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Differentiation Between Brain Tumor Recurrence and Radiation Injury Using MR Spectroscopy

Patrick Weybright1, Pia C. Sundgren1, Pavel Maly1, Diana Gomez Hassan1, Bin Nan2, Suzan Rohrer1 and Larry Junck3

1 Department of Radiology, University of Michigan, 1500 E Medical Center Dr., Ann Arbor, MI 48109-0030.
2 School of Public Health, University of Michigan, Ann Arbor, MI.
3 Department of Neurology, University of Michigan, Ann Arbor, MI.



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  		Fig. 1A —43-year-old woman after surgical resection, radiation, and chemotherapy for left frontal anaplastic oligodendroglioma. Axial T1-weighted image after contrast administration shows focal new area of contrast enhancement in right frontal lobe on 2D chemical shift imaging MR spectroscopy with volume of interest placed over lesion.

 


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  		Fig. 1B —43-year-old woman after surgical resection, radiation, and chemotherapy for left frontal anaplastic oligodendroglioma. Spectra show mild alterations in metabolic peaks, with slightly increased Cho/Cr (choline-creatine) ratio (1.76), slightly increased Cho/NAA (choline-N-acetyl aspartate) ratio (1.19), and normal NAA/Cr ratio (1.48), indicating mild elevation of choline peak. Interval follow-up showed complete resolution of contrast-enhancing lesion without any additional treatment, supporting diagnosis of radiation injury.

 


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  		Fig. 2A —7-year-old boy who previously had an ependymoma resected from left frontal lobe. Axial T1-weighted images after contrast administration show areas of irregular contrast enhancement on 36-month follow-up MRI at site of prior resection (A). Two-dimensional chemical shift image shows pathologic spectra with increased Cho/NAA (choline-N-acetyl aspartate) and Cho/Cr (choline-creatine) ratios, 3.21 and 3.24, respectively, and a decrease in the NAA/Cr ratio, 1.01, consistent with tumor recurrence (B and C). Patient underwent additional resection, and recurrent ependymoma was confirmed at histopathology.

 


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  		Fig. 2B —7-year-old boy who previously had an ependymoma resected from left frontal lobe. Axial T1-weighted images after contrast administration show areas of irregular contrast enhancement on 36-month follow-up MRI at site of prior resection (A). Two-dimensional chemical shift image shows pathologic spectra with increased Cho/NAA (choline-N-acetyl aspartate) and Cho/Cr (choline-creatine) ratios, 3.21 and 3.24, respectively, and a decrease in the NAA/Cr ratio, 1.01, consistent with tumor recurrence (B and C). Patient underwent additional resection, and recurrent ependymoma was confirmed at histopathology.

 


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  		Fig. 2C —7-year-old boy who previously had an ependymoma resected from left frontal lobe. Axial T1-weighted images after contrast administration show areas of irregular contrast enhancement on 36-month follow-up MRI at site of prior resection (A). Two-dimensional chemical shift image shows pathologic spectra with increased Cho/NAA (choline-N-acetyl aspartate) and Cho/Cr (choline-creatine) ratios, 3.21 and 3.24, respectively, and a decrease in the NAA/Cr ratio, 1.01, consistent with tumor recurrence (B and C). Patient underwent additional resection, and recurrent ependymoma was confirmed at histopathology.

 

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