Potential Value of MR Spectroscopic Imaging for the Radiosurgical Management of Patients with Recurrent High-Grade Gliomas

Previous studies have shown that metabolic information provided by 3D Magnetic Resonance Spectroscopy Imaging (MRSI) could affect the definition of target volumes for radiation treatments (RT). This study aimed to (i) investigate the effect of incorporating spectroscopic volumes as determined by MRSI on target volume definition, patient selection eligibility, and dose prescription for stereotactic radiosurgery treatment planning; (ii) correlate the spatial extent of pre-SRS spectroscopic abnormality and treatment volumes with areas of focal recurrence as defined by changes in contrast enhancement; and (iii) examine the metabolic changes following SRS to assess treatment response. Twenty-six patients treated with Gamma Knife radiosurgery for recurrent glioblastoma multiforme (GBM) were retrospectively evaluated. All patients underwent both MRI and MRSI studies prior to SRS. Follow-up MRI exams were available for all 26 patients, with MRI/MRSI available in only 15/26 patients. We observed that the initial CNI 2 contours extended beyond the pre-SRS CE in 25/26 patients ranging in volume from 0.8 cc to 18.8 cc (median 5.6 cc). The inclusion of the volume of CNI 2 extending beyond the CE would have increased the SRS target volume by 5–165% (median 23.4%). This would have necessitated decreasing the SRS prescription dose in 19/26 patients to avoid increased toxicity; the resultant treatment volume would have exceeded 20cc in five patients, thus possibly excluding those from RS treatment per our institutional practice. MRSI follow-up studies showed a decrease in Choline, stable Creatine, and increased NAA indicative of response to SRS in the majority of patients. When combined with patient survival data, metabolic information obtained during follow-up MRSI studies seemed to indicate the potential to help to distinguish necrosis from new/recurrent tumor; however, this should be further verified by biopsy studies.

[1]  Susan M. Chang,et al.  Proton magnetic resonance spectroscopy imaging in the evaluation of patients undergoing gamma knife surgery for Grade IV glioma. , 2004, Journal of neurosurgery.

[2]  Daniel B Vigneron,et al.  In vivo molecular imaging for planning radiation therapy of gliomas: An application of 1H MRSI , 2002, Journal of magnetic resonance imaging : JMRI.

[3]  Maria Werner-Wasik,et al.  Randomized comparison of stereotactic radiosurgery followed by conventional radiotherapy with carmustine to conventional radiotherapy with carmustine for patients with glioblastoma multiforme: report of Radiation Therapy Oncology Group 93-05 protocol. , 2004, International journal of radiation oncology, biology, physics.

[4]  W P Dillon,et al.  Preoperative proton MR spectroscopic imaging of brain tumors: correlation with histopathologic analysis of resection specimens. , 2001, AJNR. American journal of neuroradiology.

[5]  Susan M. Chang,et al.  Therapeutic advances for glioblastoma multiforme: Current status and future prospects , 2007, Current oncology reports.

[6]  M. Berger,et al.  Histopathological validation of a three-dimensional magnetic resonance spectroscopy index as a predictor of tumor presence. , 2002, Journal of neurosurgery.

[7]  A. Brandes,et al.  State-of-the-art treatment of high-grade brain tumors. , 2003, Seminars in oncology.

[8]  S. Nelson.  Analysis of volume MRI and MR spectroscopic imaging data for the evaluation of patients with brain tumors , 2001, Magnetic resonance in medicine.

[9]  D B Vigneron,et al.  Registration of images from sequential MR studies of the brain , 1994, Journal of magnetic resonance imaging : JMRI.

[10]  Morand Piert,et al.  Reirradiation of recurrent high-grade gliomas using amino acid PET (SPECT)/CT/MRI image fusion to determine gross tumor volume for stereotactic fractionated radiotherapy. , 2004, International journal of radiation oncology, biology, physics.

[11]  G. van Kaick,et al.  Differentiation of radiation necrosis from tumor progression using proton magnetic resonance spectroscopy , 2002, Neuroradiology.

[12]  S. Nelson,et al.  Serial evaluation of patients with brain tumors using volume MRI and 3D 1H MRSI , 1999, NMR in biomedicine.

[13]  M Schwaiger,et al.  First experience with I-123-alpha-methyl-tyrosine spect in the 3-D radiation treatment planning of brain gliomas. , 2000, International journal of radiation oncology, biology, physics.

[14]  Martin J. van den Bent,et al.  Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. , 2005, The New England journal of medicine.

[15]  R. Laing,et al.  Hypofractionated stereotactic radiotherapy in the management of recurrent glioma. , 1997, International journal of radiation oncology, biology, physics.

[16]  D. Vigneron,et al.  An automated technique for the quantitative assessment of 3D‐MRSI data from patients with glioma , 2001, Journal of magnetic resonance imaging : JMRI.

[17]  K. Houkin,et al.  Differentiation of cerebral radiation necrosis from tumor recurrence by proton magnetic resonance spectroscopy. , 1997, Neurologia medico-chirurgica.

[18]  M. Schwaiger,et al.  Implications of IMT-SPECT for postoperative radiotherapy planning in patients with gliomas. , 2002, International journal of radiation oncology, biology, physics.

[19]  M. Berger,et al.  Stereotactic Radiosurgery and Interstitial Brachytherapy for Glial Neoplasms , 2004, Journal of Neuro-Oncology.

[20]  L Verhey,et al.  A preliminary study of the prognostic value of proton magnetic resonance spectroscopic imaging in gamma knife radiosurgery of recurrent malignant gliomas. , 2000, Neurosurgery.