title: Proton magnetic resonance spectroscopy in differentiating glioblastomas from primary cerebral lymphomas and brain metastases.
abstract: OBJECTIVE
  To differentiate glioblastomas, primary cerebral lymphomas (PCLs), and brain metastases using multivoxel proton magnetic resonance (MR) spectroscopic imaging.
  
  
  METHODS
  A total of 56 patients with brain neoplasms underwent MR imaging and proton MR spectroscopic imaging. The data were analyzed from contrast-enhancing and peritumoral regions (PTR). N-acetylaspartate/creatine (Cr), choline (Cho)/Cr, glutamate+glutamine/Cr, myo-inositol/Cr, and lipids+lactate/Cr ratios were computed, and pairwise comparisons between neoplasms were made using Mann-Whitney U tests.
  
  
  RESULTS
  The PTR demonstrated most significant differences in metabolite ratios. The Cho/Cr ratio in glioblastomas (0.46 [0.01]) was significantly higher than that in metastases (0.38 [0.02], P = 0.01). Significantly elevated Cho/Cr levels were also noted in PCLs (0.48 [0.03]) compared with those in metastases (P = 0.04). In addition, PCLs also demonstrated significantly higher lipids+lactate/Cr levels (11.83 [2.59]) compared with glioblastomas (4.50 [0.59], P = 0.003) and metastases (2.79 [0.33], P = 0.001).
  
  
  CONCLUSIONS
  Proton MR spectroscopic imaging from PTR may assist in the differentiation of glioblastomas, metastases, and PCLs.
authors.affiliation: Department of Radiology, University of Pennsylvania, Philadelphia, PA 19104, USA.
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Chawla
authors.forename: Yu
authors.initials: Y
authors.lastname: Zhang
authors.forename: Sumei
authors.initials: S
authors.lastname: Wang
authors.forename: Sangeeta
authors.initials: S
authors.lastname: Chaudhary
authors.forename: Chou
authors.initials: C
authors.lastname: Chou
authors.forename: Donald M
authors.initials: DM
authors.lastname: O'Rourke
authors.forename: Arastoo
authors.initials: A
authors.lastname: Vossough
authors.forename: Elias R
authors.initials: ER
authors.lastname: Melhem
authors.forename: Harish
authors.initials: H
authors.lastname: Poptani
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001224:Aspartic Acid / Q000031:analogs & derivatives / Q000378:metabolism; D001932:Brain Neoplasms / Q000175:diagnosis* / Q000378:metabolism / Q000556:secondary; D002794:Choline / Q000378:metabolism; D003287:Contrast Media; D003401:Creatine / Q000378:metabolism; D003937:Diagnosis, Differential; D005260:Female; D019786:Gadolinium DTPA; D005909:Glioblastoma / Q000175:diagnosis* / Q000378:metabolism / Q000556:secondary; D018698:Glutamic Acid / Q000378:metabolism; D005973:Glutamine / Q000378:metabolism; D006801:Humans; D007294:Inositol / Q000378:metabolism; D050356:Lipid Metabolism; D008223:Lymphoma / Q000175:diagnosis* / Q000378:metabolism; D008279:Magnetic Resonance Imaging / Q000379:methods*; D009682:Magnetic Resonance Spectroscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D018709:Statistics, Nonparametric
chemical_list: D003287:Contrast Media; D005973:Glutamine; D001224:Aspartic Acid; D018698:Glutamic Acid; D007294:Inositol; C064925:gadodiamide; C000179:N-acetylaspartate; D019786:Gadolinium DTPA; D003401:Creatine; D002794:Choline