title: Differentiation of glioblastoma multiforme from metastatic brain tumor using proton magnetic resonance spectroscopy, diffusion and perfusion metrics at 3 T.
abstract: OBJECTIVE
  To assess the contribution of (1)H-magnetic resonance spectroscopy (1H-MRS), diffusion-weighted imaging (DWI), diffusion tensor imaging (DTI) and dynamic susceptibility contrast-enhanced (DSCE) imaging metrics in the differentiation of glioblastomas from solitary metastasis, and particularly to clarify the controversial reports regarding the hypothesis that there should be a significant differentiation between the intratumoral and peritumoral areas.
  
  
  METHODS
  Conventional MR imaging, (1)H-MRS, DWI, DTI and DSCE MRI was performed on 49 patients (35 glioblastomas multiforme, 14 metastases) using a 3.0-T MR unit. Metabolite ratios, apparent diffusion coefficient (ADC), fractional anisotropy (FA) and relative cerebral blood volume (rCBV) were measured in the intratumoral and peritumoral regions of the lesions. Receiver-operating characteristic analysis was used to obtain the cut-off values for the parameters presenting a statistical difference between the two tumor groups. Furthermore, we investigated the potential effect of the region of interest (ROI) size on the quantification of diffusion properties in the intratumoral region of the lesions, by applying two different ROI methods.
  
  
  RESULTS
  Peritumoral N-acetylaspartate (NAA)/creatine (Cr), choline (Cho)/Cr, Cho/NAA and rCBV significantly differentiated glioblastomas from intracranial metastases. ADC and FA presented no significant difference between the two tumor groups.
  
  
  CONCLUSIONS
  1H-MRS and dynamic susceptibility measurements in the peritumoral regions may definitely aid in the differentiation of glioblastomas and solitary metastases. The quantification of the diffusion properties in the intratumoral region is independent of the ROI size placed.
authors.affiliation: Medical Physics Department, University of Thessaly, Biopolis, 41110 Larissa, Greece. tsougos@med.uth.gr
authors.forename: Ioannis
authors.initials: I
authors.lastname: Tsougos
authors.forename: Patricia
authors.initials: P
authors.lastname: Svolos
authors.forename: Evanthia
authors.initials: E
authors.lastname: Kousi
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Fountas
authors.forename: Kyriaki
authors.initials: K
authors.lastname: Theodorou
authors.forename: Ioannis
authors.initials: I
authors.lastname: Fezoulidis
authors.forename: Eftychia
authors.initials: E
authors.lastname: Kapsalaki
mesh_terms: D000328:Adult; D000368:Aged; D001224:Aspartic Acid / Q000031:analogs & derivatives / Q000032:analysis; D001921:Brain / Q000378:metabolism / Q000473:pathology*; D001923:Brain Chemistry; D001932:Brain Neoplasms / Q000175:diagnosis* / Q000556:secondary; D002794:Choline / Q000032:analysis; D003401:Creatine / Q000032:analysis; D003937:Diagnosis, Differential; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D005909:Glioblastoma / Q000175:diagnosis*; D006801:Humans; D009682:Magnetic Resonance Spectroscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis / Q000175:diagnosis; D011446:Prospective Studies; D012372:ROC Curve
chemical_list: D001224:Aspartic Acid; C000179:N-acetylaspartate; D003401:Creatine; D002794:Choline