Acumulado Enero - Diciembre 2023 (93 - 96) 93
ISSN 1317-987X
 
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Imagenología
¹H Magnetic Resonance Spectroscopy demonstrates different metabolic features in Gliomatosis Cerebri

Discussion

MRS allowed us to report at least three main patterns in this GC case. The raise of the mI/Cr ratio, the increase or unaffected Cho/Cr ratio and the presence of Lac and Lip in many combination at the GC affected areas conforms the looks of the different spectral patterns. Figure 2 exhibit a totally inverted profile according to Hunter´s angle rule (HA) (HA < −50°) (4) in which the prominent peak is represented by the mI signal. Gliosis and cell proliferation are probably occurring according with the observed evidence. Previous studies have reported an increase of the mI-Gly/Cr ratio in GC (5-7) and in Low Grade Astrocytoma (8). The potential explanations for this increase are not trivial. Some authors have proposed that the high mI concentration observed in Astrocytoma could be consistent with the idea that mI is a marker for astrocytes (9). As for Astrocytoma, a considerable variation of mI in individual cases was observed. It has been recognized that the mI/Cr ratio is significantly greater in Low Grade Astrocytoma than in normal brain, Anaplastic Astrocytoma, and Glioblastoma Multiforme (10). Our GC case resemble similar spectroscopic characteristics than Low Grade Astrocytoma at the voxels located between the two brain hemispheres. The increase of mI/Cr ratio in Low Grade Astrocytomas could be related to another hypothesis which postulates that mI could be taken as a glial marker (11). In Figure 3, the spectra shows similar characteristics than the one present at Figure 2 with the main difference that the intensity signal for NAA is higher and close to the mI signal value. As well as presented in Figure 2, the Figure 3 denotes an elevated value for Cho/Cr ratio. In pathologically proven adult and pediatric brain tumors, higher Cho concentration was correlated with more malignant lesions (12). Also, in malignant Gliomas, higher Cho levels (expressed relative to Cr or NAA) correlated with shorter survival. Based on these and similar studies, the suggestion has been made that higher levels of Cho metabolites are associated with increased rates of membrane synthesis and cell proliferation. Data extracted from Figure 4 allow us to speculate about the heterogeneous nature of the cells present at the GC. The decrease of the Cho/Cr ratio observed in Figure 4 in comparison with Figure 3, probably suggests a less mitotic index for the tumour cells located at the left side in comparison with the ones at right side of the GC lesion. Common findings showed in Figures 2, 3 and 4 were the presence of signals for Lac and Lip. The presence of Lac in Brain Tumors has been attributed to a tumor-specific metabolism with increased anaerobic glycolysis as a result of ischemic compromise probably due to reduced perfusion mostly in solid tumors. Lac is present also in lesions that contain necrotic regions. GC regions explored in our study often include portions of necrotic tissue due to the heterogeneous nature of the lesion. Therefore, Lac signal intensity in tumor spectra must be interpreted carefully and require verification using long echo time as we did in our study. Previous paper has reported Lac in all tumor types. The lowest Lac levels has been observed in Low Grade Choroid Plexus Papilloma and Pineal Germinoma while the prominent levels have been detected in Pilocytic Astrocytoma and Malignant Medulloblastoma (12) . The Lip signal intensity origin is thought to be the mobile lipid molecules as a result of tissue degradation and necrosis and they it be elevated under hypoxic stress prior to necrosis (13). This is more likely to occur in rapidly dividing tumors that outgrow their blood supply such as Glioblastomas that could be display some characteristics of portions of the GC case discussed in this paper. The current GC case is similar to previous published papers (5-7, 14-16). Thus, the different profiles obtained using short echo time demonstrate that MRS may provide a useful tool to characterize the metabolic features of GC and therefore could be used for assessing the future proposed treatments. Further studies are needed to link the elevation of the mI/Cr ratio with the underlying pathophysiology of GC.




Continua: References

¹H Magnetic Resonance Spectroscopy demonstrates different metabolic features in Gliomatosis Cerebri
Introduction
Materials and methods
Results
Discussion
References

NOTA: Toda la información que se brinda en este artículo es de carácter investigativo y con fines académicos y de actualización para estudiantes y profesionales de la salud. En ningún caso es de carácter general ni sustituye el asesoramiento de un médico. Ante cualquier duda que pueda tener sobre su estado de salud, consulte con su médico o especialista.





Instituto de Medicina Tropical - Facultad de Medicina - Universidad Central de Venezuela.
Elaborado por el Centro de Análisis de Imágenes Biomédicas Computarizadas CAIBCO,
caibco@ucv.ve
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