This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Astrakas, L. G. Articles by Black, P. M. Search for Related Content PubMed PubMed Citation Articles by Astrakas, L. G. Articles by Black, P. M.

Noninvasive Magnetic Resonance Spectroscopic Imaging Biomarkers to Predict the Clinical Grade of Pediatric Brain Tumors

¹ Nuclear Magnetic Resonance Surgical Laboratory, Department of Surgery, Massachusetts General Hospital, Shriners Burns Institute, Harvard Medical School, Boston, Massachusetts; Departments of ² Biostatistics, ³ Orthopaedic Surgery, ⁴ Pathology, and ⁵ Neurosurgery, Children’s Hospital, Harvard Medical School, Boston, Massachusetts; ⁶ Department of Pathology and Anatomical Sciences, University of Missouri-Columbia, Columbia, Missouri; and ⁷ Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts

The diagnosis and therapy of childhood brain tumors, most of which are low grade, can be complicated because of their frequent adjacent location to crucial structures, which limits diagnostic biopsy. Also, although new prognostic biomarkers identified by molecular analysis or DNA microarray gene profiling are promising, they too depend on invasive biopsy. Here, we test the hypothesis that combining information from biologically important intracellular molecules (biomarkers), noninvasively obtained by proton magnetic resonance spectroscopic imaging, will increase the diagnostic accuracy in determining the clinical grade of pediatric brain tumors. We evaluate the proton magnetic resonance spectroscopic imaging exams for 66 children with brain tumors. The intracellular biomarkers for choline-containing compounds (Cho), N-acetylaspartate, total creatine, and lipids and/or lactate were measured at the highest Cho region and normalized to the surrounding healthy tissue total creatine. Neuropathological grading was done with WHO criteria. Normalized Cho and lipids and/or lactate were elevated in high-grade (n = 23) versus low-grade (n = 43) tumors, which multiple logistic regression confirmed are independent predictors of tumor grade (for Cho, odds ratio 24.8, P < 0.001; and for lipids and/or lactate, odds ratio 4.4, P < 0.001). A linear combination of normalized Cho and lipids and/or lactate that maximizes diagnostic accuracy was calculated by maximizing the area under the receiver operating characteristic curve. Proton magnetic resonance spectroscopic imaging, although not a proxy for histology, provides noninvasive, in vivo biomarkers for predicting clinical grades of pediatric brain tumors.

This article has been cited by other articles:

				A. Panigrahy, M. D. Nelson Jr, J. L. Finlay, R. Sposto, M. D. Krieger, F. H. Gilles, and S. Bluml Metabolism of diffuse intrinsic brainstem gliomas in children Neuro-oncol, February 1, 2008; 10(1): 32 - 44. [Abstract] [Full Text] [PDF]

				W. Hollingworth, L.S. Medina, R.E. Lenkinski, D.K. Shibata, B. Bernal, D. Zurakowski, B. Comstock, and J.G. Jarvik A Systematic Literature Review of Magnetic Resonance Spectroscopy for the Characterization of Brain Tumors AJNR Am. J. Neuroradiol., August 1, 2006; 27(7): 1404 - 1411. [Abstract] [Full Text] [PDF]

				S. Cha Update on Brain Tumor Imaging: From Anatomy to Physiology AJNR Am. J. Neuroradiol., March 1, 2006; 27(3): 475 - 487. [Full Text] [PDF]

				A. Panigrahy, M.D. Krieger, I. Gonzalez-Gomez, X. Liu, J.G. McComb, J.L. Finlay, M.D. Nelson Jr., F.H. Gilles, and S. Bluml Quantitative Short Echo Time 1H-MR Spectroscopy of Untreated Pediatric Brain Tumors: Preoperative Diagnosis and Characterization AJNR Am. J. Neuroradiol., March 1, 2006; 27(3): 560 - 572. [Abstract] [Full Text] [PDF]