title: Arterial spin-labeling and MR spectroscopy in the differentiation of gliomas.
abstract: OBJECTIVE
  Noninvasive grading of gliomas remains a challenge despite its important role in the prognosis and management of patients with intracranial neoplasms. In this study, we evaluated the ability of cerebral blood flow (CBF)-guided voxel-by-voxel analysis of multivoxel proton MR spectroscopic imaging ((1)H-MRSI) to differentiate low-grade from high-grade gliomas.
  
  
  METHODS
  A total of 35 patients with primary gliomas (22 high grade and 13 low grade) underwent continuous arterial spin-labeling perfusion-weighted imaging (PWI) and (1)H-MRSI. Different regions of the gliomas were categorized as "hypoperfused," "isoperfused," and "hyperperfused" on the basis of the average CBF obtained from contralateral healthy white matter. (1)H-MRSI indices were computed from these regions and compared between low- and high-grade gliomas. Using a similar approach, we applied a subgroup analysis to differentiate low- from high-grade oligodendrogliomas because they show different physiologic and genetic characteristics.
  
  
  RESULTS
  Cho(glioma (G)/white matter (WM)), Glx(G/WM), and Lip+Lac(G)/Cr(WM) were significantly higher in the "hyperperfused" regions of high-grade gliomas compared with low-grade gliomas. Cho(G/WM) and Lip+Lac(G)/Cr(WM) were also significantly higher in the "hyperperfused" regions of high-grade oligodendrogliomas. However, metabolite ratios from the "hypoperfused" or "isoperfused" regions did not exhibit any significant differences between high-grade and low-grade gliomas.
  
  
  CONCLUSIONS
  The results suggest that (1)H-MRSI indices from the "hyperperfused" regions of gliomas, on the basis of PWI, may be helpful in distinguishing high-grade from low-grade gliomas including oligodendrogliomas.
authors: Department of Radiology, University of Pennsylvania, Philadelphia, PA 19104, USA.
authors: S
authors: S
authors: Chawla
authors: S
authors: S
authors: Wang
authors: R L
authors: RL
authors: Wolf
authors: J H
authors: JH
authors: Woo
authors: J
authors: J
authors: Wang
authors: D M
authors: DM
authors: O'Rourke
authors: K D
authors: KD
authors: Judy
authors: M S
authors: MS
authors: Grady
authors: E R
authors: ER
authors: Melhem
authors: H
authors: H
authors: Poptani
mesh_terms: D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000175:diagnosis*; D003936:Diagnosis, Computer-Assisted / Q000379:methods; D003937:Diagnosis, Differential; D005260:Female; D005910:Glioma / Q000175:diagnosis*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D009682:Magnetic Resonance Spectroscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013113:Spin Labels
chemical_list: D013113:Spin Labels