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Magnetic Resonance Spectroscopy to Monitor Therapy

Brian Ross, FRCS (Eng); James T. Helsper, MD; I. Jane Cox, PhD; Ian R. Young, PhD; Raymond Kempf, MD; Andrew Makepeace, MRCP; Jacqueline Pennock, BSc

Arch Surg. 1987;122(12):1464-1469.

Abstract
• Fourteen patients with malignant tumors of bone (ten osteogenic sarcomas, one Ewing's tumor, one giant-cell tumor, two non-Hodgkin's lymphomas), plus one patient with a synovial cell sarcoma, who had been treated by standard extremity-conserving chemotherapy regimens, were examined before treatment by means of localized phosphorus 31 magnetic resonance spectroscopy. Thirteen (86%) of 15 examinations were successful, and 100% of successful examinations showed metabolic abnormality in the tumor. Tumors contained excess adenosine triphosphate and inorganic phosphate, an unusual peak of phosphomonoester, consistent with excessive glycolysis in tumors. The intratumor pH was normal in the 12 bone tumors, but acidic in the single soft-tissue sarcoma (pH 6.8). Metabolic response was observed in all seven patients monitored during chemotherapy, with the earliest examinations being performed two days after first treatment. An increase in the inorganic phosphate level, loss of adenosine triphosphate, and loss of phosphomonoester indicated tumor response; loss of all abnormal metabolites (two of seven patients) indicated regression of the tumor. Tumor relapse was accompanied by reappearance of abnormalities in the magnetic resonance spectrum. Phosphorus 31 magnetic resonance spectroscopy offers a unique means of determining the early response of these malignant tumors to therapy as well as predicting their relapse.

(Arch Surg 1987;122:1464-1469)

Author Affiliations
From the Nuclear Magnetic Resonance Unit, Hammersmith Hospital, London (Drs Ross, Cox, and Pennock); Huntington Medical Research Institutes, Pasadena, Calif (Dr Helsper); Hirst Research Laboratories (Picker International), Wembley, England (Dr Young); Norris Cancer Institute, University of Southern California, Los Angeles (Dr Kempf); and the Oncology Unit, Middlesex Hospital, London (Dr Makepeace).

Footnotes
Accepted for publication July 14, 1987.

Read before the Annual Meeting of the Society of Surgical Oncology, London, April 27, 1987.

Reprint requests to Glebe Cottage, Bell Lane, Cassington, Oxford, 0X8 IDS, England (Dr Ross).

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