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Semin Musculoskelet Radiol 2007; 11(3): 240-245
DOI: 10.1055/s-2008-1038313
© Thieme Medical Publishers

Molecular Characterization of Musculoskeletal Tumors by Proton MR Spectroscopy

Laura M. Fayad1 , Peter B. Barker2 , David A. Bluemke2
  • 1Department of Radiology and Orthopaedic Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland
  • 2Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland
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Publication History

Publication Date:
07 February 2008 (online)

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ABSTRACT

Although conventional magnetic resonance (MR) imaging with T1, T2, and gadolinium enhancement is the primary modality used for characterizing musculoskeletal lesions, its specificity for distinguishing malignancy from nonmalignant tissue remains low. Proton MR spectroscopy (MRS) is a new approach to the evaluation of musculoskeletal lesions that offers a method of metabolic imaging with MR. With proton MRS, a footprint of metabolite concentration in a region of interest can be obtained and markers for malignancy can be detected, such as elevated concentrations of the metabolite choline. Proton MRS is one of the most promising noninvasive techniques available for molecular identification of malignant tumor markers. However, the role of MRS in the assessment of musculoskeletal tumors remains in its infancy. In this article, we discuss the technical aspects of performing proton MRS, including differences between single voxel and multivoxel technique and its advantages and limitations. We demonstrate its potential utility in the evaluation of musculoskeletal lesions through a series of examples.

KEYWORDS

Neoplasm - bone - soft tissue - MR spectroscopy

REFERENCES

  • 1 Biondetti P R, Ehman R L. Soft-tissue sarcomas: Use of textural patterns in skeletal muscle as a diagnostic feature in postoperative MR imaging.  Radiology. 1992;  183 845-848
    Google Scholar
  • 2 Vanel D, Lacombe M J, Coanet D, Kalifa C, Spielmann M, Genin J. Musculoskeletal tumors: follow-up with MR imaging after treatment with surgery and radiation therapy.  Radiology. 1987;  164 243-245
    Google Scholar
  • 3 Reuther G, Mutscheler W. Detection of local recurrent disease in musculoskeletal tumors: magnetic resonance imaging versus computed tomography.  Skeletal Radiol. 1990;  19 85-89
    PubMedGoogle Scholar
  • 4 De Schepper A M, De Beuckeleer L, Vandevenne J, Somville J. Magnetic resonance imaging of soft tissue tumors.  Eur Radiol. 2000;  10 213-222
    CrossrefPubMedGoogle Scholar
  • 5 Ilaslan H, Sundaram M. Advances in musculoskeletal tumor imaging.  Orthop Clin North Am. 2006;  37 375-391
    CrossrefPubMedGoogle Scholar
  • 6 Crim J R, Seeger L L, Yao L, Chandnani V, Eckardt J J. Diagnosis of soft-tissue masses with MR imaging: can benign masses be differentiated from malignant ones?.  Radiology. 1992;  185 581-586
    CrossrefPubMedGoogle Scholar
  • 7 Kransdorf M J, Murphey M D. Radiologic evaluation of soft-tissue masses: a current perspective.  AJR Am J Roentgenol. 2000;  175 575-587
    CrossrefPubMedGoogle Scholar
  • 8 Berquist T H, Ehman R L, King B F, Hodgman C G, Ilstrup D M. Value of MR imaging in differentiating benign from malignant soft-tissue masses: study of 95 lesions.  AJR Am J Roentgenol. 1990;  155 1251-1255
    PubMedGoogle Scholar
  • 9 May D A, Good R B, Smith D K, Parsons T W. MR imaging of musculoskeletal tumors and tumor mimickers with intravenous gadolinium: experience with 242 patients.  Skeletal Radiol. 1997;  26 2-15
    CrossrefPubMedGoogle Scholar
  • 10 Castillo M, Kwock L, Mukherji S K. Clinical applications of proton MR spectroscopy.  AJNR Am J Neuroradiol. 1996;  17 1-15
    PubMedGoogle Scholar
  • 11 Miller B L. A review of chemical issues in 1H NMR spectroscopy: N-acetyl-L-aspartate, creatine and choline.  NMR Biomed. 1991;  4 47-52
    PubMedGoogle Scholar
  • 12 Kwock L, Smith J K, Smith J K et al.. Clinical role of proton magnetic resonance spectroscopy in oncology: brain, breast, and prostate cancer.  Lancet Oncol. 2006;  7 859-868
    CrossrefPubMedGoogle Scholar
  • 13 Oya N, Aoki J, Shinozaki T, Watanabe H, Takagishi K, Endo K. Preliminary study of proton magnetic resonance spectroscopy in bone and soft tissue tumors: an unassigned signal at 2.0-2.1 ppm may be a possible indicator of malignant neuroectodermal tumor.  Radiat Med. 2000;  18 193-198
    PubMedGoogle Scholar
  • 14 Fayad L M, Bluemke D A, McCarthy E F, Weber K L, Barker P B, Jacobs M A. Musculoskeletal tumors: use of proton MR spectroscopic imaging for characterization.  J Magn Reson Imaging. 2006;  23 23-28
    CrossrefPubMedGoogle Scholar
  • 15 Wang C K, Li C W, Hsieh T J, Chien S H, Liu G C, Tsai K B. Characterization of bone and soft-tissue tumors with in vivo 1H MR spectroscopy: initial results.  Radiology. 2004;  232 599-605
    CrossrefPubMedGoogle Scholar
  • 16 Fayad L M, Barker P B, Jacobs M A et al.. Characterization of musculoskeletal lesions on 3-T proton MR spectroscopy.  AJR Am J Roentgenol. 2007;  188 1513-1520
    CrossrefPubMedGoogle Scholar
  • 17 Gonen O, Gruber S, Li B S, Mlynarik V, Moser E. Multivoxel 3D proton spectroscopy in the brain at 1.5 versus 3.0 T: signal-to-noise ratio and resolution comparison.  AJNR Am J Neuroradiol. 2001;  22 1727-1731
    PubMedGoogle Scholar
  • 18 Futterer J J, Scheenen T W, Huisman H J et al.. Initial experience of 3 tesla endorectal coil magnetic resonance imaging and 1H-spectroscopic imaging of the prostate.  Invest Radiol. 2004;  39 671-680
    CrossrefPubMedGoogle Scholar
  • 19 Li C W, Kuo Y C, Chen C Y et al.. Quantification of choline compounds in human hepatic tumors by proton MR spectroscopy at 3 T.  Magn Reson Med. 2005;  53 770-776
    CrossrefPubMedGoogle Scholar
  • 20 Katz-Brull R, Rofsky N M, Lenkinski R E. Breathhold abdominal and thoracic proton MR spectroscopy at 3T.  Magn Reson Med. 2003;  50 461-467
    CrossrefPubMedGoogle Scholar
  • 21 Bolan P J, Meisamy S, Baker E H et al.. In vivo quantification of choline compounds in the breast with 1H MR spectroscopy.  Magn Reson Med. 2003;  50 1134-1143
    CrossrefPubMedGoogle Scholar
  • 22 Baik H M, Su M Y, Yu H et al.. Quantification of choline-containing compounds in malignant breast tumors by 1H MR spectroscopy using water as an internal reference at 1.5 T.  MAGMA. 2006;  19 96-104
    PubMedGoogle Scholar
  • 23 Verstraete K L, Lang P. Bone and soft tissue tumors: the role of contrast agents for MR imaging.  Eur J Radiol. 2000;  34 229-246
    CrossrefPubMedGoogle Scholar
  • 24 Shapeero L G, Vanel D, Verstraete K L, Bloem J L. Dynamic contrast-enhanced MR imaging for soft tissue sarcomas.  Semin Musculoskelet Radiol. 1999;  3 101-114
    PubMedGoogle Scholar
  • 25 van der Woude H J, Bloem J L, Hogendoorn P C. Preoperative evaluation and monitoring chemotherapy in patients with high-grade osteogenic and Ewing's sarcoma: review of current imaging modalities.  Skeletal Radiol. 1998;  27 57-71
    CrossrefPubMedGoogle Scholar
  • 26 Reddick W E, Taylor J S, Fletcher B D. Dynamic MR imaging (DEMRI) of microcirculation in bone sarcoma.  J Magn Reson Imaging. 1999;  10 277-285
    CrossrefPubMedGoogle Scholar
  • 27 Reddick W E, Bhargava R, Taylor J S, Meyer W H, Fletcher B D. Dynamic contrast-enhanced MR imaging evaluation of osteosarcoma response to neoadjuvant chemotherapy.  J Magn Reson Imaging. 1995;  5 689-694
    CrossrefPubMedGoogle Scholar
  • 28 Kumar M, Jagannathan N R, Seenu V, Dwivedi S N, Julka P K, Rath G K. Monitoring the therapeutic response of locally advanced breast cancer patients: sequential in vivo proton MR spectroscopy study.  J Magn Reson Imaging. 2006;  24 325-332
    CrossrefPubMedGoogle Scholar
  • 29 Madhu B, Waterton J C, Griffiths J R, Ryan A J, Robinson S P. The response of RIF-1 fibrosarcomas to the vascular-disrupting agent ZD6126 assessed by in vivo and ex vivo 1H magnetic resonance spectroscopy.  Neoplasia. 2006;  8 560-567
    CrossrefPubMedGoogle Scholar
  • 30 Alexander A, Murtha A, Abdulkarim B et al.. Prognostic significance of serial magnetic resonance spectroscopies over the course of radiation therapy for patients with malignant glioma.  Clin Invest Med. 2006;  29 301-311
    PubMedGoogle Scholar

Laura M FayadM.D. 

Department of Radiology and Orthopaedic Surgery, Johns Hopkins Medical Institutions

601 N. Wolfe St., Baltimore, MD 21287

Email: lfayad1@jhmi.edu

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