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The Metabolic Epicenter of Supratentorial Gliomas: A 1H-MRSI Study

Published online by Cambridge University Press:  02 December 2014

Tejas Sankar ,
Yevgeniy E. Kuznetsov ,
Robert W. Ryan ,
Zografos Caramanos ,
Samson B. Antel ,
Douglas L. Arnold  and
Mark C. Preul
Tejas Sankar
Affiliation:
Neurosurgery Research Laboratory, Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
Yevgeniy E. Kuznetsov
Affiliation:
MR Spectroscopy Unit, McConnell Brain Imaging Centre, Departments of Neurology and Neurosurgery, McGill University, Montreal Neurological Institute, Montreal, Quebec, Canada
Robert W. Ryan
Affiliation:
Neurosurgery Research Laboratory, Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
Zografos Caramanos
Affiliation:
MR Spectroscopy Unit, McConnell Brain Imaging Centre, Departments of Neurology and Neurosurgery, McGill University, Montreal Neurological Institute, Montreal, Quebec, Canada
Samson B. Antel
Affiliation:
MR Spectroscopy Unit, McConnell Brain Imaging Centre, Departments of Neurology and Neurosurgery, McGill University, Montreal Neurological Institute, Montreal, Quebec, Canada
Douglas L. Arnold
Affiliation:
MR Spectroscopy Unit, McConnell Brain Imaging Centre, Departments of Neurology and Neurosurgery, McGill University, Montreal Neurological Institute, Montreal, Quebec, Canada
Mark C. Preul*
Affiliation:
Neurosurgery Research Laboratory, Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
*
Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, 350 W. Thomas Road, Phoenix, Arizona, 85013, USA. Email: neuropub@chw.edu.
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Abstract

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Background:

Assessing the impact of glioma location on prognosis remains elusive. We approached the problem using multivoxel proton magnetic resonance spectroscopic imaging (1H-MRSI) to define a tumor “metabolic epicenter”, and examined the relationship of metabolic epicenter location to survival and histopathological grade.

Methods:

We studied 54 consecutive patients with a supratentorial glioma (astrocytoma or oligodendroglioma, WHO grades II-IV). The metabolic epicenter in each tumor was defined as the 1H-MRSI voxel containing maximum intra-tumoral choline on preoperative imaging. Tumor location was considered the X-Y-Z coordinate position, in a standardized stereotactic space, of the metabolic epicenter. Correlation between epicenter location and survival or grade was assessed.

Results:

Metabolic epicenter location correlated significantly with patient survival for all tumors (r2 = 0.30, p = 0.0002) and astrocytomas alone (r2 = 0.32, p = 0.005). A predictive model based on both metabolic epicenter location and histopathological grade accounted for 70% of the variability in survival, substantially improving on histology alone to predict survival. Location also correlated significantly with grade (r2 = 0.25, p = 0.001): higher grade tumors had a metabolic epicenter closer to the midpoint of the brain.

Conclusions:

The concept of the metabolic epicenter eliminates several problems related to existing methods of classifying glioma location. The location of the metabolic epicenter is strongly correlated with overall survival and histopathological grade, suggesting that it reflects biological factors underlying glioma growth and malignant dedifferentiation. These findings may be clinically relevant to predicting patterns of local glioma recurrence, and in planning resective surgery or radiotherapy.

Type
Other
Information
Canadian Journal of Neurological Sciences , Volume 36 , Issue 6 , November 2009 , pp. 696 - 706
Copyright
Copyright © The Canadian Journal of Neurological 2009

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