3T proton MR spectroscopy evaluation of spinal cord lesions

Abstract

Objective: The objective of this study was to evaluate intramedullary spinal cord lesions using magnetic resonance spectroscopy and correlate the results with histo-pathological examination (HPE). Materials and Methods: Approval for this study was obtained from our institute ethical committee. Overall, 50 patients were recruited (29 male and 21 female), with a maximum age of 53 years and minimum age of 7 years. The mean age group of the study was 33 years. Standard magnetic resonance imaging (MRI) spine was done on a Siemens Skyra 3Tesla MRI scanner. MR Spectroscopy (MRS) was performed for all patients with intramedullary spinal lesions after getting written consent. It was performed using single-voxel method. The change in the metabolite peak was observed in each case and the results were compared with HPE. These collected data were analyzed using SPSS 16.0 version. Descriptive statistics, frequency analysis, and percentage analysis were used for categorical variables; and for continuous variables, mean and standard deviation were analyzed. McNemar's test was used to find the significance between conventional MRI MRS. In the above statistical tool, the probability value 0.05 is considered as significant level. Results: From our study, we observed that by applying routine MRI sequences alone, we could only detect around 58% of the cases correctly. However, when MRS was done along with the conventional MR imaging, the number of cases detected significantly increased to 84%. By applying McNemar's test and comparing the conventional MRI and MRS with HPE, it was found that statistically significant difference exists with P value of 0.007. Conclusion: MRS of the spinal cord is a promising tool for research and diagnosis because it can provide additional information complementary to other non-invasive imaging methods. It is an emerging tool and adds new biomarker information for characterization of spinal cord tumors, to differentiate benign from malignant lesions and to prevent unnecessary biopsies and surgeries.

Keywords

Spinal cord tumors - spinal MR spectroscopy - 3 Tesla

• References

• 1 Abul-Kasim K, Thurner MM, McKeever P, Sundgren PC. Intradural spinal tumours: current classification and MRI features. Neuroradiology 2008; 50: 301-14
• 2 Seo HS, Kim JH, Lee DH, Lee YH, Suh SI, Kim SY. et al Non enhancing intramedullary astrocytomas and other MR imaging features: A retrospective study and systematic review. Am J Neuroradiol 2010; 31: 498-503
• 3 Preul MC, Caramanos Z, Collins DL, Villemure JG, Leblanc R, Olivier A. et al. Accurate, noninvasive diagnosis of human brain tumors by using proton magnetic resonance spectroscopy. Nat Med 1996; 2: 323-5
• 4 Kollias S, Goldstein R, Cogen P, Filly RA. Prenatally detected myelomeningoceles: sonographic accuracy in estimation of the spinal level. Radiology 1992; 185: 109-12
• 5 Dydak U, Kollias S, Schär M, Meier D, Boesiger P. et al. MR spectroscopy in different regions of the spinal cord and in spinal cord tumours. In: Proceedings of the Annual Meeting of the International Society of Magnetic Resonance in Medicine, Miami Beach, FL. USA 2005; p: 813
• 6 Baker KB, Moran CJ, Wippold FJ, Smirniotopoulos JG, Rodriguez FJ, Meyers SP. et al. MR imaging of spinal hemangioblastoma. Am J Roentgenol 2000; 174: 377-82
• 7 Marliani AF, Clementi V, Babu Peter S, Agati R, Carpenzano M, Salvi F. et al. Quantitative cervical spinal cord 3T proton MR spectroscopy in multiple sclerosis. Am J Neuroradiol 2010; 31: 180-4
• 8 Henning A, Schär M, Kollias SS, Boesiger P, Dydak U. Quantitative magnetic resonance spectroscopy in the entire human cervical spinal cord and beyond at 3T. Magn Reson Med 2008; 59: 1250-8
• 9 Kendi AT, Tan FU, Kendi M, Yilmaz S, Huvaj S, Tellioğlu S. et al. MR spectroscopy of cervical spinal cord in patients with multiple sclerosis. Nauroradiol 2004; 46: 764-9
• 10 Henning A, Schär M, Kollias SS, Boesiger P, Dydak U. Quantitative magnetic resonance spectroscopy in the entire human cervical spinal cord and beyond at 3T. Magn Reson Med 2008; 59: 1250-8
• 11 Loth F, Yardimci MA, Alperin N. Hydrodynamic modeling of cerebrospinal fluid motion within the spinal cavity. J Biomech Eng 2001; 123: 71-9
• 12 Freitas B, Holly LT, Mc Arthur DL, Salamon N. Proton magneticresonance spectroscopy to evaluate spinal cord axonal injury in cervical spondylotic myelopathy. J Neurosurg Spine 2009; 10: 194-200
• 13 Rapalino O, Law M, Salibi N JS Babb, Smith, Hesse L. Metabolite changes from MR spectroscopy in the cervical spinal cord in patients with cervical spondylosis. In: Proceedings of the AnnualMeeting of theInternational Society of Magnetic Resonance in Medicine, Seattle, Washington, DC. 2006 May 6–12. p. 3139.
• 14 Cooke FJ, Blamire AM, Manners DN, Styles P, Rajagopalan B. et al. Quantitative proton magnetic resonance spectroscopy of the cervical spinal cord. MagnReson Med 2004; 51: 1122-8
• 15 Carew JD, Nair G, Pineda-Alonso N, Usher S, Hu X, Benatar M. et al. Magnetic resonance spectroscopy of the cervical cord in amyotrophic lateral sclerosis. Amyotroph Lateral Scler 2011; 12: 185
• 16 De Vita E, Kachramanoglou C, Wheeler-Kingshott CA. Spinal cord 1H-MR spectroscopy in patients after brachial plexus root reimplantation. In: Proceedings of the Annual Meeting of the International Society of Magnetic Resonance in Medicine, Montreal, Quebec, Canada. 2011;May 7-13, p. 4290.
• 17 Smith AB, Soderlund KA, Rushing EJ, Smirniotopolous JG. Radiologic and pathologic correlation of pediatric and adolescent spinal neoplasms: Part 1, intramedullary spinal neoplasm. Am J Roentgenol 2012; 198: 34-43
• 18 Hock A, Henning A, Boesiger P, Kollias SS.. 1H-MR spectroscopy in the human spinal cord. Am J Neuroradiol 2013; 34: 1682-9
• 19 Kim YG, Choi GH, Kim DH, Kim YD, Kang YK, Kim J. et al. In vivo proton magnetic resonance spectroscopy of human spinal mass lesions. J Spinal DisordTech 2004; 17: 405-11