Target Volume Determination 2015

Brain: Physiologic metabolites

Brain: Pathologic metabolites

Typical spectra

• NAA: Neuronal marker – N-acetyl-L-aspartate – δ = 2.01 ppm • Cr: Energy store – (Phospho-) Creatine – δ = 3.03 ppm and 4 ppm • Cho: Membrane turnover – Phosphocholin, Glycerophosphorylcholin – δ = 3.22 ppm

Normal

Tumor

• Lactate: Anaerobic glycolysis – Hypoxic areas – Macrophages – δ = 1.33 ppm doublet (inverted at 135 ms) • Lipids (fatty acids): Necrosis – δ = 1.2 - 1.4 ppm

NAA

Cho

NAA

Cr

Cho

Cr

Lactate

Bachert et al., Radiologe 2004

Metastasis

Grade II glioma

Cho

Cho

NAA

6 months

Tumor characterization

ppm

4.0

3.5

3.0

2.5

2.0

1.5

1.0

0.5

Schlemmer et al., AJNR 2001; Weber et al., Radiologe 2003