Magnetic resonance spectroscopy detection of high lipid levels in intraaxial tumors without central necrosis: a characteristic of malignant lymphoma.

Abstract

OBJECT:

The differentiation of malignant lymphomas from gliomas or malignant gliomas by conventional MRI can be difficult. The authors studied Gd-enhanced MR images to obtain a differential diagnosis between malignant lymphomas and gliomas without central necrosis or cystic changes and investigated the diagnostic value of single-voxel proton MR spectroscopy ((1)H-MRS) using different parameters, including lipid levels.

METHODS:

This was a retrospective study of patients with primary malignant CNS lymphoma (n = 17) and glioma (n = 122 [Grades I, II, III, and IV in 10, 30, 33, and 49 patients, respectively]) who were treated between 2007 and 2013. The authors focused on 15 patients with homogeneously enhanced primary malignant CNS lymphomas and 7 homogeneously enhanced gliomas. Images of all the included tumors were acquired with (1)H-MRS at 3 T, and the diagnoses were histologically confirmed.

RESULTS:

Using a short echo time (1)H-MRS, large lipid peaks were observed in all 17 patients with a malignant lymphoma, in 39 patients (79.6%) with a Grade IV glioma, and in 10 patients (30.3%) with a Grade III glioma. A focus on homogeneously enhanced tumors revealed large lipid peaks in 15 malignant lymphomas that were free of central necrosis on Gd-enhanced T1-weighted images. Conversely, in the 7 homogeneously enhanced gliomas (glioblastoma and anaplastic astrocytoma, n = 2 each; anaplastic oligodendroglioma, diffuse astrocytoma, and pilomyxoid astrocytoma, n = 1 each), lipid peaks were small or absent.

CONCLUSIONS:

Large lipid peaks on (1)H-MRS images of tumors without central necrosis were characteristic of malignant lymphomas. Conversely, small or absent lipid peaks in intraaxial tumors without central necrosis were strongly suggestive of glioma.

• Authors: Fumiyuki Yamasaki, Takeshi Takayasu, Ryo Nosaka, Vishwa Jeet Amatya, Aidos Doskaliyev, Yuji Akiyama, Atsushi Tominaga, Yukio Takeshima, Kazuhiko Sugiyama, Kaoru Kurisu
• Journal: Journal of neurosurgery (J Neurosurg) Vol. 122 Issue 6 Pg. 1370-9 (Jun 2015) ISSN: 1933-0693 [Electronic] United States
• PMID: 25748300 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Lipids

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Brain Neoplasms (metabolism, pathology)
• Child
• Child, Preschool
• Female
• Glioma (metabolism, pathology)
• Humans
• Infant
• Lipids (analysis)
• Lymphoma, Non-Hodgkin (metabolism, pathology)
• Magnetic Resonance Spectroscopy
• Male
• Middle Aged
• Necrosis (metabolism, pathology)
• Retrospective Studies
• Young Adult