Utilization of glutamate/creatine ratios for proton spectroscopic diagnosis of meningiomas

• Published in: Neuroradiology 2007-02, Vol.49 (2), p.121-127
• Main Authors: HAZANY, Saman, HESSELINK, John R, HEALY, John F, IMBESI, Steven G
• Format: Article
• Language: English
• Subjects: Adult; Aged; Alanine - metabolism; Biological and medical sciences; Biomarkers - metabolism; Brain; Brain - metabolism; Creatine - metabolism; Diagnostic tests; Fatty acids; Female; Glutamic Acid - metabolism; Glutathione - metabolism; Humans; Hypotheses; Investigative techniques, diagnostic techniques (general aspects); Magnetic Resonance Spectroscopy; Male; Medical sciences; Meningeal Neoplasms - diagnosis; Meningeal Neoplasms - metabolism; Meningioma - diagnosis; Meningioma - metabolism; Middle Aged; Nervous system; NMR; Nuclear magnetic resonance; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Reproducibility of Results; Spectrum analysis; Tumors
• ISSN: 0028-3940; 1432-1920
• DOI: 10.1007/s00234-006-0167-z

Our purpose was to determine the potential of metabolites other than alanine to diagnose intracranial meningiomas on proton magnetic resonance spectroscopy (MRS). Using a 1.5-T MR system the lesions were initially identified on FLAIR, and T1- and T2-weighted images. Employing standard point-resolved spectroscopy (PRESS) for single voxel proton MRS (TR 1500 ms, TE 30 ms, 128 acquisitions, voxel size 2 x 2 x 2 cm, acquisition time 3.12 min), MR spectra were obtained from 5 patients with meningiomas, from 20 with other intracranial lesions, and from 4 normal controls. Peak heights of nine resonances, including lipid, lactate, alanine, NAA (N-acetylaspartate), beta/gamma-Glx (glutamate + glutamine), creatine, choline, myo-inositol, and alpha-Glx/glutathione, were measured in all spectra. The relative quantity of each metabolite was measured as the ratio of its peak height to the peak height of creatine. Relative quantities of alpha-Glx/glutathione, beta/gamma-Glx, and total Glx/glutathione were significantly elevated in meningiomas compared to the 20 other intracranial lesions and the normal control brains. Alanine was found in four of five meningiomas, but lactate partially masked the alanine in three meningiomas. None of the other lesions or control brains showed an alanine peak. The one meningioma with no alanine and the three others with lactate had elevated Glx. While alanine is a relatively unique marker for meningioma, our results support the hypothesis that the combination of glutamate/creatine ratios and alanine on proton MRS is more specific and reliable for the diagnosis of meningiomas than alanine alone.