title: Mapping of brain tumor metabolites with proton MR spectroscopic imaging: clinical relevance.
abstract: Brain tumor metabolism was studied with hydrogen-1 magnetic resonance spectroscopy and positron emission tomography with fluorine-18 fluorodeoxyglucose in 50 patients. N-acetylaspartate (NAA) was generally decreased in tumors and radiation necrosis but was somewhat preserved at neoplasm margins. Choline was increased in most solid tumors. Solid high-grade gliomas had higher normalized choline values than did solid low-grade gliomas (P < .02), but the normalized choline value was not a discriminator of tumor grade, since necrotic high-grade lesions had reduced choline values. Serial studies in one case showed an increase in choline as the glioma underwent malignant degeneration. Choline values were lower in chronic radiation necrosis than in solid anaplastic tumors (P < .001). In two cases studied before and after treatment, clinical improvement and a reduction in choline followed therapy. Lactate is more likely to be found in high-grade gliomas, but its presence is not a reliable indicator of malignancy.
authors.affiliation: Neuroimaging Branch, National Institute of Neurological Diseases and Stroke, National Institutes of Health, Bethesda, MD 20892.
authors.forename: M J
authors.initials: MJ
authors.lastname: Fulham
authors.forename: A
authors.initials: A
authors.lastname: Bizzi
authors.forename: M J
authors.initials: MJ
authors.lastname: Dietz
authors.forename: H H
authors.initials: HH
authors.lastname: Shih
authors.forename: R
authors.initials: R
authors.lastname: Raman
authors.forename: G S
authors.initials: GS
authors.lastname: Sobering
authors.forename: J A
authors.initials: JA
authors.lastname: Frank
authors.forename: A J
authors.initials: AJ
authors.lastname: Dwyer
authors.forename: J R
authors.initials: JR
authors.lastname: Alger
authors.forename: G
authors.initials: G
authors.lastname: Di Chiro
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001224:Aspartic Acid / Q000031:analogs & derivatives / Q000032:analysis; D001921:Brain / Q000000981:diagnostic imaging / Q000378:metabolism / Q000473:pathology; D001932:Brain Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000378:metabolism*; D002794:Choline / Q000032:analysis; D003401:Creatine / Q000032:analysis; D005260:Female; D005947:Glucose / Q000378:metabolism; D006801:Humans; D007773:Lactates / Q000032:analysis; D019344:Lactic Acid; D008279:Magnetic Resonance Imaging; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D008875:Middle Aged; D014055:Tomography, Emission-Computed
chemical_list: D007773:Lactates; D001224:Aspartic Acid; D019344:Lactic Acid; C000179:N-acetylaspartate; D005947:Glucose; D003401:Creatine; D002794:Choline