Rationale and Objectives
Phosphorous magnetic resonance spectroscopy ( 31 P MRS) has been used to evaluate and predict treatment response in squamous cell carcinoma of the head and neck (HNSCC). Several studies have also shown the potential of proton MRS ( 1 H MRS) in assessing response in HNSCC. In view of the inherent limitations associated with performing 31 P MRS in clinical settings, the current study was performed to explore whether 1 H MRS could provide similar or complementary metabolic information in HNSCC.
Materials and Methods
Fifteen patients with HNSCC underwent pretreatment magnetic resonance imaging. Both 1 H MRS and 31 P MRS were performed on viable solid parts of the metastatic lymph nodes of these patients. Peak areas of total choline (tCho) and unsuppressed water as observed on 1 H MRS and phosphomonoester (PME) and β-nucleotide triphosphate (β-NTP) on 31 P MRS were computed. Pearson’s correlation coefficient was used to correlate the tCho/water and PME/β-NTP ratios.
Results
In all patients, the metastatic nodes appeared hyperintense on T2-weighted images and hypointense on T1-weighted images with variable signal intensity. A prominent resonance of tCho on 1 H MRS and a resonance of PME on 31 P MRS from the metastatic nodes of all patients were observed. A moderate correlation of 0.31 was observed between tCho/water and PME/β-NTP ( P > .05).
Conclusions
The biochemical pathways involved in 1 H MRS of tCho may be different from the phospholipid metabolites seen on 31 P MRS of head and neck cancers, and thus the two MRS techniques may be complementary to each other.
Squamous cell carcinoma of the head and neck (HNSCC) is a malignant tumor arising most frequently in the nonkeratinized epithelial tissue of the upper aerodigestive tract. This disease accounts for about 5% of all cancers and about 90% of all malignant tumors of the head and neck region . These tumors are characterized by a multiphasic and multifactorial etiopathogenesis . Despite recent progress in diagnosis and advances in local and systemic therapeutic approaches, HNSCC remains a clinically challenging disease . It is expected that developments in treatment modalities, along with consistent, reliable, and reproducible prognostic biomarkers that monitor and predict therapeutic response, may improve the clinical outcome of patients with HNSCC.
Phosphorous magnetic resonance (MR) spectroscopy ( 31 P MRS) provides a window for assessing tissue bioenergetics and metabolism of membrane phospholipids . Specifically, the 31 P MRS spectrum demonstrates signals from phosphomonoesters (PMEs; phospholipid precursors) and phosphodiesters (PDEs; phospholipid catabolites), inorganic phosphate (Pi), phosphocreatine (PCr), and nucleotide triphosphates (NTPs) related to energy metabolism. Using 31 P MRS, it has been reported that head and neck tumors exhibit elevated PME/β-NTP ratios , and this ratio has been used as a response indicator for chemotherapy and/or radiation therapy in head and neck tumors .
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Materials and methods
Subjects
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Data Acquisition
MR Imaging
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1 H MRS
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31 P MRS
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Data Analysis
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SI=ρ[1−exp(−TR/T1)][exp(−TE/T2)] SI
=
ρ
[
1
−
exp
(
−
TR
/
T
1
)
]
[
exp
(
−
TE
/
T2
)
]
where SI is the signal intensity of the unsuppressed water signal, ρ is proton density, T1 is the spin-lattice relaxation time, and T2 is the spin-spin relaxation time measured from each patient. At a TR of 1500 ms and a TE of 135 ms, the value of ρ was determined from equation 1 using the T1 and T2 values from each metastatic node. Quantitative T2 and T1 measurements in each case were performed by acquiring a series of T2-weighted images (at four different TEs: 13, 53, 80, and 120 ms [TR, 2000 ms]) and T1-weighted images [at five different inversion times: 60, 200, 400, 800, and 1600 ms [TR, 1880 ms; TE, 4.38 ms]), respectively. The tCho/ρ ratio was computed from all patients.
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Results
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Discussion
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Acknowledgments
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