Mark C. Preul, MD, Barrow Neurological Institute presents: "Meningiomas assessed with ex vivo NMR and in vivo 3D 1H-magnetic resonance spectroscopy: Determining biochemical markers of clinically aggressive behavior and providing a resection advantage."
Explorations of human cerebral tumors using magnetic resonance spectroscopy have yielded special insight into their in vivo metabolic processes and pointed to means that could prove helpful in treatment. Much of our work has concentrated on malignant human cerebral tumors, yet meningiomas that make up nearly one third of intracranial tumors have received comparatively less attention. I will track the progress made in using ex vivo nuclear magnetic resonance spectroscopy (NMR) of resected meningioma tissue by the BNI meningioma study collaboration showing that meningiomas are made up of biochemically heterogeneous regions, and that the quantities of various biochemical markers are correlated to specific genetic markers of aggression. The background work allowed us to test the hypothesis that in vivo, multivoxel, three-dimensional proton magnetic resonance spectroscopic imaging (3D 1H-MRSI) can be used to identify regional biochemical alterations unique to clinically aggressive meningiomas and suggest that 3D 1H-MRSI can-non-invasively-detect more aggressive regions within individual meningiomas. Non-invasive detection of various intratumoral biochemical markers using 3D 1H-MRSI can distinguish more aggressive or recurrent from newly-diagnosed meningiomas. There is significant regional heterogeneity in the concentrations of these markers within individual tumors. Furthermore, 3D 1H-MRSI can exploit these regional differences to separate more aggressive from less aggressive areas within a given meningioma, and can be incorporated into a standard neurosurgical image-guidance platform to be used intraoperatively. Such knowledge may be useful to the neurosurgeon faced with the task of meningioma resection, and in planning adjuvant therapy for residual meningioma tissue following subtotal removal.
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