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X. Μασκαλίδης και συν. Η μαγνητική φασματοσκοπία στη διερεύνηση του πολύμορφου γλοιοβλαστώματος
of this method.
Material-methods:
We reviewed 21 patients, 12
male and 9 female, between 36 and 79 years old. In
all cases, there was a conventional magnetic resonance
imaging examination and a magnetic resonance
spectroscopy examination available (single-voxel proton
MR spectroscopy, long-TE). The procedure protocol
included the use of Cho, Cr, NAA, lipids and lactate.
All the examinations were performed in a 3T unit.
Results:
Elevation of choline in combination with
reduction of NAA and increase of the metabolic
ratios Cho/NAA>3 and Cho/Cr>2.5 was registered
in 16 patients. In three cases, the ratio Cho/NAA
was elevated (>3), but the metabolic ratio Cho/Cr
was normal, because of increased values of creatine.
The spectroscopic analysis in a patient was wrongly
performed in an area of necrosis and hemorrhage
with low values of Cho, NAA, Cr and elevated levels
of lactate and lipids. Similar findings were registered
in another patient, where voxel contained mainly
necrotic elements.
Conclusions:
The great elevation of choline, which is
confirmed through the increase of the metabolic ratios
Cho/NAA (>3) and Cho/Cr (>2.5), as well as the great
reduction of NAA indicate a high degree of malignancy
and in combination with the imaging characteristics
of conventional magnetic resonance imaging, may be
sufficient for the diagnosis of glioblastoma multiforme.
Magnetic resonance spectroscopy is particularly useful
in the differential diagnosis between areas of post
radiation necrosis and recurrence of malignant tissue
after surgery and radiation therapy.
Keywords:
Glioblastoma, magnetic spectroscopy, choline,
N-acetyl aspartase, metabolic ratios.
Radiologic Department of Thessaloniki “Papageor-
giou” Hospital
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