sweden
de Kok, Wendy Philips Healthcare Philips Global

Patient history:

A 54-year-old male patient presented to Uppsala University Hospital with severe headache. An MR-examination was performed.

 

The patient's brain tumor was histologically confirmed to be glioblastoma multiform, a very agressive primary brain tumor. It is highly malignant, can infiltrate the brain extensively and at times, becomes enormous before turning symptomatic.

 

Spectroscopic imaging was performed to assist in determining if the mass lesion was a neoplasm or an abcess and to evaluate if there were neoplastic tissue outside the enhancing area.

 

MR examination:

At Uppsala University Hospital, a routine brain examination in case of tumor pathology contains T1-weighted spin echo sequences in the sagittal and axial planes. These are followed by a T2-weighted FLAIR sequence in the axial plane, and two T2-weighted turbo spin echo sequences in the axial and coronal planes to provide images in all orthogonal directions. 

 

Then, contrast agent is administered. The T1-weighted spin echo sequence is repeated in all three orthogonal directions to detect possible lesion enhancement.

In this case, spectroscopic imaging through one plane of the lesion is also performed.

MR images and interpretation:

sagittal T1W_SE TR 484 ms, TE 14 ms
19 slices 5.0/1.0 mm: full brain coverage.
Scan time 2:50 min
axial T2W_FLAIR TR 11.000 ms, TI 2800 ms, TE 140 ms
25 slices 5.0/0.5 mm
Scan time 1:50 min
coronal T2W_TSE TR 5075 ms, TE 100 ms.
25 slices 5.0/0.5 mm
Scan time 2:02 min
sagittal T1W_SE
axial T2W_FLAIR
coronal T2W_TSE
TR 484 ms, TE 14 ms 19 slices 5.0/1.0 mm: full brain coverage. Scan time 2:50 min
TR 11.000 ms, TI 2800 ms, TE 140 ms 25 slices 5.0/0.5 mm Scan time 1:50 min
TR 5075 ms, TE 100 ms. 25 slices 5.0/0.5 mm Scan time 2:02 min

 

A T1-weighted spin echo sequence is performed in both axial and sagittal plane with full brain coverage. To obtain good T1-weighted contrast, repetition time and echo time are kept short.

A T2-weighted FLAIR sequence is acquired in the axial plane. Repetition time, inversion delay time and echo time are long to obtain very good T2-weighting while signal of CSF is suppressed. The heterogeneity of the lesion is clearly visible.

 

Additionally, two T2-weighted turbo spin echo sequences in both axial and coronal plane are acquired.

A space occupying lesion with a probable necrotic center is detected.

Axial T1W_SE Post-contrast image.Sagittal T1W_SE Post-contrast image.Coronal T1W_SE Post-contrast image.
Axial T1W_SE
Sagittal T1W_SE
Coronal T1W_SE
Post-contrast image.
Post-contrast image.
Post-contrast image.

 

A gadolinium-based contrast agent is administered (0,1 mmoll/kg), after which the T1-weighted spin echo sequence is performed in three orthogonal directions. All images show heterogeneous enhancement of the outer portion of the tumor. The center portion of the tumor doesn't show enhancement.

 

The enhancing mass with a necrotic center was confirmed to be a malignant tumor.

 

Spectroscopic imaging is performed to differentiate between a possible neoplasm and an abcess and to evaluate if there is possible neoplastic tissue outside the enhancing area.

 

 

A spectroscopic image is acquired in the axial plane through the tumor. The echo time used is 144 ms,  which is optimal for lactate detection. The repetition time is 1500 ms.

Spatial resolution is 0.96 x 0.96 x 1.5 cm. Total scan time for this sequence is 14:24 minutes. The spectral resolution is +/- 1 Hz and results in good spectral differentiation.

 

The dataset is processed in SpectroView. Several metabolite maps maps are generated, of which the NAA map and the Cho map are displayed in this screen setting.

An array of spectra is selected for display, positions are corresponding to the marked voxels in the grid display. The spectra show increased choline levels in the solid periphery of the tumor, indicating possible active tumor tissue. NAA is low in the entire lesion. The spectra in the center of the tumor mainly show lactate/lipid signal, related to necrosis.

Note that with this postprocessing all the tops, including the lactate tops are upwards oriented.

 

No signs of tumor growth outside the enhanced area.

 



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Nov 15, 2005

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