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Early in vivo detection of metabolic response: a pilot study of 1H MR spectroscopy in extracranial lymphoma and germ cell tumours

A J Schwarz, PhD, MInstP1, N R Maisey, MBBS, MRCP1,2, D J Collins, BA, MInstP1, D Cunningham, MD, MRCP2, R Huddart, MA, MRCP, FRCR3 and M O Leach, PhD, FInstP, FMedSci1

1 Cancer Research UK Clinical Magnetic Resonance Research Group, 2 Department of Medicine and 3 Academic Department of Radiotherapy, Institute of Cancer Research and Royal Marsden Hospital, Downs Road, Sutton, Surrey SM2 5PT, UK



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  		Figure 1. Sagittal T1 weighted localizer image from patient 8, showing para-aortic lesion in the lower middle of the image, with surrounding fatty tissue visible. The surface receive coil was placed over the patient's anterior abdominal wall (left).

 


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  		Figure 2. Pre-treatment echo time =20 ms spectra from (a) a B-cell lymphoma (low grade), (b) a large B-cell non-Hodgkin's lymphoma mass with sclerosis (high grade), (c) a Stage IIE nodular sclerosing Hodgkin's disease mass in the anterior chest wall, and (d) a para-aortal seminoma stage IIC metastasis. tCho, choline-containing metabolite.

 


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  		Figure 3. Differential changes in choline-containing metabolite (tCho):water ratio between (a) subsequent responders and (b) non-responders. "Early" post-treatment scan corresponds to 3–7 days, "late" post-treatment to 14-35 days following commencement of chemotherapy. Values of zero reflect a tCho signal undetectable below the noise level.

 


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  		Figure 4. Post-treatment choline-containing metabolite (tCho):water ratios, normalized to pre-treatment baseline values. The five patients scanned 3–7 days post-treatment are shown with the noise standard deviation taken as an upper limit on the tCho signal for those with no discernible tCho. SEM, standard error of the mean.

 




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