title: Comparison of 3 Tesla proton MR spectroscopy, MR perfusion and MR diffusion for distinguishing glioma recurrence from posttreatment effects.
abstract: OBJECTIVE
  To compare 3 Tesla (3T) multi-voxel and single-voxel proton MR spectroscopy (MRS), dynamic susceptibility contrast perfusion MRI (DSC), and diffusion-weighted MRI (DWI) for distinguishing recurrent glioma from postradiation injury.
  
  
  METHODS
  We reviewed all 3T MRS, DSC and DWI studies performed for suspicion of malignant glioma recurrence between October 2006 and December 2008. Maximum Cho/NAA and Cho/Cr peak-area and peak-height ratios were recorded for both multi-voxel and single-voxel MRS. Maximum cerebral blood volume (CBV) and minimum apparent diffusion coefficient (ADC) were normalized to white matter. Histopathology and clinical-radiologic follow-up served as reference standards. Receiver operating characteristic curves for each parameter were compared.
  
  
  RESULTS
  Forty lesions were classified as glioma recurrence (n = 30) or posttreatment effect (n = 10). Diagnostic performance was similar for CBV ratio (AUC = 0.917, P < 0.001), multi-voxel Cho/Cr peak-area (AUC = 0.913, P = 0.002), and multi-voxel Cho/NAA peak-height (AUC = 0.913, P = 0.002), while ADC ratio (AUC = 0.726, P = 0.035) did not appear to perform as well. Single-voxel MRS parameters did not reliably distinguish tumor recurrence from posttreatment effects.
  
  
  CONCLUSIONS
  A 3T DSC and multi-voxel MRS Cho/Cr peak-area and Cho/NAA peak-height appear to outperform DWI for distinguishing glioma recurrence from posttreatment effects. Single-voxel MRS parameters do not appear to distinguish glioma recurrence from posttreatment effects reliably, and therefore should not be used in place of multi-voxel MRS.
authors: Department of Radiology, University of Washington, Seattle, Washington 98195-7115, USA. jrfink@uw.edu
authors: James R
authors: JR
authors: Fink
authors: Robert B
authors: RB
authors: Carr
authors: Eiji
authors: E
authors: Matsusue
authors: Ramesh S
authors: RS
authors: Iyer
authors: Jason K
authors: JK
authors: Rockhill
authors: David R
authors: DR
authors: Haynor
authors: Kenneth R
authors: KR
authors: Maravilla
mesh_terms: D000328:Adult; D000368:Aged; D019540:Area Under Curve; D001932:Brain Neoplasms / Q000175:diagnosis* / Q000628:therapy; D003952:Diagnostic Imaging / Q000379:methods; D004058:Diffusion; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D005910:Glioma / Q000175:diagnosis* / Q000628:therapy; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D009682:Magnetic Resonance Spectroscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010477:Perfusion; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome