Page 48 - GTM-2-3

Global Translational Medicine Deep learning by NMR-biochemical

suspected breast cancer due to limited peer-reviewed xiii. The 19 F MRS used SR4554 (fluorinated
clinical literature on cancer MRS use in theranosis. 2-nitroimidazole) as a hypoxia intra-tumoral marker in
1
19
The diagnostic value of H-MRS in cancer is based the phase I trial. The H/ F surface coils and localized
1
on the detection of elevated choline levels as a marker of 19 F MRS acquisition spectra showed different signals in
active tumors. The H-MRS with breast MRI improves the post-SR4554 infusion (MRS no.1) after 16 h (MRS no. 2)
1
specificity to distinguish benign from malignant lesions and 20 h (MRS no. 3) in both unlocalized and localized
[89]
and monitors to predict the neoadjuvant chemotherapy MRS indicating different grades of hypoxia .
response to treat patients. Integrating MRI with H-MRS 6. Clinical trial reports on MRSI in the years
1
evaluation cuts down the need for multiple benign biopsies, 2010 – 2022
and MRS may predict response within 24 h after the first
dose of neoadjuvant chemotherapy given . The present consensus on clinical MRS acceptance was
[84]
The non-invasive in vivo H-MRS differentiated the focused on new guidelines and meta-analyses. MRI
1
benign and malignant breast lesions as different increased generates an image, while MRS generates a graph or peak
levels of choline (Cho) compounds and increased Cho “spectrum” array of metabolite types to quantify them
metabolism in breast pre-cancer cells showing infiltrating in the brain or other organs. The present consensus on
ductal carcinoma, infiltrating medullary, mucinous, and MRS metabolite interpretation is in favor of theranosis
lobular adenoid cystic carcinoma as active lesions by and treatment planning in neurological and other human
1 H-MRS. However, H-MRS showed no change or normal diseases. Documented meta-analysis and review studies
1
metabolites in benign breast lesions, including cysts, in recent years (2010 – 2022) recommend the need for
investigative and reproducible multicentric cost-effective
galactoceles, ductal carcinoma, papilloma, fibroadenoma, clinical trials on large patient numbers with diagnostic
fibrocystic changes, tubular adenoma, and phyllodes accuracy and validation before clinical practice. Still, MRS
tumors . The author suggests stronger ultrahigh field evaluation in primary brain tumors or metastases remains
[85]
MR imagers with advanced coils will increase the H-MRS investigational/experimental due to the lack of peer-
1
sensitivity. Ultrahigh field H-MRS will detect the smallest reviewed clinical literature on the effectiveness of MRS.
1
malignant lesions to characterize the malignant lesions into
non-invasive or invasive disease progression monitoring. The Food and Drug Administration (FDA) granted 510
(k) clearance to prescribe MRS to cancer patients. However,
The clinical evidence is insufficient for MRS in the
evaluation of leukoencephalopathy and childhood white MRI and MRS use different postprocessing software to
acquire data, integrate, and manipulate the spectroscopic
matter diseases because both disorders show similar MRI image signal.
signal intensity changes despite different pathologies.
The H-MRSI distinguished three conditions of white 6.1. Malignancy and tumors in human
1
matter rarefaction, hypomyelination, and demyelination.
Neurochemicals from six white matter rarefaction and 6.1.1. The clinical evidence is inconclusive on the MRS
intra-intervoxel (relative to gray matter) neurochemical of prostate cancer
ratios showed significant pathophysiological differences MRS offers prostate gland choline and citrate metabolic
in high Cho/NAA, Cho/Cr, and low NAA/Cr ratios. information as prognostic information that is useful for
These measurements serve as accurate linear discriminant treatment planning. Combined proton MRSI with T2wt
parameters for classifying hypomyelinating conditions . MRI to T2wt MRI improves tumor localization, volume
[86]
Combined MRI/MRS explored risk profiles in prostate estimation, tumor staging, tissue characterization, and
cancer and can be a promising cost-effective screening test identification of recurrent disease after therapy. The
for low-risk patients . American College of Radiology Imaging Network showed
[87]
1
In a prospective, multicenter trial on patients that the combined H-MRSI and T2wt MR images do not
undergoing radical prostatectomy and visualized with improve tumor detection in patients with low-grade, low-
endorectal 1.5 tesla MRI and MRS reported an accurate volume diseases selected to undergo radical prostatectomy.
1
sextant localization of peripheral zone (PZ) in prostate Thus positive H-MRSI reflects only higher tumor grade and/
cancer tissue matched with biopsy-confirmed prostate or volume. In a retrospective trial, MRI and MRS predicted
adenocarcinoma to schedule the removal of prostate or the normal prostate or suggestive of progressive prostate
radical prostatectomy . T1-weighted, T2wt, and 1.5 tesla cancer malignancy risk of the Gleason score and subsequent
[88]
[89]
MRS with pelvic-phased array coil in combination with an biopsy. MRSI did not predict cancer progression .
endorectal coil improved the diagnostic accuracy of MRI- A retrospective MRSI study with T2wt MRI images
MRS over MRI alone. showed recurrent prostate cancer after androgen therapy

Volume 2 Issue 3 (2023) 16 https://doi.org/10.36922/gtm.337