Cerebral Ketones Detected by 3T MR Spectroscopy in Patients with High-Grade Glioma on an Atkins-Based Diet

A. Berrington, K. C. Schreck, B. J. Barron, L. Blair, D. D.M. Lin, A. L. Hartman, E. Kossoff, L. Easter, C. T. Whitlow, Y. Jung, F. C. Hsu, M. C. Cervenka, J. O. Blakeley, P. B. Barker, R. E. Strowd

Research output: Contribution to journalArticle

Abstract

BACKGROUND AND PURPOSE: Ketogenic diets are being explored as a possible treatment for several neurological diseases, but the physiologic impact on the brain is unknown. The objective of this study was to evaluate the feasibility of 3T MR spectroscopy to monitor brain ketone levels in patients with high-grade gliomas who were on a ketogenic diet (a modified Atkins diet) for 8 weeks. MATERIALS AND METHODS: Paired pre- and post-ketogenic diet MR spectroscopy data from both the lesion and contralateral hemisphere were analyzed using LCModel software in 10 patients. RESULTS: At baseline, the ketone bodies acetone and β-hydroxybutyrate were nearly undetectable, but by week 8, they increased in the lesion for both acetone (0.06 ± 0.03 ≥ 0.27 ± 0.06 IU, P = .005) and β-hydroxybutyrate (0.07 ± 0.07 ≥ 0.79 ± 0.32 IU, P = .046). In the contralateral brain, acetone was also significantly increased (0.041 ± 0.01 ≥ 0.16 ± 0.04 IU, P = .004), but not β-hydroxybutyrate. Acetone was detected in 9/10 patients at week 8, and β-hydroxybutyrate, in 5/10. Acetone concentrations in the contralateral brain correlated strongly with higher urine ketones (r = 0.87, P = .001) and lower fasting glucose (r = -0.67, P = .03). Acetoacetate was largely undetectable. Small-but-statistically significant decreases in NAA were also observed in the contralateral hemisphere at 8 weeks. CONCLUSIONS: This study suggests that 3T MR spectroscopy is feasible for detecting small cerebral metabolic changes associated with a ketogenic diet, provided that appropriate methodology is used.

Original languageEnglish (US)
Pages (from-to)1908-1915
Number of pages8
JournalAJNR. American journal of neuroradiology
Volume40
Issue number11
DOIs
StatePublished - Nov 1 2019

Fingerprint

Carbohydrate-Restricted Diet
Ketogenic Diet
Hydroxybutyrates
Acetone
Ketones
Glioma
Magnetic Resonance Spectroscopy
Brain
Ketone Bodies
Fasting
Software
Urine
Glucose

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Clinical Neurology

Cite this

Cerebral Ketones Detected by 3T MR Spectroscopy in Patients with High-Grade Glioma on an Atkins-Based Diet. / Berrington, A.; Schreck, K. C.; Barron, B. J.; Blair, L.; Lin, D. D.M.; Hartman, A. L.; Kossoff, E.; Easter, L.; Whitlow, C. T.; Jung, Y.; Hsu, F. C.; Cervenka, M. C.; Blakeley, J. O.; Barker, P. B.; Strowd, R. E.

In: AJNR. American journal of neuroradiology, Vol. 40, No. 11, 01.11.2019, p. 1908-1915.

Research output: Contribution to journalArticle

Berrington, A. ; Schreck, K. C. ; Barron, B. J. ; Blair, L. ; Lin, D. D.M. ; Hartman, A. L. ; Kossoff, E. ; Easter, L. ; Whitlow, C. T. ; Jung, Y. ; Hsu, F. C. ; Cervenka, M. C. ; Blakeley, J. O. ; Barker, P. B. ; Strowd, R. E. / Cerebral Ketones Detected by 3T MR Spectroscopy in Patients with High-Grade Glioma on an Atkins-Based Diet. In: AJNR. American journal of neuroradiology. 2019 ; Vol. 40, No. 11. pp. 1908-1915.
@article{8bf98c355a3249bf9755ec4ffed6fa58,
title = "Cerebral Ketones Detected by 3T MR Spectroscopy in Patients with High-Grade Glioma on an Atkins-Based Diet",
abstract = "BACKGROUND AND PURPOSE: Ketogenic diets are being explored as a possible treatment for several neurological diseases, but the physiologic impact on the brain is unknown. The objective of this study was to evaluate the feasibility of 3T MR spectroscopy to monitor brain ketone levels in patients with high-grade gliomas who were on a ketogenic diet (a modified Atkins diet) for 8 weeks. MATERIALS AND METHODS: Paired pre- and post-ketogenic diet MR spectroscopy data from both the lesion and contralateral hemisphere were analyzed using LCModel software in 10 patients. RESULTS: At baseline, the ketone bodies acetone and β-hydroxybutyrate were nearly undetectable, but by week 8, they increased in the lesion for both acetone (0.06 ± 0.03 ≥ 0.27 ± 0.06 IU, P = .005) and β-hydroxybutyrate (0.07 ± 0.07 ≥ 0.79 ± 0.32 IU, P = .046). In the contralateral brain, acetone was also significantly increased (0.041 ± 0.01 ≥ 0.16 ± 0.04 IU, P = .004), but not β-hydroxybutyrate. Acetone was detected in 9/10 patients at week 8, and β-hydroxybutyrate, in 5/10. Acetone concentrations in the contralateral brain correlated strongly with higher urine ketones (r = 0.87, P = .001) and lower fasting glucose (r = -0.67, P = .03). Acetoacetate was largely undetectable. Small-but-statistically significant decreases in NAA were also observed in the contralateral hemisphere at 8 weeks. CONCLUSIONS: This study suggests that 3T MR spectroscopy is feasible for detecting small cerebral metabolic changes associated with a ketogenic diet, provided that appropriate methodology is used.",
author = "A. Berrington and Schreck, {K. C.} and Barron, {B. J.} and L. Blair and Lin, {D. D.M.} and Hartman, {A. L.} and E. Kossoff and L. Easter and Whitlow, {C. T.} and Y. Jung and Hsu, {F. C.} and Cervenka, {M. C.} and Blakeley, {J. O.} and Barker, {P. B.} and Strowd, {R. E.}",
year = "2019",
month = "11",
day = "1",
doi = "10.3174/ajnr.A6287",
language = "English (US)",
volume = "40",
pages = "1908--1915",
journal = "American Journal of Neuroradiology",
issn = "0195-6108",
publisher = "American Society of Neuroradiology",
number = "11",

}

TY - JOUR

T1 - Cerebral Ketones Detected by 3T MR Spectroscopy in Patients with High-Grade Glioma on an Atkins-Based Diet

AU - Berrington, A.

AU - Schreck, K. C.

AU - Barron, B. J.

AU - Blair, L.

AU - Lin, D. D.M.

AU - Hartman, A. L.

AU - Kossoff, E.

AU - Easter, L.

AU - Whitlow, C. T.

AU - Jung, Y.

AU - Hsu, F. C.

AU - Cervenka, M. C.

AU - Blakeley, J. O.

AU - Barker, P. B.

AU - Strowd, R. E.

PY - 2019/11/1

Y1 - 2019/11/1

N2 - BACKGROUND AND PURPOSE: Ketogenic diets are being explored as a possible treatment for several neurological diseases, but the physiologic impact on the brain is unknown. The objective of this study was to evaluate the feasibility of 3T MR spectroscopy to monitor brain ketone levels in patients with high-grade gliomas who were on a ketogenic diet (a modified Atkins diet) for 8 weeks. MATERIALS AND METHODS: Paired pre- and post-ketogenic diet MR spectroscopy data from both the lesion and contralateral hemisphere were analyzed using LCModel software in 10 patients. RESULTS: At baseline, the ketone bodies acetone and β-hydroxybutyrate were nearly undetectable, but by week 8, they increased in the lesion for both acetone (0.06 ± 0.03 ≥ 0.27 ± 0.06 IU, P = .005) and β-hydroxybutyrate (0.07 ± 0.07 ≥ 0.79 ± 0.32 IU, P = .046). In the contralateral brain, acetone was also significantly increased (0.041 ± 0.01 ≥ 0.16 ± 0.04 IU, P = .004), but not β-hydroxybutyrate. Acetone was detected in 9/10 patients at week 8, and β-hydroxybutyrate, in 5/10. Acetone concentrations in the contralateral brain correlated strongly with higher urine ketones (r = 0.87, P = .001) and lower fasting glucose (r = -0.67, P = .03). Acetoacetate was largely undetectable. Small-but-statistically significant decreases in NAA were also observed in the contralateral hemisphere at 8 weeks. CONCLUSIONS: This study suggests that 3T MR spectroscopy is feasible for detecting small cerebral metabolic changes associated with a ketogenic diet, provided that appropriate methodology is used.

AB - BACKGROUND AND PURPOSE: Ketogenic diets are being explored as a possible treatment for several neurological diseases, but the physiologic impact on the brain is unknown. The objective of this study was to evaluate the feasibility of 3T MR spectroscopy to monitor brain ketone levels in patients with high-grade gliomas who were on a ketogenic diet (a modified Atkins diet) for 8 weeks. MATERIALS AND METHODS: Paired pre- and post-ketogenic diet MR spectroscopy data from both the lesion and contralateral hemisphere were analyzed using LCModel software in 10 patients. RESULTS: At baseline, the ketone bodies acetone and β-hydroxybutyrate were nearly undetectable, but by week 8, they increased in the lesion for both acetone (0.06 ± 0.03 ≥ 0.27 ± 0.06 IU, P = .005) and β-hydroxybutyrate (0.07 ± 0.07 ≥ 0.79 ± 0.32 IU, P = .046). In the contralateral brain, acetone was also significantly increased (0.041 ± 0.01 ≥ 0.16 ± 0.04 IU, P = .004), but not β-hydroxybutyrate. Acetone was detected in 9/10 patients at week 8, and β-hydroxybutyrate, in 5/10. Acetone concentrations in the contralateral brain correlated strongly with higher urine ketones (r = 0.87, P = .001) and lower fasting glucose (r = -0.67, P = .03). Acetoacetate was largely undetectable. Small-but-statistically significant decreases in NAA were also observed in the contralateral hemisphere at 8 weeks. CONCLUSIONS: This study suggests that 3T MR spectroscopy is feasible for detecting small cerebral metabolic changes associated with a ketogenic diet, provided that appropriate methodology is used.

UR - http://www.scopus.com/inward/record.url?scp=85074964029&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85074964029&partnerID=8YFLogxK

U2 - 10.3174/ajnr.A6287

DO - 10.3174/ajnr.A6287

M3 - Article

C2 - 31649157

AN - SCOPUS:85074964029

VL - 40

SP - 1908

EP - 1915

JO - American Journal of Neuroradiology

JF - American Journal of Neuroradiology

SN - 0195-6108

IS - 11

ER -