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Low-Grade Gliomas and Focal Cortical Developmental Malformations: Differentiation with Proton MR Spectroscopy¹

¹ From the Departments of Radiology (K.V., L.V., N.L.), Oncology (L.K., A.M.H., H.J.), Child Neurology, Hospital for Children and Adolescents (E.G., M.L.G.), Neurosurgery (G.B.), and Pathology (A.P.), Haartman Institute, Helsinki University Central Hospital, Haartmaninkatu 4, PO Box 180, 00029 Helsinki, Finland. Received December 31, 2002; revision requested March 10, 2003; final revision received July 10; accepted August 6. Supported by a HUCH Special Federal Grant TYH0227. K.V. supported by grants from Nylands Nation and the Kurt and Doris Palander Foundation. Address correspondence to K.V. (e-mail: kim.vuori@oriola.com).

View larger version (24K): [in a new window]   Figure 1a.  Graphs of relative metabolite changes in astrocytomas (), oligodendrogliomas and oligoastrocytomas (), FCDs (), and DNTs (). Graphs depict (a) NAA change versus Cho change and (b) Cr change versus Cho change. The dotted lines are the linear discriminant functions (LDF) that differentiate (a) gliomas from FCDMs (LDF = 12.04 - 0.043 · Cho + 0.181 · NAA, where Cho is change in Cho and NAA is change in NAA) and (b) astrocytomas from oligodendrogliomas and oligoastrocytomas (LDF = 17.68 - 0.145 · Cho - 0.123 · Cr, where Cho is change in Cho and Cr is change in Cr). Cho can be substantially increased (up to 150%-200%) in both low-grade gliomas and FCDMs, but NAA is relatively well preserved only in the latter.

View larger version (21K): [in a new window]   Figure 1b.  Graphs of relative metabolite changes in astrocytomas (), oligodendrogliomas and oligoastrocytomas (), FCDs (), and DNTs (). Graphs depict (a) NAA change versus Cho change and (b) Cr change versus Cho change. The dotted lines are the linear discriminant functions (LDF) that differentiate (a) gliomas from FCDMs (LDF = 12.04 - 0.043 · Cho + 0.181 · NAA, where Cho is change in Cho and NAA is change in NAA) and (b) astrocytomas from oligodendrogliomas and oligoastrocytomas (LDF = 17.68 - 0.145 · Cho - 0.123 · Cr, where Cho is change in Cho and Cr is change in Cr). Cho can be substantially increased (up to 150%-200%) in both low-grade gliomas and FCDMs, but NAA is relatively well preserved only in the latter.

View larger version (19K): [in a new window]   Figure 2a.  Graphs depict metabolite ratios (a) NAA/Cho, (b) NAA/Cr, and (c) Cho/Cr of the lesion core in low-grade gliomas (LGG), in FCDMs, and in the corresponding areas in the controls. NAA/Cho and NAA/Cr ratios could help differentiate low-grade gliomas (range, 0.1-1.0 and 0.2-1.2, respectively) from FCDMs (range, 1.1-5.0 and 1.6-2.6, respectively), without overlap.

View larger version (17K): [in a new window]   Figure 2b.  Graphs depict metabolite ratios (a) NAA/Cho, (b) NAA/Cr, and (c) Cho/Cr of the lesion core in low-grade gliomas (LGG), in FCDMs, and in the corresponding areas in the controls. NAA/Cho and NAA/Cr ratios could help differentiate low-grade gliomas (range, 0.1-1.0 and 0.2-1.2, respectively) from FCDMs (range, 1.1-5.0 and 1.6-2.6, respectively), without overlap.

View larger version (18K): [in a new window]   Figure 2c.  Graphs depict metabolite ratios (a) NAA/Cho, (b) NAA/Cr, and (c) Cho/Cr of the lesion core in low-grade gliomas (LGG), in FCDMs, and in the corresponding areas in the controls. NAA/Cho and NAA/Cr ratios could help differentiate low-grade gliomas (range, 0.1-1.0 and 0.2-1.2, respectively) from FCDMs (range, 1.1-5.0 and 1.6-2.6, respectively), without overlap.

View larger version (21K): [in a new window]   Figure 3a.  Graphs depict (a) cellular density and (b) MIB-1 proliferation index from the histologically verified FCD, DNT, astrocytomas (A), and oligodendrogliomas and oligoastrocytomas (OD&OA). Low-grade gliomas show higher cellular density and MIB-1 proliferation index than do FCDMs.

View larger version (21K): [in a new window]   Figure 3b.  Graphs depict (a) cellular density and (b) MIB-1 proliferation index from the histologically verified FCD, DNT, astrocytomas (A), and oligodendrogliomas and oligoastrocytomas (OD&OA). Low-grade gliomas show higher cellular density and MIB-1 proliferation index than do FCDMs.

View larger version (123K): [in a new window]   Figure 4a.  (a, c, e) Transverse fluid-attenuated inversion recovery images (9,999/105) and (b, d, f) the corresponding spectra (2,600/270) of the lesion core of patient 6 with FCD (a, b), patient 8 with DNT (c, d), and patient 13 with grade 2 oligodendroglioma (e, f). All lesions were verified histologically. The rectangles represent the volumes from which the corresponding spectra arise. The Cho resonance is higher in FCD (patient 6, b) than in oligodendroglioma (patient 13, e), whereas the NAA resonance is well preserved in FCD but is almost invisible in oligodendroglioma. Lac = lactate.

View larger version (30K): [in a new window]   Figure 4b.  (a, c, e) Transverse fluid-attenuated inversion recovery images (9,999/105) and (b, d, f) the corresponding spectra (2,600/270) of the lesion core of patient 6 with FCD (a, b), patient 8 with DNT (c, d), and patient 13 with grade 2 oligodendroglioma (e, f). All lesions were verified histologically. The rectangles represent the volumes from which the corresponding spectra arise. The Cho resonance is higher in FCD (patient 6, b) than in oligodendroglioma (patient 13, e), whereas the NAA resonance is well preserved in FCD but is almost invisible in oligodendroglioma. Lac = lactate.

View larger version (145K): [in a new window]   Figure 4c.  (a, c, e) Transverse fluid-attenuated inversion recovery images (9,999/105) and (b, d, f) the corresponding spectra (2,600/270) of the lesion core of patient 6 with FCD (a, b), patient 8 with DNT (c, d), and patient 13 with grade 2 oligodendroglioma (e, f). All lesions were verified histologically. The rectangles represent the volumes from which the corresponding spectra arise. The Cho resonance is higher in FCD (patient 6, b) than in oligodendroglioma (patient 13, e), whereas the NAA resonance is well preserved in FCD but is almost invisible in oligodendroglioma. Lac = lactate.

View larger version (29K): [in a new window]   Figure 4d.  (a, c, e) Transverse fluid-attenuated inversion recovery images (9,999/105) and (b, d, f) the corresponding spectra (2,600/270) of the lesion core of patient 6 with FCD (a, b), patient 8 with DNT (c, d), and patient 13 with grade 2 oligodendroglioma (e, f). All lesions were verified histologically. The rectangles represent the volumes from which the corresponding spectra arise. The Cho resonance is higher in FCD (patient 6, b) than in oligodendroglioma (patient 13, e), whereas the NAA resonance is well preserved in FCD but is almost invisible in oligodendroglioma. Lac = lactate.

View larger version (146K): [in a new window]   Figure 4e.  (a, c, e) Transverse fluid-attenuated inversion recovery images (9,999/105) and (b, d, f) the corresponding spectra (2,600/270) of the lesion core of patient 6 with FCD (a, b), patient 8 with DNT (c, d), and patient 13 with grade 2 oligodendroglioma (e, f). All lesions were verified histologically. The rectangles represent the volumes from which the corresponding spectra arise. The Cho resonance is higher in FCD (patient 6, b) than in oligodendroglioma (patient 13, e), whereas the NAA resonance is well preserved in FCD but is almost invisible in oligodendroglioma. Lac = lactate.

View larger version (30K): [in a new window]   Figure 4f.  (a, c, e) Transverse fluid-attenuated inversion recovery images (9,999/105) and (b, d, f) the corresponding spectra (2,600/270) of the lesion core of patient 6 with FCD (a, b), patient 8 with DNT (c, d), and patient 13 with grade 2 oligodendroglioma (e, f). All lesions were verified histologically. The rectangles represent the volumes from which the corresponding spectra arise. The Cho resonance is higher in FCD (patient 6, b) than in oligodendroglioma (patient 13, e), whereas the NAA resonance is well preserved in FCD but is almost invisible in oligodendroglioma. Lac = lactate.