Improving contrast enhancement in magnetic resonance imaging using 5-aminolevulinic acid‑induced protoporphyrin IX for high-grade gliomas

  • Authors:
    • Junkoh Yamamoto
    • Shingo Kakeda
    • Tetsuya Yoneda
    • Shun‑Ichiro Ogura
    • Shohei Shimajiri
    • Tohru Tanaka
    • Yukunori Korogi
    • Shigeru Nishizawa
  • View Affiliations

  • Published online on: December 27, 2016     https://doi.org/10.3892/ol.2016.5539
  • Pages: 1269-1275
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Abstract

Magnetic resonance imaging (MRI) with a gadolinium-based contrast agent is the gold standard for high-grade gliomas (HGGs). The compound 5‑aminolevulinic acid (5‑ALA) undergoes a high rate of cellular uptake, particularly in cancer cells. In addition, fluorescence‑guided resection with 5‑ALA is widely used for imaging HGGs. 5‑ALA is water soluble, while protoporphyrin IX (PpIX) is water insoluble. It was speculated whether converting from 5‑ALA to PpIX may relatively increase intracellular water content, and consequently, might enhance the T2 signal intensity in HGG. The aim of the present study was to assess whether 5‑ALA‑induced PpIX enhances the T2 signal intensity in patients with HGGs. A total of 4 patients who were candidates for HGG surgical treatment were prospectively analyzed with preoperative MRI. Patients received oral doses of 5‑ALA (20 mg/kg) 3 h prior to anesthesia. At 2.5 h post‑5‑ALA administration, T2‑weighted images (T2WIs) were obtained from all patients. Subsequently, tumors were evaluated via fluorescence using a modified operating microscope. Fluorescent tumor tissues were obtained to analyze the accumulation of 5-ALA-induced PpIX within the tumors, which was confirmed quantitatively by high‑performance liquid chromatography (HPLC) analysis. The MRI T2 signal intensity within the tumors was evaluated prior to and following 5-ALA administration. Three glioblastoma multiformes (GBMs) and 1 anaplastic oligodendroglioma (AO) were included in the analysis. Intraoperatively, all GBMs exhibited strong fluorescence of 5‑ALA‑induced PpIX, whilst no fluorescence was observed in the AO sample. HPLC analysis indicated a higher accumulation of 5‑ALA‑induced PpIX in the GBM samples compared with the AO sample. In total, 48 regions of interest were identified within the tumors from T2‑WIs. In the GBM group, the relative T2 signal intensity value within the tumors following 5‑ALA administration was significantly increased compared with the T2 signal intensity value prior to 5‑ALA administration (1.537±0.021 and 1.577±0.023, respectively; P=0.0055). No significant differences were observed in the AO group. These results suggest that the 5-ALA-induced PpIX enhanced the T2 signal intensity in HGG. Therefore, 5‑ALA may be a potentially useful MRI contrast reagent for HGG.
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March-2017
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Spandidos Publications style
Yamamoto J, Kakeda S, Yoneda T, Ogura SI, Shimajiri S, Tanaka T, Korogi Y and Nishizawa S: Improving contrast enhancement in magnetic resonance imaging using 5-aminolevulinic acid‑induced protoporphyrin IX for high-grade gliomas. Oncol Lett 13: 1269-1275, 2017
APA
Yamamoto, J., Kakeda, S., Yoneda, T., Ogura, S., Shimajiri, S., Tanaka, T. ... Nishizawa, S. (2017). Improving contrast enhancement in magnetic resonance imaging using 5-aminolevulinic acid‑induced protoporphyrin IX for high-grade gliomas. Oncology Letters, 13, 1269-1275. https://doi.org/10.3892/ol.2016.5539
MLA
Yamamoto, J., Kakeda, S., Yoneda, T., Ogura, S., Shimajiri, S., Tanaka, T., Korogi, Y., Nishizawa, S."Improving contrast enhancement in magnetic resonance imaging using 5-aminolevulinic acid‑induced protoporphyrin IX for high-grade gliomas". Oncology Letters 13.3 (2017): 1269-1275.
Chicago
Yamamoto, J., Kakeda, S., Yoneda, T., Ogura, S., Shimajiri, S., Tanaka, T., Korogi, Y., Nishizawa, S."Improving contrast enhancement in magnetic resonance imaging using 5-aminolevulinic acid‑induced protoporphyrin IX for high-grade gliomas". Oncology Letters 13, no. 3 (2017): 1269-1275. https://doi.org/10.3892/ol.2016.5539