Abstract
The present case report was aimed at identifying the molecular profile characteristic of a primitive neuro-ectodermal tumor (PNET) in a 3-year-old child affected by a lesion localized in the cerebellar region. The histological diagnosis was medulloblastoma. In vivo single voxel 1H magnetic resonance spectroscopy (MRS) shows high specificity in detecting the main metabolic alterations in the primitive cerebellar lesion; a very high amount of the choline-containing compounds and very low level of creatine derivatives and N-acetylaspartate. Ex vivo high resolution magic angle spinning (HR-MAS) 1H magnetic resonance spectroscopy, performed at 9.4 Tesla on the neoplastic specimen collected during surgery, allows for the unambiguous identification of several metabolites giving a more in-depth evaluation of the metabolic pattern of the lesion. The ex vivo HR-MAS MR spectra show that the spectral detail is much higher than that obtained in vivo and that, for example, myo-inositol, taurine and phosphorylethanolamine contribute to the in vivo signal at 3.2 ppm, usually attributed to choline-containing compounds. In addition, the spectroscopic data appear to correlate with some morphological features of the medulloblastoma. Consequently, the present study shows that ex vivo HR-MAS 1H MRS is able to strongly improve the clinical possibility of in vivo MRS and can be used in conjunction with in vivo spectroscopy for clinical purposes.
Highlights
In clinical examinations, in vivo magnetic resonance spectroscopy (MRS) is a non-invasive method to detect the biochemical changes accompanying the disease
Ex vivo high resolution magic angle spinning (HR-MAS) 1H magnetic resonance spectroscopy, performed at 9.4 Tesla on the neoplastic specimen collected during surgery, allows for the unambiguous identification of several metabolites giving a more in-depth evaluation of the metabolic pattern of the lesion
We present a case where a comparison between in vivo single voxel and ex vivo HR-MAS 1H MRS was performed on a child affected by medulloblastoma
Summary
In vivo magnetic resonance spectroscopy (MRS) is a non-invasive method to detect the biochemical changes accompanying the disease. A 3-year-old child was admitted to the hospital because of persistent headaches, which started 1 month previously, and a refusal to eat due to persistent nausea He underwent magnetic resonance imaging (MRI) and in vivo 1H MRS of the head on a 1.5 Tesla clinical imager (Philips Intera, Best, Netherlands), which revealed an intracranial tumor occupying most of the left portion of the posterior fossa. Two-dimensional (2D) 1H,1H-total correlation spectroscopy (TOCSY), [17,18] spectra were acquired using a standard pulse sequence (mlevphpr) and 1 sec water-presaturation during relaxation delay, 100 ms mixing (spin-lock) time, 4 kHz spectral width, 4k data points, 32 scans per increment, 128 increments. Two-dimensional 1H,13C-heteronuclear single quantum coherence (HSQC) [19] were acquired using a echoantiecho phase sensitive standard pulse sequence (hsqcetgp) and 0.5 sec relaxation delay, 1.725 ms evolution time, 4 kHz spectral width in f2, 4k data points, 128 scans per increment, 17 kHz spectral width in f1, 256 increments
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