title: Proton MRS imaging in the follow-up of patients with suspected low-grade gliomas.
abstract: We compared the value of changes in proton magnetic resonance spectroscopic imaging ((1)H-MRSI) with changes in clinical status and/or contrast-enhanced magnetic resonance imaging (MRI) in the monitoring of patients with suspected low-grade glioma (LGG). From June 1, 1999 till May 31, 2002, we included consecutive, neurologically intact adult patients suspected of having an LGG, demonstrating non-enhancing supratentorial lesions without edema or mass effect on MRI, and in whom all treatment (including a diagnostic biopsy) was deferred. Till January 1, 2003, patients were surveyed clinically and radiologically (contrast-enhanced MRI and (1)H-MRSI). Patients who showed progression on clinical examination and/or MRI were denoted as progressive disease. Other patients were denoted as stable disease. A decrease in NAA/CHO ratio of > or =20% compared to the baseline value was considered as indicative for progression on (1)H-MRSI. We included 14 patients with suspected LGG. Seven patients demonstrated progressive disease during the follow-up period, preceded or accompanied by concomitant (1)H-MRSI changes in five patients. Four of these five patients were operated on within the follow-up interval. The histological diagnosis demonstrated high-grade glioma in three and LGG in one patient. In the other two patients with progressive disease, no progression was found on (1)H-MRSI. The other seven patients demonstrated stable disease, but four of them showed progression on (1)H-MRSI. Our data do not show convincing evidence that (1)H-MRSI contributes to adequate monitoring and follow-up of patients with suspected LGG. Future research should preferably include pathological data at the time of (1)H-MRSI changes.
authors.affiliation: Department of Neurology, University Medical Center Utrecht, The Netherlands. jc.reijneveld@vumc.nl
authors.forename: J C
authors.initials: JC
authors.lastname: Reijneveld
authors.forename: J
authors.initials: J
authors.lastname: van der Grond
authors.forename: L M P
authors.initials: LM
authors.lastname: Ramos
authors.forename: J E C
authors.initials: JE
authors.lastname: Bromberg
authors.forename: M J B
authors.initials: MJ
authors.lastname: Taphoorn
mesh_terms: D000328:Adult; D001932:Brain Neoplasms / Q000473:pathology*; D003287:Contrast Media / Q000008:administration & dosage; D018450:Disease Progression; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D011379:Prognosis; D011522:Protons; D012680:Sensitivity and Specificity
chemical_list: D003287:Contrast Media; D011522:Protons