MR spectroscopy differences between lipomatosis of nerve and neuromuscular choristoma: a potential adjunctive diagnostic
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TECHNICAL REPORT
MR spectroscopy differences between lipomatosis of nerve and neuromuscular choristoma: a potential adjunctive diagnostic tool T. Marek 1 & K. K. Amrami 2 & R. J. Spinner 1 & J. D. Port 2 Received: 10 April 2020 / Revised: 18 May 2020 / Accepted: 19 May 2020 # ISS 2020
Abstract Objective To describe differences between lipomatosis of nerve (LN) and neuromuscular choristoma (NMC) evaluated with MR spectroscopy (MRS). Materials and methods Eight patients were included in this prospective pilot study: three patients with LNs and five with NMCs. Single voxel PRESS MRS of the tumors were acquired with 3 T MRI. MRS data were processed with LCModel version 6.3-1J using the internal “lipid-8” basis set. From individual lipid peak and water content measurements, total fatty acid molecules (TFAM), unsaturated fatty acid molecules (UFAM), and glycerol molecules (GM) were computed and analyzed, as well as ratios of UFAM/TFAM, TFAM/GM, and a fatty-acid chain-length index (CLI). Results The LN group included two men and one woman (average age 58.3 years); the NMC group included two men and three women (average age 20.4 years). Lipid composition analysis showed that LN had considerably more fat than NMC: TFAM: LN = 15.29 vs NMC = 7.14; UFAM: LN = 4.48 vs NMC = 2.63; GM: LN = 5.20 vs NMC = 1.02. Both tumors had a similar fraction of unsaturated fatty acids: UFAM/TFAM: LN = 0.29 vs NMC = 0.37. LN had the usual number of FA molecules/ glycerol molecule, while NMC had considerably more: TFAM/GM: LN = 2.94 vs NMC = 6.98. Finally, average FA chains were longer in NMC: CLI: LN = 17.39 vs NMC = 22.55. Conclusion Our analysis suggests measurable differences in the amount and composition of lipid in LN and NMC. While a larger, statistically powered study is needed, these initial findings may be helpful to properly diagnose ambiguous cases and thereby avoid surgical intervention such as biopsy. Keywords Fatty acids . MR spectroscopy . Lipomatosis of nerve . Neuromuscular choristoma
Introduction Lipomatosis of nerve (LN) and neuromuscular choristoma (NMC) are two rare pathologies affecting peripheral nerve. LN is characterized by abundant proliferation of adipose tissue within the epineurium and by perineurial fibrosis [1–4]. The most commonly affected nerve is median at the wrist; Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00256-020-03479-9) contains supplementary material, which is available to authorized users. * J. D. Port [email protected] 1
Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA
2
Department of Radiology, Mayo Clinic, Mayo E2-31, 200 First Street SW, Rochester, MN, USA
however, any peripheral nerve can be affected, including the lumbosacral plexus and other nerves of lower extremities [5–7]. One of the clinical hallmarks of LN is associated nerve-territory overgrowth, which is present in about 62% and is often times progressive. Most LN cases are congenital or diagnosed in early age [5]. The overgrowth effects of LNs on the lower extremitie
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