Proton magnetic resonance spectroscopy in immunocompetent patients with primary central nervous system lymphoma Journal Article

Authors: Raizer, J. J.; Koutcher, J. A.; Abrey, L. E.; Panageas, K. S.; De Angelis, L. M.; Lis, E.; Xu, S.; Zakian, K. L.
Article Title: Proton magnetic resonance spectroscopy in immunocompetent patients with primary central nervous system lymphoma
Abstract: Background: Magnetic resonance spectroscopy imaging (MRSI) non-invasively evaluates the metabolic profile of normal and abnormal brain tissue. Primary central nervous system lymphoma (PCNSL) is a highly aggressive tumor responsive to high-dose methotrexate based regimens. Patients often have complete responses but relapses are common. We characterized the MR spectra of PCNSL patients, correlated MRSI with MRI and evaluated whether early recurrence could be detected by MRSI. Methods: Patients with PCNSL had multi-voxel MRSI before, during, and after treatment. The region of interest was defined using axial FLAIR images. Metabolites assessed were N-acetyl-aspartate (NAA), choline (Cho), creatine (Cr), lipid, and lactate. Ratios of Cho/Cr, NAA/Cho, and NAA/Cr were calculated and correlated with MRI. Overall survival (OS), progression free survival (PFS), and relative risks of each of the ratios were determined. Results: MRSI was performed on 11 men and seven women; median age of 59. Sixty-seven MRSI studies were performed, 17 baseline and 48 follow-up studies. Median ratios in 16 pretreated patients were Cho/Cr-1.90, NAA/ Cho-0.39, and NAA/Cr-1.27. Two patients had lipid at baseline, five had lactate and two had both. MRSI correlated with tumor response or progression on MRI; in three patients MRSI suggested disease progression prior to changes on MRI. Univariate analysis of metabolite ratios, lipid, and lactate revealed that none significantly affected PFS or OS. Kaplan-Meier analysis of the presence or absence of lipid, lactate or both revealed a trend for increased PFS. Conclusion: MRSI and MRI correlate with tumor response or progression and may allow early detection of disease recurrence. The presence or absence of lipid and/or lactate may have prognostic significance. Further research using MRSI needs to be done to validate our findings and determine the role of MRSI in PCNSL. © Springer 2005.
Keywords: survival; adult; cancer survival; clinical article; aged; aged, 80 and over; middle aged; survival analysis; disease course; cancer recurrence; cancer risk; dose response; primary central nervous system lymphoma; methotrexate; drug megadose; nuclear magnetic resonance imaging; follow up; magnetic resonance imaging; metabolism; neoplasm recurrence, local; antimetabolites, antineoplastic; image analysis; lipid; creatinine; dose-response relationship, drug; central nervous system tumor; risk assessment; central nervous system neoplasms; imaging system; standard; survival time; immunology; correlation analysis; diagnostic agent; evaluation; early diagnosis; disease progression; tumor recurrence; lymphoma; drug derivative; magnetic resonance spectroscopy; choline; creatine; nuclear magnetic resonance spectroscopy; protons; kaplan meier method; tumor growth; antineoplastic antimetabolite; lipid metabolism; non invasive measurement; n acetylaspartic acid; aspartic acid; n-acetylaspartate; immunocompetence; proton nuclear magnetic resonance; proton; lactic acid; brain lymphoma
Journal Title: Journal of Neuro-Oncology
Volume: 71
Issue: 2
ISSN: 0167-594X
Publisher: Springer  
Date Published: 2005-01-01
Start Page: 173
End Page: 180
Language: English
DOI: 10.1007/s11060-004-1360-8
PUBMED: 15690135
PROVIDER: scopus
Notes: --- - "Cited By (since 1996): 21" - "Export Date: 24 October 2012" - "CODEN: JNODD" - "Source: Scopus"
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MSK Authors
  1. Eric Lis
    108 Lis
  2. Lauren E Abrey
    273 Abrey
  3. Katherine S Panageas
    335 Panageas
  4. Jason A Koutcher
    241 Koutcher