Isobe Tomonori, Matsumura Akira, Anno Izumi, Nagatomo Yasushi, Yoshizawa Takashi, Itai Yuji, Nose Tadao
Department of Neurosurgery, Instituete of Clinical Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba city, Ibaraki 305-8575, Japan.
No Shinkei Geka. 2003 Feb;31(2):167-72.
The evaluation of the response to radiation therapy in brain tumor patients is a major and an important issue. Although CT and MRI can measure changes in tumor size, it is difficult to use these imaging methods to evaluate the viability or the proliferation activity of a tumor. In this study, we investigated the metabolite changes in glioma patients using 1H-MRS from before to after radiation therapy, to see whether or not early metabolic changes occur during therapy. Seven patients with histologically proven glioma (1 astrocytoma, 1 anaplastic astrocytoma, 2 oligoastrocytoma, 1 oligodendroglioma, 2 glioblastoma) were examined by means of 1H-MRS using a point-resolved spectroscopy (PRESS) sequence with a repetition time of 2,000 ms and echo times of 68 ms, 136 ms and 272 ms. The 1H-MRS was evaluated by both the spectrum pattern and the quantification of the metabolites. As to radiation therapy, each patient received a total dose of 64.8 Gy (1.8 Gy/fraction) with a 10-MeV linear accelerator. The results revealed that the concentration of choline-containing compounds (Cho) was 4.55 +/- 1.08 mmol/kg wet weight before radiation therapy and was reduced to 2.69 +/- 0.56 mmol/kg wet weight (p < 0.01) after radiation therapy. Moreover, both the N-acetylaspartate (NAA) peak and creatine/phosphocreatine (t-Cr) peak were lower after radiation therapy than before. The peaks of both the lipids (Lip) and lactate (Lac) were higher after radiation therapy than before. In conclusion, Cho concentration is thought to be a useful marker for the evaluation of early post-radiation response. The effect of radiation therapy can be evaluated according to the value of Cho. Further long-term MRS study is needed to prove whether or not the decrease of the Cho value in the present study will change before recurrence at later stages.
脑肿瘤患者放射治疗反应的评估是一个主要且重要的问题。尽管CT和MRI能够测量肿瘤大小的变化,但利用这些成像方法来评估肿瘤的生存能力或增殖活性却很困难。在本研究中,我们使用氢质子磁共振波谱(1H-MRS)对胶质瘤患者放疗前后的代谢物变化进行了研究,以观察治疗期间是否会出现早期代谢变化。7例经组织学证实的胶质瘤患者(1例星形细胞瘤、1例间变性星形细胞瘤、2例少突星形细胞瘤、1例少突胶质细胞瘤、2例胶质母细胞瘤)接受了1H-MRS检查,采用点分辨波谱(PRESS)序列,重复时间为2000 ms,回波时间分别为68 ms、136 ms和272 ms。1H-MRS通过谱图模式和代谢物定量进行评估。至于放射治疗,每位患者使用10 MeV直线加速器接受了总量为64.8 Gy(1.8 Gy/分次)的照射。结果显示,放疗前含胆碱化合物(Cho)的浓度为4.55±1.08 mmol/kg湿重,放疗后降至2.69±0.56 mmol/kg湿重(p<0.01)。此外,放疗后N-乙酰天门冬氨酸(NAA)峰和肌酸/磷酸肌酸(t-Cr)峰均低于放疗前。放疗后脂质(Lip)峰和乳酸(Lac)峰均高于放疗前。总之,Cho浓度被认为是评估放疗后早期反应的有用标志物。可根据Cho值评估放射治疗的效果。需要进一步进行长期的MRS研究,以证实本研究中Cho值在后期复发前是否会发生变化。