Glutamate weighted imaging contrast in gliomas with 7â¯Tesla magnetic resonance imaging.
Neuroimage Clin
; 22: 101694, 2019.
Article
en En
| MEDLINE
| ID: mdl-30822716
INTRODUCTION: Diffuse gliomas are incurable malignancies, which undergo inevitable progression and are associated with seizure in 50-90% of cases. Glutamate has the potential to be an important glioma biomarker of survival and local epileptogenicity if it can be accurately quantified noninvasively. METHODS: We applied the glutamate-weighted imaging method GluCEST (glutamate chemical exchange saturation transfer) and single voxel MRS (magnetic resonance spectroscopy) at 7â¯Telsa (7â¯T) to patients with gliomas. GluCEST contrast and MRS metabolite concentrations were quantified within the tumour region and peritumoural rim. Clinical variables of tumour aggressiveness (prior adjuvant therapy and previous radiological progression) and epilepsy (any prior seizures, seizure in last month and drug refractory epilepsy) were correlated with respective glutamate concentrations. Images were separated into post-hoc determined patterns and clinical variables were compared across patterns. RESULTS: Ten adult patients with a histo-molecular (nâ¯=â¯9) or radiological (nâ¯=â¯1) diagnosis of grade II-III diffuse glioma were recruited, 40.3 +/- 12.3â¯years. Increased tumour GluCEST contrast was associated with prior adjuvant therapy (pâ¯=â¯.001), and increased peritumoural GluCEST contrast was associated with both recent seizures (pâ¯=â¯.038) and drug refractory epilepsy (pâ¯=â¯.029). We distinguished two unique GluCEST contrast patterns with distinct clinical and radiological features. MRS glutamate correlated with GluCEST contrast within the peritumoural voxel (Râ¯=â¯0.89, pâ¯=â¯.003) and a positive trend existed in the tumour voxel (Râ¯=â¯0.65, pâ¯=â¯.113). CONCLUSION: This study supports the role of glutamate in diffuse glioma biology. It further implicates elevated peritumoural glutamate in epileptogenesis and altered tumour glutamate homeostasis in glioma aggressiveness. Given the ability to non-invasively visualise and quantify glutamate, our findings raise the prospect of 7â¯T GluCEST selecting patients for individualised therapies directed at the glutamate pathway. Larger studies with prospective follow-up are required.
Palabras clave
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Neoplasias Encefálicas
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Espectroscopía de Resonancia Magnética
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Ácido Glutámico
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Epilepsia
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Glioma
Tipo de estudio:
Etiology_studies
Límite:
Adult
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
Neuroimage Clin
Año:
2019
Tipo del documento:
Article
Pais de publicación:
Países Bajos