title: (1)H MRSI and progression-free survival in patients with WHO grades II and III gliomas.
abstract: OBJECTIVE
  To evaluate if metabolic changes in WHO grades II and III gliomas measured in vivo with proton magnetic resonance spectroscopic imaging ((1)H-MRSI) correlate with progression-free survival (PFS).
  
  
  METHODS
  (1)H-MRSI and MRI were performed before surgery in 61 patients with histopathological proven WHO grades II and III gliomas. Averaged (av) and maximum (max) metabolite concentrations of creatine/phosphocreatine (tCr) and choline-containing compounds (tCho) from the tumor were normalized to contralateral brain tissue. In 50 patients with a median follow-up of 34 (WHO grade II) and 19.5 (WHO grade III) months, spectroscopic data as well as the extent of tumor resection, histopathological subtype, adjuvant therapy and patients' ages were analysed for PFS times with Cox regression analysis. Kaplan-Meier method was performed with categorized tCr values (cutoff: 0.93) to estimate the median PFS time.
  
  
  RESULTS
  The normalized tCr(av) was prognostic for the PFS in patients with WHO grades II and III gliomas (p<0.0001 and p=0.034, respectively). For WHO grade II gliomas, tCr(max) (p=0.008) and the patients' ages (p=0.006) were also prognostic. The multivariate analysis provided tCr(av) (p=0.001) as single independent prognostic factor for the PFS of WHO grade II gliomas. Patients with WHO grades II and III gliomas revealing a normalized tCr(av) greater than 0.93 had a significant shorter PFS.
  
  
  CONCLUSIONS
  Potential tumor progression in WHO grades II and III gliomas is best indicated by the normalized tCr(av). Normalized tCr(av) >0.93 seems to indicate gliomas with earlier progression.
authors.affiliation: Institute of Neuroradiology Johann Wolfgang Goethe University Frankfurt/Main, 60528 Frankfurt/Main, Germany. elke.hattingen@kgu.de
authors.forename: Elke
authors.initials: E
authors.lastname: Hattingen
authors.forename: Oliver
authors.initials: O
authors.lastname: Delic
authors.forename: Kea
authors.initials: K
authors.lastname: Franz
authors.forename: Ulrich
authors.initials: U
authors.lastname: Pilatus
authors.forename: Peter
authors.initials: P
authors.lastname: Raab
authors.forename: Heinrich
authors.initials: H
authors.lastname: Lanfermann
authors.forename: Rüdiger
authors.initials: R
authors.lastname: Gerlach
mesh_terms: D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000378:metabolism / Q000401:mortality / Q000628:therapy; D002794:Choline / Q000378:metabolism; D003401:Creatine / Q000378:metabolism; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D005910:Glioma / Q000378:metabolism / Q000401:mortality / Q000628:therapy; D006801:Humans; D053208:Kaplan-Meier Estimate; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D008875:Middle Aged; D010725:Phosphocreatine / Q000378:metabolism; D011522:Protons; D012372:ROC Curve; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D014944:World Health Organization; D055815:Young Adult
chemical_list: D011522:Protons; D010725:Phosphocreatine; D003401:Creatine; D002794:Choline