Magnetic resonance spectroscopy (MRS) in the evaluation of pediatric brain tumors, Part II: Clinical analysis

Over a 1-year period (1994-1995), 75 children with brain neoplasms were evaluated with a new automated magnetic resonance spectroscopy (MRS) software package called Proton Brain Exam/Single-Voxel (PROBE/SV) to determine the efficacy of this modality in children. The children ranged in age from newborn to 17 years and were comprised of 30 girls and 45 boys. The types of brain neoplasms consisted of 45 astrocytomas, 4 medulloblastomas, 2 ependymomas, 3 craniopharyngiomas, 3 germinomas, 1 pineoblastoma, 2 teratomas, 1 choroid plexus papilloma, 4 meningiomas, 2 astroblastomas, 3 rhabdoids, and 5 metastases from primary brain neoplasms. All children underwent magnetic resonance imaging (MRI) at the same setting as the MRS examination. The MRS examination was performed with the stimulated echo acquisition mode (STEAM) pulse sequence in all children, and occasionally the point resolved spectroscopy (PRESS) sequence also was used. Qualitative spectra were obtained in all children, and at times quantification data also were obtained. We found that our spectra over the brain neoplasms were consistent with the MRS findings of brain neoplasms in the literature. There was markedly elevated choline with markedly decreased or absent N-acetylasparate and at times elevated lactate and lipid peaks. In children with meningiomas, there was also an elevated alanine peak. We found MRS to be extremely useful in 1) characterizing a brain mass as a neoplasm, 2) differentiating radiation necrosis and radiation-induced meningiomas from the recurrent primary tumor, 3) following treatment response of the primary neoplasm, 4) differentiating residual or recurrent primary neoplasm from postsurgical changes, and 5) identifying inactive neoplasms or neoplasms in remission.