Potential of Magnetic Resonance Spectroscopy for Radiotherapy Planning

  • Andrea Pirzkall
Part of the Medical Radiology book series (MEDRAD)

10.4 Conclusion

MRSI has the potential to provide metabolic evidence of tumor activity that may be an important guide for therapeutic decisions. The treatment planning process and treatment planning systems should therefore have the ability to incorporate both metabolic and anatomic data in order to determine appropriate target volumes. Many problems need to be addressed and much work needs to be done in order to determine the optimal way to incorporate indices of metabolic activity, especially in light of newer treatment techniques such as IMRT; however, it is the present author’s belief that strong consideration should be given to the incorporation of functional imaging into the treatment process for focal or boost treatments for brain and prostate tumors. Given the discrepancies that have been found between MRI and MRSI determinants of target volumes, the results of controlled dose escalation studies for malignant tumors of the brain that have used MRI-derived target volumes should also be reevaluated given the possibility that these volumes may have been suboptimally defined.


Radiat Oncol Biol Phys Intensity Modulate Radiation Therapy Gamma Knife Magn Reson Image Recurrent Glioma 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. Aboagye EO, Bhujwalla ZM (1999) Malignant transformation alters membrane choline phospholipid metabolism of human mammary epithelial cells. Cancer Res 59:80–84PubMedGoogle Scholar
  2. Bleehen NM, Stenning SP (1991) A Medical Research Council trial of two radiotherapy doses in the treatment of grades 3 and 4 astrocytoma. The Medical Research Council Brain Tumour Working Party. Br J Cancer 64:769–774Google Scholar
  3. Burger PC, Heinz ER, Shibata T et al. (1988) Topographic anatomy and CT correlations in the untreated glioblastoma multiforme. J Neurosurg 68:698–704PubMedGoogle Scholar
  4. Chamberlain MC, Barba D, Kormanik P et al. (1994) Stereotactic radiosurgery for recurrent gliomas. Cancer 74:1342–1347PubMedGoogle Scholar
  5. Chan AA, Lau A, Pirzkall A et al. (2004) 1H-MRSI as a tool for evaluating grade IV glioma patients undergoing gamma knife radiosurgery. J Neurosurg 101:467–475PubMedGoogle Scholar
  6. Chan JL, Lee SW, Fraass BA et al. (2002) Survival and failure patterns of high-grade gliomas after three-dimensional conformal radiotherapy. J Clin Oncol 20:1635–1642PubMedGoogle Scholar
  7. Chuang C, Chan AA, Larson DL et al. (2004) Prognostic value of pre-Gamma Knife MR spectroscopic imaging for treatment strategy and clinical outcome. Int J Radiat Oncol Biol Phys (Abstract)Google Scholar
  8. Coakley FV, Teh BS, Quayyum A et al. (2004) Endorectal MR and MR spectroscopic imaging of locally recurrent prostate cancer after external beam radiation therapy: preliminary experience. Radiology 233:441–448PubMedGoogle Scholar
  9. Costello LC, Franklin RB (1991a) Concepts of citrate production and secretion by prostate. 1. Metabolic relationships. Prostate 18:25–46PubMedGoogle Scholar
  10. Costello LC, Franklin RB (1991b) Concepts of citrate production and secretion by prostate. 2. Hormonal relationships in normal and neoplastic prostate. Prostate 19:181–205PubMedGoogle Scholar
  11. Crook JM, Perry GA, Robertson S et al. (1995) Routine prostate biopsies following radiotherapy for prostate cancer: results for 226 patients. Urology 45:624–631PubMedCrossRefGoogle Scholar
  12. D’Amico AV, Schnall M, Whittington R et al. (1998) Endorectal coil magnetic resonance imaging identifies locally advanced prostate cancer in select patients with clinically localized disease. Urology 51:449–454PubMedGoogle Scholar
  13. Esteve F, Rubin C, Grand S et al. (1998) Transient metabolic changes observed with proton MR spectroscopy in normal human brain after radiation therapy. Int J Radiat Oncol Biol Phys 40:279–286PubMedGoogle Scholar
  14. Fitzek MM, Thornton AF, Rabinov JD et al. (1999) Accelerated fractionated proton/photon irradiation to 90 cobalt gray equivalent for glioblastoma multiforme: results of a phase II prospective trial. J Neurosurg 91:251–260PubMedGoogle Scholar
  15. Garden AS, Maor MH, Yung WK et al. (1991) Outcome and patterns of failure following limited-volume irradiation for malignant astrocytomas. Radiother Oncol 20:99–110PubMedCrossRefGoogle Scholar
  16. Graves EE, Nelson SJ, Vigneron DB et al. (2000) A preliminary study of the prognostic value of proton magnetic resonance spectroscopic imaging in gamma knife radiosurgery of recurrent malignant gliomas. Neurosurgery 46:319–328PubMedGoogle Scholar
  17. Graves EE, Pirzkall A, Nelson SJ et al. (2001) Registration of magnetic resonance spectroscopic imaging to computed tomography for radiotherapy treatment planning. Med Phys 28:2489–2496PubMedGoogle Scholar
  18. Gupta RK, Cloughesy TF, Sinha U et al. (2000) Relationships between choline magnetic resonance spectroscopy, apparent diffusion coefficient and quantitative histopathology in human glioma. J Neurooncol 50:215–226PubMedCrossRefGoogle Scholar
  19. Hall WA, Djalilian HR, Sperduto PW et al. (1995) Stereotactic radiosurgery for recurrent malignant gliomas. J Clin Oncol 13:1642–1648PubMedGoogle Scholar
  20. Heston WD (1991) Prostatic polyamines and polyamine targeting as a new approach to therapy of prostatic cancer. Cancer Surv 11:217–238PubMedGoogle Scholar
  21. Hirose M, Bharatha A, Hata N et al. (2002) Quantitative MR imaging assessment of prostate gland deformation before and during MR imaging-guided brachytherapy. Acad Radiol 9:906–912PubMedGoogle Scholar
  22. Hochberg FH, Pruitt A (1980) Assumptions in the radiotherapy of glioblastoma. Neurology 30:907–911PubMedGoogle Scholar
  23. Hricak H, White S, Vigneron D et al. (1994) Carcinoma of the prostate gland: MR imaging with pelvic phased-array coils versus integrated endorectal: pelvic phased-array coils. Radiology 193:703–709PubMedGoogle Scholar
  24. Jung JA, Coakley FV, Quayyum A et al. (2004) Endorectal MR spectroscopi imaging of the prostate: investigation of a standardized evaluation system. Radiology 233:701–708PubMedGoogle Scholar
  25. Kahn T, Burrig K, Schmitz-Drager B et al. (1989) Prostatic carcinoma and benign prostatic hyperplasia: MR imaging with histopathologic correlation. Radiology 173:847–851PubMedGoogle Scholar
  26. Kelly PJ, Daumas-Duport C, Kispert DB et al. (1987) Imagingbased stereotaxic serial biopsies in untreated intracranial glial neoplasms. J Neurosurg 66:865–874PubMedGoogle Scholar
  27. Kurhanewicz J, Swanson MG, Nelson SJ et al. (2002) Combined magnetic resonance imaging and spectroscopic imaging approach to molecular imaging of prostate cancer. J Magn Reson Imaging 16:451–463PubMedCrossRefGoogle Scholar
  28. Kurhanewicz J, Vigneron DB, Hricak H et al. (1996) Three-dimensional H-1 MR spectroscopic imaging of the in situ human prostate with high (0.24–0.7 cm3) spatial resolution. Radiology 198:795–805PubMedGoogle Scholar
  29. Kurhanewicz J, Vigneron DB, Nelson SJ (2000) Three-dimensional magnetic resonance spectroscopic imaging of brain and prostate cancer. Neoplasia 2:166–189PubMedCrossRefGoogle Scholar
  30. Larson DA, Gutin PH, McDermott M et al. (1996) Gamma knife for gliomas: selection factors and survival. Int J Radiat Oncol Biol Phys 36:1045–1053PubMedGoogle Scholar
  31. Lee MC, Pirzkall A, McKnight TR et al. (2004) 1H-MRSI of radiation effects in normal-appearing white matter: dosedependence and impact on automated spectral classification. J Magn Reson Imaging 19:379–388PubMedCrossRefGoogle Scholar
  32. Li X, Lu Y, Pirzkall A et al. (2002) Analysis of the spatial characteristics of metabolic abnormalities in newly diagnosed glioma patients. J Magn Reson Imaging 16:229–237PubMedGoogle Scholar
  33. Li X, Jin H, Lu Y et al. (2004) Identification of MRI and 1H MRSI parameters that may predict survival for patients with malignant gliomas. NMR Biomed 17:10–20PubMedCrossRefGoogle Scholar
  34. Liang BC, Thornton AF Jr, Sandler HM et al. (1991) Malignant astrocytomas: focal tumor recurrence after focal external beam radiation therapy. J Neurosurg 75:559–563PubMedGoogle Scholar
  35. Maire JP, Coudin B, Guérin J et al. (1987) Neuropsychologic impairment in adults with brain tumors. Am J Clin Oncol 10:156–162PubMedGoogle Scholar
  36. Marks JE, Baglan RJ, Prassad SC et al. (1981) Cerebral radionecrosis: incidence and risk in relation to dose, time, fractionation and volume. Int J Radiat Oncol Biol Phys 7:243–252PubMedGoogle Scholar
  37. McKnight TR, Noworolski SM, Vigneron DB et al. (2001) An automated technique for the quantitative assessment of 3D-MRSI data from patients with glioma. J Magn Reson Imaging 13:167–177PubMedCrossRefGoogle Scholar
  38. McKnight TR, Bussche MH von dem, Vigneron DB et al. (2002a) Histopathological validation of a three-dimensional magnetic resonance spectroscopy index as a predictor of tumor presence. J Neurosurg 97:794–802PubMedGoogle Scholar
  39. McKnight TM, Vigneron DB, Love T et al. (2002b) Comparison of a Cho-NAA index with the MIB-1 proliferative index and cell density of tissue samples from grades II and III glioma. Proc 10th Scientific Meeting of the International Society of Magnetic Resonance in Medicine (ISMRM), Honolulu, Hawaii, p 43Google Scholar
  40. Morris DE, Bourland JD, Rosenman JG et al. (2001) Three-dimensional conformal radiation treatment planning and delivery for low-and intermediate-grade gliomas. Semin Radiat Oncol 11:124–137PubMedGoogle Scholar
  41. Nakagawa K, Aoki Y, Fujimaki T et al. (1998) High-dose conformal radiotherapy influenced the pattern of failure but did not improve survival in glioblastoma multiforme. Int J Radiat Oncol Biol Phys 40:1141–1149PubMedCrossRefGoogle Scholar
  42. Nelson SJ (2001) Analysis of volume MRI and MR spectroscopic imaging data for the evaluation of patients with brain tumors. Magn Reson Med 46:228–239PubMedCrossRefGoogle Scholar
  43. Nelson SJ, McKnight TR, Henry RG (2002a) Characterization of untreated gliomas by magnetic resonance spectroscopic imaging. Neuroimag Clin North Am 12:599–613Google Scholar
  44. Nelson SJ, Graves E, Pirzkall A et al. (2002b) In vivo molecular imaging for planning radiation therapy of gliomas: an application of 1H MRSI. J Magn Reson Imaging 16:464–476PubMedCrossRefGoogle Scholar
  45. Oh J, Henry RG, Pirzkall A et al. (2004) Survival analysis in patients with glioblastoma multiforme: predictive value of choline-to-N-acetylaspartate index, apparent diffusion coefficient, and relative cerebral blood volume. J Magn Reson Imaging 19:546–554PubMedCrossRefGoogle Scholar
  46. Pickett B, Vigneault E, Kurhanewicz J et al. (1999) Static field intensity modulation to treat a dominant intra-prostatic lesion to 90 Gy compared to seven field 3-dimensional radiotherapy. Int J Radiat Oncol Biol Phys 44:921–929PubMedCrossRefGoogle Scholar
  47. Pickett B, Pirzkall A, Kurhanewicz J et al. (2000) Radiosurgical intensity modulated radiotherapy for prostate cancer. Int J Radiat Oncol Biol Phys 48:S23CrossRefGoogle Scholar
  48. Pickett B, Kurhanewicz J, Fein B et al. (2003) Use of magnetic resonance imaging and spectroscopy in the evaluation of external beam radiation therapy for prostate cancer. Int J Radiat Oncol Biol Phys 57:S163–S164CrossRefGoogle Scholar
  49. Pickett B, TenHaken RK, Kurhanewicz J et al. (2004) Time course to metabolic atrophy following permanent prostate seed implantation based on magnetic resonance spectroscopic imaging. Int J Radiat Oncol Biol Phys 59:665–673PubMedCrossRefGoogle Scholar
  50. Pirzkall A (2005) Magnetic resonance spectroscopy and its use in brain tumor diagnosis and therapy. In: Black P, Loeffler JS (eds) Cancer of the nervous system, 2nd edn. Lippincott Williams and Wilkins, Philadelphia, pp 109–122Google Scholar
  51. Pirzkall A, McKnight TR, Graves EE et al. (2001a) MR-spectroscopy guided target delineation for high-grade gliomas. Int J Radiat Oncol Biol Phys 50:915–928PubMedCrossRefGoogle Scholar
  52. Pirzkall A, Graves EE, Lau A et al. (2001b) Gamma knife (GK) radiosurgery (RS) for recurrent high-grade gliomas: What does magnetic resonance spectroscopy have to add? Fifth International Stereotactic Radiosurgery Society Congress (ISRS), Las Vegas, Nevada, p 44Google Scholar
  53. Pirzkall A, Nelson SJ, McKnight TR et al. (2002) Metabolic imaging of low-grade gliomas with three-dimensional magnetic resonance spectroscopy. Int J Radiat Oncol Biol Phys 53:1254–1264PubMedGoogle Scholar
  54. Pirzkall A, Li X, Oh J et al. (2004) 3D MRSI for resected highgrade gliomas before RT: tumor extent according to metabolic activity in relation to MRI. Int J Radiat Oncol Biol Phys 59:126–137PubMedCrossRefGoogle Scholar
  55. Pollack A, Zagars GK (1997) External beam radiotherapy dose response of prostate cancer. Int J Radiat Oncol Biol Phys 39:1011–1018PubMedGoogle Scholar
  56. Pouliot J, Yongbok K, Lessard E et al. (2004) Inverse planning for HDR prostate brachytherapy use to boost dominant intraprostatic lesion defined by magnetic resonance spectroscopic imaging. Int J Radiat Oncol Biol Phys 59:1196–1207PubMedCrossRefGoogle Scholar
  57. Roach M III, Faillace-Akazawa P, Malfatti C et al. (1996) Prostate volumes defined by magnetic resonance imaging and computerized tomographic scans for three-dimensional conformal radiotherapy. Int J Radiat Oncol Biol Phys 35:1011–1018PubMedGoogle Scholar
  58. Scheidler J, Hricak H, Vigneron DB et al. (1999) Prostate cancer: localization with three-dimensional proton MR spectroscopic imaging: clinicopathologic study. Radiology 213:473–480PubMedGoogle Scholar
  59. Schiebler ML, Tomaszewski JE, Bezzi M et al. (1989) Prostatic carcinoma and benign prostatic hyperplasia: correlation of high-resolution MR and histopathologic findings. Radiology 172:131–137PubMedGoogle Scholar
  60. Schricker AA, Pauly JM, Kurhanewicz J et al. (2001) Dualband spectral-spatial RF pulses for prostate MR spectroscopic imaging. Magn Reson Med 46:1079–1087PubMedCrossRefGoogle Scholar
  61. Shrieve DC, Alexander E III, Wen PY et al. (1995) Comparison of stereotactic radiosurgery and brachytherapy in the treatment of recurrent glioblastoma multiforme. Neurosurgery 36:275–282PubMedGoogle Scholar
  62. Sijens PE, Vecht CJ, Levendag PC et al. (1995) Hydrogen magnetic resonance spectroscopy follow-up after radiation therapy of human brain cancer. Unexpected inverse correlation between the changes in tumor choline level and post-gadolinium magnetic resonance imaging contrast. Invest Radiol 30:738–744PubMedGoogle Scholar
  63. Sneed PK, Lamborn KR, Larson DA et al. (1996) Demonstration of brachytherapy boost dose-response relationships in glioblastoma multiforme. Int J Radiat Oncol Biol Phys 35:37–44PubMedCrossRefGoogle Scholar
  64. Stamey TA, McNeal JE, Freiha FS et al. (1988) Morphometric and clinical studies on 68 consecutive radical prostatectomies. J Urol 139:1235–1241PubMedGoogle Scholar
  65. Swanson MG, Vigneron DB, Tabatabai ZL et al. (2003) Proton HR-MAS spectroscopy and quantitative pathologic analysis of MRI/3D-MRSI-targeted postsurgical prostate tissues. Magn Reson Med 50:944–954PubMedCrossRefGoogle Scholar
  66. Taylor JS, Langston JW, Reddick WE et al. (1996) Clinical value of proton magnetic resonance spectroscopy for differentiating recurrent or residual brain tumor from delayed cerebral necrosis. Int J Radiat Oncol Biol Phys 36:1251–1261PubMedGoogle Scholar
  67. Teh BS, McGary JE, Dong L et al. (2002) The use of rectal balloon during the delivery of intensity modulated radiotherapy (IMRT) for prostate cancer: More than just a prostate gland immobilization device? Cancer J 8:476–483PubMedGoogle Scholar
  68. Thilmann C, Zabel A, Grosser KH et al. (2001) Intensitymodulated radiotherapy with an integrated boost to the macroscopic tumor volume in the treatment of high-grade gliomas. Int J Cancer 96:341–349PubMedCrossRefGoogle Scholar
  69. Tran TK, Vigneron DB, Sailasuta N et al. (2000) Very selective suppression pulses for clinical MRSI studies of brain and prostate cancer. Magn Reson Med 43:23–33PubMedCrossRefGoogle Scholar
  70. Vigneault E, Pouliot J, Laverdiere J et al. (1997) Electronic portal imaging device detection of radioopaque markers for the evaluation of prostate position during megavoltage irradiation: a clinical study. Int J Radiat Oncol Biol Phys 37:205–212PubMedCrossRefGoogle Scholar
  71. Vigneron DB, Males R, Hricak H et al. (1998) Prostate cancer: correlation of 3D MRSI metabolite levels with histologic grade. RSNA, Chicago, p 181Google Scholar
  72. Virta A, Patronas N, Raman R et al. (2000) Spectroscopic imaging of radiation-induced effects in the white matter of glioma patients. Magn Reson Imaging 18:851–857PubMedGoogle Scholar
  73. Wald LL, Nelson SJ, Day MR et al. (1997) Serial proton magnetic resonance spectroscopy imaging of glioblastoma multiforme after brachytherapy. J Neurosurg 87:525–534PubMedGoogle Scholar
  74. Wallner KE, Galicich JH, Krol G et al. (1989) Patterns of failure following treatment for glioblastoma multiforme and anaplastic astrocytoma. Int J Radiat Oncol Biol Phys 16:1405–1409PubMedGoogle Scholar
  75. Wefer AE, Hricak H, Vigneron DB et al. (2000) Sextant localization of prostate cancer: comparison of sextant biopsy, magnetic resonance imaging and magnetic resonance spectroscopic imaging with step section histology. J Urol 164:400–404PubMedCrossRefGoogle Scholar
  76. Xia P, Pickett B, Vigneault E et al. (2001) Forward or inversely planned segmental multileaf collimator IMRT and sequential tomotherapy to treat multiple dominant intraprostatic lesions of prostate cancer to 90 Gy. Int J Radiat Oncol Biol Phys 51:244–254PubMedGoogle Scholar
  77. Yu KK, Scheidler J, Hricak H et al. (1999) Prostate cancer: prediction of extracapsular extension with endorectal MR imaging and three-dimensional proton MR spectroscopic imaging. Radiology 213:481–488PubMedGoogle Scholar
  78. Zaider M, Zelefsky MJ, Lee EK et al. (2000) Treatment planning for prostate implants using magnetic-resonance spectroscopy imaging. Int J Radiat Oncol Biol Phys 47:1085–1096PubMedCrossRefGoogle Scholar
  79. Zakian KL, Eberhardt S, Hricak H et al. (2003) Transition zone prostate cancer: metabolic characteristics at 1H MR spectroscopic imaging: initial results. Radiology 229:241–247PubMedGoogle Scholar
  80. Zelefsky MJ, Fuks Z, Hunt M et al. (2001) High dose radiation delivered by intensity modulated conformal radiotherapy improves the outcome of localized prostate cancer. J Urol 166:876–881PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2006

Authors and Affiliations

  • Andrea Pirzkall
    • 1
  1. 1.Departments of Radiation Oncology,Radiology and Neurological SurgeryUniversity of California, San FranciscoSan FranciscoUSA

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