Rationale and Objectives
Central neurocytomas (CNCs) are rare benign tumors typically located in the lateral ventricle of the central nervous system. The authors report five patients with CNCs and review 16 previously published studies that included 52 patients with CNCs to explore the magnetic resonance spectroscopic features of CNCs.
Materials and Methods
Five patients with CNCs were retrospectively reviewed. They were examined using point-resolved spectroscopic series with short and/or long echo times. The integrals of choline, creatine, and the 3.55-ppm peak were determined using Magnetic Resonance User Interface software, and the metabolite ratios relative to creatine were obtained. In two cases, T2 relaxation times of choline and the metabolite resonance at 3.55 ppm were calculated using data points acquired with different echo times and an exponential decay model.
Results
Consistent with previously published studies, all five patients showed highly increased choline and reduced N-acetylaspartate and creatine. Four patients in the present study and 35 in published data demonstrated prominent peaks at 3.55 ppm, which were assigned to glycine because of its relaxation pattern and long T2 relaxation time. In addition, increased in vivo glutamate and glutamine was also confirmed in three patients examined with short echo times. Alanine and lactate peaks were observed in three and two patients, respectively.
Conclusions
The present study shows that the 3.55-ppm peak characteristic of CNC should be assigned to glycine according to its T2 relaxation time. Besides increased glycine and choline, the presence of glutamate or glutamine, which appears on series with short echo times, may further confirm the diagnosis of CNC.
Central neurocytoma (CNC) is a rare brain tumor of neuronal origin first identified by Hassoun et al in 1982, accounting for approximately .25% to .5% of all tumors in the central nervous system . It usually affects young adults aged 20 to 40 years . On conventional magnetic resonance imaging, CNC typically exhibits an intraventricular mass with hypointensity on T1-weighted images and hyperintensity on T2-weighted images, with mild to remarkable heterogeneous enhancement after the administration of gadolinium diethylenetriamine penta-acetic acid . However, it may be difficult to differentiate CNC from other intraventricular tumors on the basis of magnetic resonance imaging alone.
In vivo proton magnetic resonance spectroscopy (MRS) has been proven useful in providing biochemical information on these lesions. The spectroscopy of CNC is characterized by prominent choline (Cho) peak, small N-acetylaspartate (NAA) and creatine (Cr) peaks, and a 3.55-ppm peak, with or without alanine (Ala) or lactate (Lac). The 3.55-ppm peak is considered the biomarker of CNC, but whether it is glycine (Gly) or myoinositol (MI) has not been fully clarified. Also, most previous studies were performed at 1.5 T with long echo times (TEs). As a result, spectral resolution was relatively poor compared with that obtained at 3.0 T, and metabolites with short T2 relaxation times, such as glutamate and glutamine (Glx) may therefore be underestimated. In the present study, we report five patients with CNC, two of whom were examined using a 3.0-T scanner and three using both short and long TEs. We also review published MRS reports of CNC to outline its features on the basis of a larger case population.
Materials and methods
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Table 1
Patient Information of the Present Study
Patient Gender Age (y) Clinical Conditions Tumor Location MRI Findings Proliferation Index 1 F 24 Headache and vomiting Right LV T1↓, T2↑, hetero, cyst(+), Ca(+), he(+) >2% 2 M 35 Headache and vomiting Right LV T1↓, T2↑, hetero, cyst(+), Ca(+), he(+) 3%–7% 3 F 17 Headache, vomiting, and blurred vision Left LV T1↓, T2↑, cyst(+), Ca(+), he(−) <1% 4 F 31 Headache and vomiting Right LV Slightly T1↓, slightly T2↑, hetero, cyst(+), Ca(+), he(−) <1% 5 M 29 Headache and vomiting Left LV Slightly T1↓, slightly T2↑, hetero, cyst(+), Ca(+), he(−) <1%
Ca(+), with calcification; cyst(+), with cystic lesion; he(+), with hemorrhage; he(−), without hemorrhage; hetero, heterogeneous enhancement; LV, lateral ventricle; MRI, magnetic resonance imaging; ↓, hypointense; ↑, hyperintense.
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Ms=M0×exp(−2τT2), M
s
=
M
0
×
exp
(
−
2
τ
T
2
)
,
where M s denotes the signal intensity of the measurement at a given TE, M 0 denotes the signal intensity at a TE of 0 ms, and τ denotes TE/2.
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Results
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Table 2
MRS Findings of CNCs in the Present Study and Published Data
Study Number of Patients Field Strength (T) TE (ms) MRS Findings NAA Cr Cho Average Cho/Cr 3.55-ppm Peak at Short TE 3.55-ppm Peak at Long TE Glx Ala Lac Present study Patient 1 3.0 30/135/270 ↓ ↓ ↑ 10.01 Yes Yes Yes Yes No Patient 2 3.0 30/135 ↓ ↓ ↑ 9.62 Yes Yes Yes Yes Yes Patient 3 1.5 68/136/272 ↓ ↓ ↑ 5.82 Yes Yes No No No Patient 4 1.5 30 ↓ ↓ ↑ 12.74 No NA Yes Yes Yes Patient 5 1.5 135 ↓ ↓ ↑ 5.15 NA Yes No No No Subtotal 5 ↓ (5/5) ↓ (5/5) ↑ (5/5) 8.67 3/4 4/4 3/5 3/5 2/5 Previous studies Shah et al 11 1.5 135 ↓ (8/11) ↓ (8/11) ↑ (11/11) NA NA 10/11 0/11 7/11 1/11 Bobek-Billewicz et al 2 3.0/1.5 135/144 ↓ (2/2) ↓ (2/2) ↑ (2/2) 3.84 NA 2/2 0/2 0/2 0/2 Majos et al 2 1.5 30/136 ↓ (2/2) ↓ (2/2) ↑ (2/2) NA 2/2 2/2 2/2 2/2 0/2 Kocaoglu et al 7 1.5 136 ↓ (7/7) ↓ (7/7) ↑ (7/7) 5.18 NA 1/7 0/7 0/7 1/7 Balaji et al 1 1.5 144 ↓ (1/1) ↓ (1/1) ↑ (1/1) NA NA 1/1 0/1 1/1 1/1 Yeh et al 3 1.5 35/144 ↓ (3/3) ↓ (3/3) ↑ (3/3) NA 2/2 3/3 0/3 0/3 0/3 Ueda et al 5 1.5 35 ↓ (5/5) ↓ (5/5) ↑ (5/5) 3.94 3/5 N/A 0/5 0/5 2/5 Krishnamoorthy et al 3 1.5 135 ↓ (3/3) ↓ (3/3) ↑ (3/3) NA NA 3/3 0/3 3/3 1/3 Kawaguchi et al 2 1.5 272 ↓ (2/2) ↓ (2/2) ↑ (2/2) NA NA 1/2 0/2 0/2 1/2 Chuang et al 3 3.0 144 ↓ (3/3) ↓ (3/3) ↑ (3/3) 2.2 NA 1/3 0/3 1/3 0/3 Jayasundar et al 2 1.5 135 ↓ (2/2) ↓ (2/2) ↑ (2/2) NA NA 2/2 0/2 2/2 0/2 Moller-Hartmann et al 1 1.5 135 ↓ (1/1) ↓ (1/1) ↑ (1/1) 2.42 NA 0/1 0/1 0/1 0/1 Kanamori et al 3 1.5 272 ↓ (3/3) ↓ (3/3) ↑ (3/3) NA NA 1/3 0/3 0/3 0/3 Ando et al 1 1.5 270 ↓ (1/1) ↓ (1/1) ↑ (1/1) NA NA 0/1 0/1 0/1 1/1 Kim et al 5 1.5 135 ↓ (5/5) ↓ (5/5) ↑ (5/5) 5.25 NA 5/5 0/5 0/5 5/5 Warmuth-Metz et al 1 1.5 135 ↓ (1/1) ↓ (1/1) ↑ (1/1) NA NA 0/1 0/1 0/1 1/1 Subtotal 52 ↓ (52/52) ↓ (52/52) ↑ (52/52) 4.30 7/9 32/47 2/52 16/52 14/52 Total 57 ↓ (57/57) ↓ (57/57) ↑ (57/57) 5.08 10/13 36/51 5/57 19/57 16/57
Ala, alanine; Cho, choline; CNC, central neurocytoma; Cr, creatine; Glx, glutamate and glutamine; Lac, lactate; MRS, magnetic resonance spectroscopic; NA, not available; NAA, N-acetylaspartate; TE, echo time.
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Discussion
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Conclusions
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