MRS,SPECT,PET

DR Eslam MoHMAD Abd EL-Ghaffar

Ahmed Maher Teaching Hospital

PROTON MAGNETIC RESONANCE

SPECTROSCOPY
PHYSICS
MRS is a noninvasive in vivo method of assessment of brain
metabolites. MRS is based on chemical shift, or modification of
proton resonance frequency, in certain molecular environments.
The MRS data are ordinarily presented as a linear graph with the
chemical shift (in ppm) on the x-axis and the plot of relative signal
amplitude on the y-axis.
When interpreting the MRS data it is crucial to consider what
metabolites are found in normal spectra and at what concentrations.

FIGURE 19-26 Infiltrating medial temporal glioma. A, Axial

contrastenhanced
image showing the predominant peripheral enhancement
with central stippling and necrosis. The overlying grid shows voxel
locations. B, A magnetic resonance spectroscopy grid as defined
in
A shows the greatest lipid-lactate concentration in the central
column, whose voxels contain the greatest apparentdegree of
necrosis. There is also a prominent choline signal

N-Acetylaspartate is the highest peak in normal spectra and is classically

described as a marker for neuronal integrity and density.
Malignant tumors and neuronal death are associated with a decline in NAA
Choline is a metabolic marker of membrane density and integrity.
Malignant tumors show an increase in the choline peak because of
increased cell membrane turnover; however, elevated choline can also be
seen in inflammatory processes as well.
Creatine is a marker of energy metabolism.
Because creatine values are relatively stable, the ratio of another
metabolite to creatine helps normalize the concentration of that metabolite.
Glutamate is the most abundant excitatory neurotransmitter,
Lactate is not seen under normal conditions but is present in scenarios of
anaerobic glycolysis, such as in brain ischemia and seizures.

Myoinositol is a glial marker that is found almost

exclusively in astrocytes and is believed to reflect
the degree of glial proliferation.
Alanine has a role in the citric acid cycle and can
be increased in meningiomas.
Lipid may be seen as a broad peak or two peaks at
longer echo times, but it may be better visualized
on MRS with short echo times. Lipid can be seen in
areas of increased
cell turnover,

Clinical Uses and Applications

MRS is now perhaps most widely used for the characterization
of brain neoplasms
In general, with increasing grade of glioma, one sees a reduction
in the NAA peak and elevation of the choline peak .
The ultimate diagnosis is made by pathologic evaluation, but MRS
can aid in determining the prognosis in some patients; for
example, the percent change in the choline-NAA ratio has been
shown to be useful for predicting
progression of brain tumor in children.
Overall, spectroscopy should be considered as a supplement to
other imaging data in tumor analysis.

POSITRON EMISSION
TOMOGRAPHY
Positron emission tomography, as the name implies, uses positronEmitting isotopes, commonly 15-oxygen (15O) to measure cerebral
perfusion and oxygen metabolism, and 2-fluoro-2-deoxy-D-glucose (18F-FDG) to measure
cerebral glucose metabolism.
BASIC PRINCIPLES:
The essential components of PET are as follows:
1.Production of the positron-emitting radionuclide in a cyclotron
2. Radiopharmaceutical synthesis procedures to attach the positron- emitting radionuclide to a
molecule of interest, which is called a tracer or probe
3. Positron tomograph camera (PET scanner) to measure the photons resulting from positronelectron annihilation and computer algorithms to construct images based on localization of the
positron-emitting radionuclides
4. Tracer kinetic model for the interpretation of temporal changes in the regional distribution,
accumulation, and clearance of the positron-emitting radionuclides

PET imaging provides an in vivo characterization of biologic

processes at the neurochemical level
It is used for DETECTION AND DIAGNOSIS OF NEUROLOGICAL
DYSFUNCTION such as :
Movement Disorders :Parkinsonsdisease, Huntingtons disease
Dementias and Mental Illness :
At present, FDG-PET can diagnose Alzheimers disease and
distinguish it from patterns of normal aging
Epilepsy: FDG-PET demonstrated focal seizure
abnormalities in the absence of
structural changes
Fluoro-2-deoxy-d-glucose (FDG) and positron emission
tomography (PET)computed tomography (CT) imaging. Left, The
two columns show the tomographic planes of sagittal (column 1)
and transaxial (column 2) CT data (top row) and the PET data
overlaid on the
CT images (bottom).

Brain Tumors: Applications of PET studies of brain tumors range

from diagnosis and grading of gliomas to postsurgical assessment of
gliomas
and metastatic tumors.
Brain Injury:
PET is unique in its ability to study brain energy metabolism
because it is the only imaging modality that can provide all the
parameters of energy metabolism

SINGLE-PHOTON EMISSION
COMPUTED TOMOGRAPHY
Single photon emission tomography (SPECT), a nuclear
medicine study, uses gamma-emitting isotopes (e.g., [133Xe]
and technetium-99-m-hexamethyl-propylamine-oxime [99TcHMPAO]) to measure cerebral blood flow (CBF)
It can potentially provide a better long-term prognostic
predictor in comparison to CT or conventional MRI.
For example, a worse prognosis has been associated with
multiple CBF abnormalities, larger CBF defects, and defects
that involve the basal ganglia, temporal and parietal lobes,
and brainstem
SPECT is less sensitive in detecting smaller lesions that are
visible on MRI

SPECT is most appropriate for peri-ictal imaging in patients with partial

epileptic syndromes being considered for epilepsy surgery
Ictal perfusion single-photon emission computed tomography
(SPECT) may demonstrate increased blood flow at the site of
seizure onset.
(SPECT) is additional functional and metabolic imaging modalities that
contribute to the diagnosis and management of LGG patients.
These modalities supplement the characterization of tumor grade because
LGGs are typically hypometabolic compared with high-grade lesions

PERI-ICTAL SINGLE-PHOTON EMISSION

COMPUTED TOMOGRAPHY
IN THIS PATIENT SHOWS A REGION OF
HYPERPERFUSION ADJACENT TO THE AREA
OF FOCAL NECROSIS

THANK YOU