Hsieh Tsyh-Jyi, Li Chun-Wei, Chuang Hung-Yi, Liu Gin-Chung, Wang Chien-Kuo
Department of Medical Imaging, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
J Comput Assist Tomogr. 2008 Nov-Dec;32(6):987-94. doi: 10.1097/RCT.0b013e31815b9ce9.
To investigate the value of in vivo proton (H) magnetic resonance spectroscopy (MRS) in longitudinally monitoring the treatment response of malignant musculoskeletal tumors under chemotherapy.
Twenty-three studies in 3 patients with bone and soft-tissue tumors (2 lymphomas and 1 alveolar soft part sarcoma) were included in the study. The dynamic contrast-enhanced magnetic resonance (MR) imaging and single-voxel proton MRS with 135 milliseconds of echo time were carried out using a whole-body 1.5-T scanner and a surface coil. The volume of interest within the lesion was positioned on the area of early enhancement according to the finding of the first dynamic contrast-enhanced MR imaging with subtraction. The choline and water intensities were measured at the peak areas at 3.2 and 4.5 ppm. The choline-water ratios were calculated as well. Statistical analysis was performed by using Kruskal-Wallis 1-way analysis of variance test ().(Table is included in full-text article.)
The changes observed on the dynamic contrast-enhanced MR images and tumor size after chemotherapy fell into 2 clearly distinct patterns: subsequent partial response (patients 1 and 2) and progressive disease (patient 3). The choline concentration, choline-volume ratio, and choline-water ratio in the first 2 patients were reduced substantially to zero in the follow-up MRS. In the remaining patient, the choline, choline-volume ratio, and choline-water ratio remained high in the follow-up MRS. The water concentration and water-volume ratio between the 3 patients showed significant statistical differences (Kruskal-Wallis test, P = 0.004 and 0.039).
In vivo proton MRS is technically feasible for the evaluation of musculoskeletal tumors. Choline can be detected in malignant bone and soft-tissue tumors, and the early metabolite changes after chemotherapy can also be identified in the in vivo proton MRS by using a standard clinical-use 1.5-T MR scanner and a surface coil. The decline of choline after treatment in malignant bone and soft-tissue tumors correlates with the response of the dynamic contrast MR images and the tumor size. The information provided with MR imaging and proton MRS may improve the diagnostic specificity of MR examination in the follow-up of tumor treatment.
探讨体内质子（H）磁共振波谱（MRS）在纵向监测恶性肌肉骨骼肿瘤化疗治疗反应中的价值。
本研究纳入了3例骨与软组织肿瘤患者（2例淋巴瘤和1例肺泡软组织肉瘤）的23项研究。使用全身1.5-T扫描仪和表面线圈进行动态对比增强磁共振（MR）成像以及回波时间为135毫秒的单体素质子MRS。根据首次动态对比增强MR成像减影后的结果，将病变内的感兴趣体积定位在早期强化区域。在3.2和4.5 ppm的峰值区域测量胆碱和水的强度。同时计算胆碱与水的比值。采用Kruskal-Wallis单向方差分析进行统计分析。（表格包含在全文中）
化疗后动态对比增强MR图像和肿瘤大小的变化呈现出两种明显不同的模式：后续部分缓解（患者1和2）和疾病进展（患者3）。前2例患者在随访MRS中胆碱浓度、胆碱体积比和胆碱水比大幅降低至零。在其余患者中，随访MRS中胆碱、胆碱体积比和胆碱水比仍保持较高水平。3例患者之间的水浓度和水体积比存在显著统计学差异（Kruskal-Wallis检验，P = 0.004和0.039）。
体内质子MRS在评估肌肉骨骼肿瘤方面在技术上是可行的。在恶性骨与软组织肿瘤中可检测到胆碱，并且使用标准临床用1.5-T MR扫描仪和表面线圈，在体内质子MRS中也可识别化疗后的早期代谢物变化。恶性骨与软组织肿瘤治疗后胆碱的下降与动态对比MR图像的反应和肿瘤大小相关。MR成像和质子MRS提供的信息可能会提高MR检查在肿瘤治疗随访中的诊断特异性。
