title: MR spectroscopy in gliomatosis cerebri.
abstract: OBJECTIVE
  The diagnosis of gliomatosis cerebri with MR imaging is known to be difficult. We report on the value of MR spectroscopy in the diagnosis, grading, and biopsy planing in eight patients with histopathologically proved gliomatosis cerebri.
  
  
  METHODS
  Patients underwent MR imaging and MR spectroscopy (single-voxel point-resolved spectroscopy [PRESS] at 1500/135, and chemical-shift imaging [CSI] PRESS at 1500/135) before open (n = 4) or stereotactic (n = 4) biopsy. In six patients who underwent CSI, biopsy samples were taken from regions of maximally elevated levels of choline/N-acetylaspartate (Cho/NAA).
  
  
  RESULTS
  All patients showed elevated Cho/creatine (Cr) and Cho/NAA levels as well as varying degrees of decreased NAA/Cr ratios, which were most pronounced in the anaplastic lesions. In low-grade lesions, there was a maximum Cho/NAA ratio of 1.3, whereas in anaplastic tumors, the maximum Cho/NAA level was at least 2.5. Spectra in two patients with grade III lesions revealed a lactate peak; lactate and lipid signals were seen in two patients with grade IV lesions. Biopsy specimens from regions with maximally elevated levels of Cho/NAA showed dense infiltration of tumor cells.
  
  
  CONCLUSIONS
  MR spectroscopy might be used to classify gliomatosis cerebri as a stable or a progressive disease indicating its potential therapeutic relevance.
authors.affiliation: Department of Neuroradiology, University of Würzburg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Bendszus
authors.forename: M
authors.initials: M
authors.lastname: Warmuth-Metz
authors.forename: R
authors.initials: R
authors.lastname: Klein
authors.forename: R
authors.initials: R
authors.lastname: Burger
authors.forename: C
authors.initials: C
authors.lastname: Schichor
authors.forename: J C
authors.initials: JC
authors.lastname: Tonn
authors.forename: L
authors.initials: L
authors.lastname: Solymosi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001224:Aspartic Acid / Q000031:analogs & derivatives / Q000378:metabolism; D001706:Biopsy; D001921:Brain / Q000473:pathology; D001932:Brain Neoplasms / Q000175:diagnosis* / Q000473:pathology; D002648:Child; D002794:Choline / Q000378:metabolism; D003401:Creatine / Q000378:metabolism; D018450:Disease Progression; D005260:Female; D006801:Humans; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D008875:Middle Aged; D018302:Neoplasms, Neuroepithelial / Q000175:diagnosis* / Q000473:pathology; D011379:Prognosis; D013238:Stereotaxic Techniques
chemical_list: D001224:Aspartic Acid; C000179:N-acetylaspartate; D003401:Creatine; D002794:Choline