title: (1)H magnetic resonance spectroscopy in the diagnosis of paediatric low grade brain tumours.
abstract: BACKGROUND
  Low grade gliomas are the commonest brain tumours in children but present in a myriad of ways, each with its own treatment challenges. Conventional MRI scans play an important role in their management but have limited ability to identify likely clinical behaviour. The aim of this study is to investigate (1)H magnetic resonance spectroscopy (MRS) as a method for detecting differences between the various low grade gliomas and related tumours in children.
  
  
  METHODS
  Short echo time single voxel (1)H MRS at 1.5 or 3.0 T was performed prior to treatment on children with low grade brain tumours at two centres and five MR scanners, 69 cases had data which passed quality control. MRS data was processed using LCModel to give mean spectra and metabolite concentrations which were compared using T-tests, ANOVA, Receiver Operator Characteristic curves and logistic regression in SPSS.
  
  
  RESULTS
  Significant differences were found in concentrations of key metabolites between glioneuronal and glial tumours (T-test p<0.05) and between most of the individual histological subtypes of low grade gliomas. The discriminatory metabolites identified, such as choline and myoinositol, are known tumour biomarkers. In the set of pilocytic astrocytomas and unbiopsied optic pathway gliomas, significant differences (p<0.05, ANOVA) were found in metabolite profiles of tumours depending on location and patient neurofibromatosis type 1 status. Logistic regression analyses yielded equations which could be used to assess the probability of a tumour being of a specific type.
  
  
  CONCLUSIONS
  MRS can detect subtle differences between low grade brain tumours in children and should form part of the clinical assessment of these tumours.
authors.affiliation: School of Cancer Sciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK. eleni.orphanidou@googlemail.com
authors.forename: E
authors.initials: E
authors.lastname: Orphanidou-Vlachou
authors.forename: D
authors.initials: D
authors.lastname: Auer
authors.forename: M A
authors.initials: MA
authors.lastname: Brundler
authors.forename: N P
authors.initials: NP
authors.lastname: Davies
authors.forename: T
authors.initials: T
authors.lastname: Jaspan
authors.forename: L
authors.initials: L
authors.lastname: MacPherson
authors.forename: K
authors.initials: K
authors.lastname: Natarajan
authors.forename: Y
authors.initials: Y
authors.lastname: Sun
authors.forename: T N
authors.initials: TN
authors.lastname: Arvanitis
authors.forename: R G
authors.initials: RG
authors.lastname: Grundy
authors.forename: A C
authors.initials: AC
authors.lastname: Peet
mesh_terms: D000293:Adolescent; D014408:Biomarkers, Tumor / Q000032:analysis*; D001932:Brain Neoplasms / Q000175:diagnosis* / Q000378:metabolism*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005910:Glioma / Q000175:diagnosis* / Q000378:metabolism*; D006801:Humans; D007223:Infant; D009682:Magnetic Resonance Spectroscopy / Q000379:methods*; D008297:Male; D060787:Neoplasm Grading; D011522:Protons; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D006113:United Kingdom
chemical_list: D014408:Biomarkers, Tumor; D011522:Protons