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MR-Spektroskopie bei Hirntumoren

Magnetic resonance spectroscopy of brain tumors

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Zusammenfassung

Hintergrund

Die konventionelle MRT ermöglicht unter Berücksichtigung klinischer Information bei einem Großteil zerebraler Raumforderungen die richtige Diagnose und Therapie. Einige wichtige Differenzialdiagnosen wie niedrig- vs. hochmaligne Tumore bedürfen allerdings zusätzlicher MR-Methoden.

Fragestellung

Es soll der Stellenwert der MR-Spektroskopie (MRS) bei Hirntumoren kritisch diskutiert werden.

Material und Methoden

Die 1H-MRS misst nicht invasiv Konzentrationen normaler und pathologischer Hirnmetabolite. Sie basiert auf dem Prinzip, dass chemische Protonenverbindungen bestimmter Hirnmetabolite das äußere Magnetfeld fokal abschwächen und die Protonenresonanzfrequenz nach typischen Mustern verändern. Parameterkarten der MRS Imaging (MRSI) bilden zudem Tumorheterogenität und peritumorale Veränderungen ab. Hierbei sind die Muster von N-Acetyl-Aspartat, „total“ Cholin (tCho) oder Kreatin relativ robust. Die Erkennung anderer Metabolite wie Myoinositol, Glutamat, Laktat oder Lipide hängt hingegen stark von Faktoren wie Feldstärke und Echozeit ab.

Ergebnisse

Für solide Hirntumoren gilt, dass die tCho-Signalintensität in vitalem Tumorgewebe mit dem WHO-Grad des Hirntumors, d. h. mit der Malignität ansteigt. Die MRSI hilft, Gliome zu graduieren und den Zielpunkt bei Tumorbiopsien zu bestimmen. Unterschiedliche Verteilungsmuster bzw. spezielle Metabolitensignale erleichtern, zwischen Abszessen, Metastasen, ZNS-Lymphomen und Gliomen zu unterscheiden.

Schlussfolgerung

Die 1H-MRSI liefert diagnostisch wertvolle Informationen zur Differenzialdiagnose und Graduierung von Hirntumoren, allerdings erschweren Artefakte, Signalstärke, Parameterauswahl und fehlende Standardisierung – bislang – deren Einsatz in der Routinediagnostik.

Abstract

Background

Conventional magnetic resonance imaging (MRI) under consideration of clinical information enables the correct diagnosis and therapy for the majority of cerebral space-occupying lesions. Some important differential diagnoses, e. g. low vs. high-grade tumors, require additional MRI methods.

Objective

This article critically discusses the importance of magnetic resonance spectroscopy (1H-MRS) in brain tumors.

Material and methods

The concentration of normal and pathological brain metabolites can be non-invasively measured by 1H-MRS. It is based on the principle that chemical proton compounds of certain brain metabolites focally attenuate the external magnetic field and change the proton resonance frequency according to typical patterns. In addition, parameter maps of MRS imaging (MRSI) can show the tumor heterogeneity as well as changes in the surrounding brain tissue. In this context, the patterns of N‑acetylaspartate, total choline (tCho) and creatine are relatively robust, whereas the patterns of other metabolites, such as myoinositol, glutamate, lactate or lipids greatly depend on the external field strength and echo time.

Results

The signal intensity of tCho in vital tumor tissue increases with the WHO grade of the brain tumor, i.e. increases with the level of malignancy. The use of MRSI facilitates the WHO grading of gliomas by determining target points in biopsies. Different distribution patterns and specific metabolite signals enable a better differentiation between abscesses, metastases, central nervous system (CNS) lymphomas and gliomas.

Conclusion

The use of 1H-MRS provides valuable information on the differential diagnosis and graduation of brain tumors; however, so far artefacts, signal strength, parameter selection and a lack of standardization impede the establishment of 1H-MRS for use in clinical routine diagnostics.

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Abbreviations

(1H)-MRS:

(„Proton) magnetic resonance spectroscopy“

1H MRSI:

„Magnetic resonance spectroscopic imaging“

2-HG:

2-Hydroxyglutarat

ADEM:

„Acute disseminated encephalomyelitis“

CSI:

„Chemical shift imaging“

DWI:

„Diffusion-weighted imaging“

IDH:

Isocitrat-Dehydroxygenase

KM:

Kontrastmittel

MS:

Multiple Sklerose

ppm:

„Parts per million“

tCho:

„Total choline“

tCr:

„Total creatine“

tNAA:

„Total N‑acetyl aspartate“

WHO:

World Health Organization

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Authors and Affiliations

  1. FE Neuroradiologie, Radiologische Klinik, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Deutschland

    P. Ditter &  E. Hattingen

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  2. E. Hattingen
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Correspondence to E. Hattingen.

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Interessenkonflikt

P. Ditter und E. Hattingen geben an, dass kein Interessenkonflikt besteht.

Alle beschriebenen Untersuchungen am Menschen wurden mit Zustimmung der zuständigen Ethik-Kommission, im Einklang mit nationalem Recht sowie gemäß der Deklaration von Helsinki von 1975 (in der aktuellen, überarbeiteten Fassung) durchgeführt. Von allen beteiligten Patienten liegt eine Einverständniserklärung vor.

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Ditter, P., Hattingen, E. MR-Spektroskopie bei Hirntumoren. Radiologe 57, 450–458 (2017). https://doi.org/10.1007/s00117-017-0241-z

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