title: Determination of histopathological tumor grade in neuroepithelial brain tumors by using spectral pattern analysis of in vivo spectroscopic data.
abstract: OBJECTIVE
  In this study, 1H magnetic resonance (MR) spectroscopy was prospectively tested as a reliable method for presurgical grading of neuroepithelial brain tumors.
  
  
  METHODS
  Using a database of tumor spectra obtained in patients with histologically confirmed diagnoses, 94 consecutive untreated patients were studied using single-voxel 1H spectroscopy (point-resolved spectroscopy; TE 135 msec, TE 135 msec, TR 1500 msec). A total of 90 tumor spectra obtained in patients with diagnostic 1H MR spectroscopy examinations were analyzed using commercially available software (MRUI/VARPRO) and classified using linear discriminant analysis as World Health Organization (WHO) Grade I/II, WHO Grade III, or WHO Grade IV lesions. In all cases, the classification results were matched with histopathological diagnoses that were made according to the WHO classification criteria after serial stereotactic biopsy procedures or open surgery. Histopathological studies revealed 30 Grade I/II tumors, 29 Grade III tumors, and 31 Grade IV tumors. The reliability of the histological diagnoses was validated considering a minimum postsurgical follow-up period of 12 months (range 12-37 months). Classifications based on spectroscopic data yielded 31 tumors in Grade I/II, 32 in Grade III, and 27 in Grade IV. Incorrect classifications included two Grade II tumors, one of which was identified as Grade III and one as Grade IV; two Grade III tumors identified as Grade II; two Grade III lesions identified as Grade IV; and six Grade IV tumors identified as Grade III. Furthermore, one glioblastoma (WHO Grade IV) was classified as WHO Grade I/II. This represents an overall success rate of 86%, and a 95% success rate in differentiating low-grade from high-grade tumors.
  
  
  CONCLUSIONS
  The authors conclude that in vivo 1H MR spectroscopy is a reliable technique for grading neuroepithelial brain tumors.
authors.affiliation: Department of Neurosurgery and Institute of Neuroradiology, Johann W. Goethe University, Frankfurt am Main, Germany. sherminha@aol.de
authors.forename: Sebastian
authors.initials: S
authors.lastname: Herminghaus
authors.forename: Thomas
authors.initials: T
authors.lastname: Dierks
authors.forename: Ulrich
authors.initials: U
authors.lastname: Pilatus
authors.forename: Walter
authors.initials: W
authors.lastname: Möller-Hartmann
authors.forename: Jörg
authors.initials: J
authors.lastname: Wittsack
authors.forename: Gerhard
authors.initials: G
authors.lastname: Marquardt
authors.forename: Christoph
authors.initials: C
authors.lastname: Labisch
authors.forename: Heinrich
authors.initials: H
authors.lastname: Lanfermann
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Schlote
authors.forename: Friedhelm E
authors.initials: FE
authors.lastname: Zanella
mesh_terms: D001932:Brain Neoplasms / Q000175:diagnosis* / Q000473:pathology* / Q000601:surgery; D003937:Diagnosis, Differential; D005500:Follow-Up Studies; D006801:Humans; D009682:Magnetic Resonance Spectroscopy; D018302:Neoplasms, Neuroepithelial / Q000175:diagnosis* / Q000473:pathology* / Q000601:surgery; D011300:Preoperative Care; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013057:Spectrum Analysis; D013997:Time Factors