MR Spectroscopic Evaluation of Brain Tissue Damage After Treatment for Pediatric Brain Tumors
The aim of this study was to evaluate the metabolic profile of uninvolved brain tissue after treatment for pediatric brain tumors.
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stract Purpose The aim of this study was to evaluate the metabolic profile of uninvolved brain tissue after treatment for pediatric brain tumors. Material A group of 24 patients aged 4–18 years was analyzed after combined treatment for brain tumors. In this group, there were nine medulloblastomas, seven low-grade gliomas, three high-grade gliomas, two ependymomas and three children with conservatively treated diffuse brainstem gliomas. Methods Short echo-time (TE = 30 ms) point-resolved spectra were acquired using a 2 T clinical scanner (Elscint Prestige). The ratios of signal intensities for N-acetylaspartate (NAA), choline (Cho), myo-inositol (mI), lactate (Lac), and lipids (Lip) were calculated using the creatine (Cr) signal as an internal reference. The spectra were acquired both from the tumor bed and from contralateral uninvolved brain tissue; only control spectra were analyzed. The first examination was made between the third and sixth month after therapy (24 spectra), the second examination occurred 8–12 months after treatment (15 spectra available), and the third was performed approximately 18 months after completion of therapy (eight spectra available). The results were compared using the t-test for dependent samples. Results At all time points, the metabolite ratios showed alterations indicating brain tissue damage. The most impor-
S. Blamek (), K. Ficek, L. Miszczyk, and R. Tarnawski Department of Radiotherapy, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branchul, Wybrzeże Armii Krajowej 15, Gliwice 44-100, Poland e-mail: [email protected] M. Sokół Department of Medical Physics, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branchul, Wybrzeże Armii Krajowej 15, Gliwice 44-101, Poland D. Larysz Department of Neurosurgery, Medical University of Silesia, Katowice, U1 Medykow 16, Katowice 40-752, Poland
tant were the decrease of NAA/Cr and increase of Lac/Cr and Lip/Cr ratios. The mean NAA/Cr values were 0.91, 0.91, and 0.86, respectively, for the three examinations, while the Lac/ Cr and Lip/Cr values were 1.66, 2.11, 1.19 and 12.24, 12.05, 5.69, respectively. Interestingly, in children with supratentorial tumors, a significant increase in NAA/Cr value was observed (from 0.82 to 1.11 in the first and second examinations, respectively; p = 0.0487), which may be indicative of neuronal function recovery. Conclusions MRS examinations of uninvolved brain tissue indicate long-lasting metabolic disturbances. However, the NAA/Cr ratio increase may be a sign of at least partial recovery of metabolic function of the brain. Keywords Magnetic resonance spectroscopy • children • brain tumors • radiotherapy • radiation damage
Background and Purpose Radiation-induced alterations of brain function and metabolism are important sequelae of radiotherapy for brain tumors, especially in patients with good prognoses. The importance of these phenomena is even more pronounced in children, as a significant number of patients treated for brain tumors wil
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