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MRS of oligodendroglial tumors

Correlation with histopathology and genetic subtypes

From the Departments of Neurosurgery (Drs. Jenkinson and Warnke) and Neuroradiology (Dr. Smith), The Walton Centre for Neurology and Neurosurgery, Liverpool, UK; Department of Neurological Science (Drs. Jenkinson, du Plessis, and Warnke), University of Liverpool, Liverpool, UK; Department of Neuropathology (Dr. du Plessis), Hope Hospital, Salford, UK; Clatterbridge Cancer Research Trust (K. Joyce and D. Fildes, Dr. Walker), JK Douglas Laboratories, Clatterbridge Hospital, Bebington, Wirral, UK.

Address correspondence and reprint requests to Dr Jenkinson, Department of Neurologic Science, University of Liverpool, Clinical Science Centre, Lower Lane, Liverpool L9 7LJ, UK; e-mail: michael.jenkinson{at}liv.ac.uk

Background: Oligodendroglial neoplasms with combined loss of chromosomes 1p and 19q may have a good prognosis and respond to procarbazine-lomustine (CCNU)-vincristine

(PCV) chemotherapy.

Objective: To determine whether single voxel magnetic resonance spectroscopy (SV-MRS) obtained through routine clinical practice distinguishes between histopathologic and genetic subtypes of oligodendroglial tumors.

Methods: Forty-eight patients with oligodendroglial tumors (19 oligodendrogliomas and 29 oligoastrocytomas) underwent molecular genetic analysis to determine allelic imbalance in chromosomes 1p36 and 19q13. SV-MRS was obtained pretherapy to determine tumor metabolite ratios.

Results: Grade III oligodendroglial tumors had higher choline (Mann–Whitney; p = 0.002), methyl lipid (Mann–Whitney; p = 0.002), and combined methylene lipid and lactate ratios (Mann–Whitney; p < 0.001) than grade II tumors. Lactate did not distinguish between tumor types (Fisher exact test; p = 0.342) or grade (Fisher exact test; p = 0.452). There were no significant associations when tumors were analyzed according to histopathology or genetic subtypes.

Conclusion: As a noninvasive diagnostic tool used in routine clinical practice, SV-MRS has the potential benefit of determining oligodendroglial tumor grade but not subtypes classified by histopathology or molecular genetics. MRS may be useful for determining the timing of therapy but is unlikely to predict chemosensitivity.

Additional material related to this article can be found on the Neurology Web site. Go to www.neurology.org and scroll down the Table of Contents for the June 28 issue to find the link for this article.

Supported by Clatterbridge Cancer Research Trust and The Walton Centre for Neurology and Neurosurgery Neuroscience Fund.

Received October 20, 2004. Accepted in final form March 14, 2005.

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