Characterization of peripheral nerve sheath tumors with 3T proton MR spectroscopy

Laura M. Fayad, X. Wang, J. O. Blakeley, D. J. Durand, M. A. Jacobs, S. Demehri, Ty Subhawong, T. Soldatos, P. B. Barker

Research output: Contribution to journalArticle

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Abstract

BACKGROUND AND PURPOSE: The characterization of peripheral nerve sheath tumors is challenging. The purpose here was to investigate the diagnostic value of quantitative proton MR spectroscopy at 3T for the characterization of peripheral nerve sheath tumors as benign or malignant, compared with PET. MATERIALS AND METHODS: Twenty participants with 24 peripheral nerve sheath tumors underwent MR spectroscopy by use of a point-resolved sequence (TE, 135 ms). Six voxels were placed in 4 histologically proven malignant peripheral nerve sheath tumors and 22 voxels in 20 benign peripheral nerve sheath tumors (9 histologically proven, 11 with documented stability). The presence or absence of a trimethylamine signal was evaluated, the trimethylamine concentration estimated by use of phantom replacement methodology, and the trimethylamine fraction relative to Cr measured. MR spectroscopy results for benign and malignant peripheral nerve sheath tumors were compared by use of a Mann-Whitney test, and concordance or discordance with PET findings was recorded. RESULTS: In all malignant tumors and in 9 of 18 benign peripheral nerve sheath tumors, a trimethylamine peak was detected, offering the presence of trimethylamine as a sensitive (100%), but not specific (50%), marker of malignant disease. Trimethylamine concentrations (2.2 ± 2.8 vs 6.6 ± 5.8 institutional units; P < .049) and the trimethylamine fraction (27 ± 42 vs 88 ± 22%; P < .012) were lower in benign than malignant peripheral nerve sheath tumors. A trimethylamine fraction threshold of 50% resulted in 100% sensitivity (95% CI, 58.0%-100%) and 72.2% (95% CI, 59.5%-75%) specificity for distinguishing benign from malignant disease. MR spectroscopy and PET results were concordant in 12 of 16 cases, (2 false-positive results for MR spectroscopy and PET each). CONCLUSIONS: Quantitative measurement of trimethylamine concentration by use ofMRspectroscopy is feasible in peripheral nerve sheath tumors and shows promise as a method for the differentiation of benign and malignant lesions. Trimethylamine presence within a peripheral nerve sheath tumor is a sensitive marker of malignant disease, but quantitative measurement of trimethylamine content is required to improve specificity.

Original languageEnglish
Pages (from-to)1035-1041
Number of pages7
JournalAmerican Journal of Neuroradiology
Volume39
Issue number5
DOIs
StatePublished - Jan 1 2014

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Nerve Sheath Neoplasms
Protons
Magnetic Resonance Spectroscopy
Neurilemmoma
trimethylamine

ASJC Scopus subject areas

  • Clinical Neurology
  • Radiology Nuclear Medicine and imaging

Cite this

Fayad, L. M., Wang, X., Blakeley, J. O., Durand, D. J., Jacobs, M. A., Demehri, S., ... Barker, P. B. (2014). Characterization of peripheral nerve sheath tumors with 3T proton MR spectroscopy. American Journal of Neuroradiology, 39(5), 1035-1041. https://doi.org/10.3174/ajnr.A3778

Characterization of peripheral nerve sheath tumors with 3T proton MR spectroscopy. / Fayad, Laura M.; Wang, X.; Blakeley, J. O.; Durand, D. J.; Jacobs, M. A.; Demehri, S.; Subhawong, Ty; Soldatos, T.; Barker, P. B.

In: American Journal of Neuroradiology, Vol. 39, No. 5, 01.01.2014, p. 1035-1041.

Research output: Contribution to journalArticle

Fayad, LM, Wang, X, Blakeley, JO, Durand, DJ, Jacobs, MA, Demehri, S, Subhawong, T, Soldatos, T & Barker, PB 2014, 'Characterization of peripheral nerve sheath tumors with 3T proton MR spectroscopy', American Journal of Neuroradiology, vol. 39, no. 5, pp. 1035-1041. https://doi.org/10.3174/ajnr.A3778
Fayad LM, Wang X, Blakeley JO, Durand DJ, Jacobs MA, Demehri S et al. Characterization of peripheral nerve sheath tumors with 3T proton MR spectroscopy. American Journal of Neuroradiology. 2014 Jan 1;39(5):1035-1041. https://doi.org/10.3174/ajnr.A3778
Fayad, Laura M. ; Wang, X. ; Blakeley, J. O. ; Durand, D. J. ; Jacobs, M. A. ; Demehri, S. ; Subhawong, Ty ; Soldatos, T. ; Barker, P. B. / Characterization of peripheral nerve sheath tumors with 3T proton MR spectroscopy. In: American Journal of Neuroradiology. 2014 ; Vol. 39, No. 5. pp. 1035-1041.
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abstract = "BACKGROUND AND PURPOSE: The characterization of peripheral nerve sheath tumors is challenging. The purpose here was to investigate the diagnostic value of quantitative proton MR spectroscopy at 3T for the characterization of peripheral nerve sheath tumors as benign or malignant, compared with PET. MATERIALS AND METHODS: Twenty participants with 24 peripheral nerve sheath tumors underwent MR spectroscopy by use of a point-resolved sequence (TE, 135 ms). Six voxels were placed in 4 histologically proven malignant peripheral nerve sheath tumors and 22 voxels in 20 benign peripheral nerve sheath tumors (9 histologically proven, 11 with documented stability). The presence or absence of a trimethylamine signal was evaluated, the trimethylamine concentration estimated by use of phantom replacement methodology, and the trimethylamine fraction relative to Cr measured. MR spectroscopy results for benign and malignant peripheral nerve sheath tumors were compared by use of a Mann-Whitney test, and concordance or discordance with PET findings was recorded. RESULTS: In all malignant tumors and in 9 of 18 benign peripheral nerve sheath tumors, a trimethylamine peak was detected, offering the presence of trimethylamine as a sensitive (100{\%}), but not specific (50{\%}), marker of malignant disease. Trimethylamine concentrations (2.2 ± 2.8 vs 6.6 ± 5.8 institutional units; P < .049) and the trimethylamine fraction (27 ± 42 vs 88 ± 22{\%}; P < .012) were lower in benign than malignant peripheral nerve sheath tumors. A trimethylamine fraction threshold of 50{\%} resulted in 100{\%} sensitivity (95{\%} CI, 58.0{\%}-100{\%}) and 72.2{\%} (95{\%} CI, 59.5{\%}-75{\%}) specificity for distinguishing benign from malignant disease. MR spectroscopy and PET results were concordant in 12 of 16 cases, (2 false-positive results for MR spectroscopy and PET each). CONCLUSIONS: Quantitative measurement of trimethylamine concentration by use ofMRspectroscopy is feasible in peripheral nerve sheath tumors and shows promise as a method for the differentiation of benign and malignant lesions. Trimethylamine presence within a peripheral nerve sheath tumor is a sensitive marker of malignant disease, but quantitative measurement of trimethylamine content is required to improve specificity.",
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AU - Wang, X.

AU - Blakeley, J. O.

AU - Durand, D. J.

AU - Jacobs, M. A.

AU - Demehri, S.

AU - Subhawong, Ty

AU - Soldatos, T.

AU - Barker, P. B.

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N2 - BACKGROUND AND PURPOSE: The characterization of peripheral nerve sheath tumors is challenging. The purpose here was to investigate the diagnostic value of quantitative proton MR spectroscopy at 3T for the characterization of peripheral nerve sheath tumors as benign or malignant, compared with PET. MATERIALS AND METHODS: Twenty participants with 24 peripheral nerve sheath tumors underwent MR spectroscopy by use of a point-resolved sequence (TE, 135 ms). Six voxels were placed in 4 histologically proven malignant peripheral nerve sheath tumors and 22 voxels in 20 benign peripheral nerve sheath tumors (9 histologically proven, 11 with documented stability). The presence or absence of a trimethylamine signal was evaluated, the trimethylamine concentration estimated by use of phantom replacement methodology, and the trimethylamine fraction relative to Cr measured. MR spectroscopy results for benign and malignant peripheral nerve sheath tumors were compared by use of a Mann-Whitney test, and concordance or discordance with PET findings was recorded. RESULTS: In all malignant tumors and in 9 of 18 benign peripheral nerve sheath tumors, a trimethylamine peak was detected, offering the presence of trimethylamine as a sensitive (100%), but not specific (50%), marker of malignant disease. Trimethylamine concentrations (2.2 ± 2.8 vs 6.6 ± 5.8 institutional units; P < .049) and the trimethylamine fraction (27 ± 42 vs 88 ± 22%; P < .012) were lower in benign than malignant peripheral nerve sheath tumors. A trimethylamine fraction threshold of 50% resulted in 100% sensitivity (95% CI, 58.0%-100%) and 72.2% (95% CI, 59.5%-75%) specificity for distinguishing benign from malignant disease. MR spectroscopy and PET results were concordant in 12 of 16 cases, (2 false-positive results for MR spectroscopy and PET each). CONCLUSIONS: Quantitative measurement of trimethylamine concentration by use ofMRspectroscopy is feasible in peripheral nerve sheath tumors and shows promise as a method for the differentiation of benign and malignant lesions. Trimethylamine presence within a peripheral nerve sheath tumor is a sensitive marker of malignant disease, but quantitative measurement of trimethylamine content is required to improve specificity.

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