Dynamic 1H-MRS assessment of brain tumors: a novel approach for differential diagnosis of glioma.
OBJECTIVE
To determine whether the changes of [Cho/NAA] ratio in patients with glioma, measured by dynamic 1H-MRS can be used to differentiate between high-grade and low-grade gliomas.


METHODS
This prospective study was approved by the institutional ethics committee. Written informed consent was obtained. Forty-nine patients with biopsy-proven glioma and 20 normal control subjects were recruited in this study. The maximum [Cho/NAA] ratios, acquired at 0 min, and at 6 min, were calculated and assessed from volume of interests (VOI) in the tumor areas and in the surrounding normal tissue for each patient. Absolute difference in the [Cho/NAA] ratios, from MRS acquired at 0 and 6 min, in high-grade glioma, low-grade glioma, and control subjects were compared.


RESULTS
The maximum [Cho/NAA] ratio acquired from the tumor area at the 0 min is 6.08 ± 2.02, which was significantly different (p = .017) from that acquired after 6 min, 4.87 ± 2.13. The [Cho/NAA] ratio from the surrounding normal tissue area did not change significantly from spectra acquired at different times (0 min, 6 min). Absolute difference in [Cho/NAA] ratios acquired at 0 and 6 min time points were significantly higher (P < 0.001) in high-grade glioma (= 3.86 ± 3.31) than in low-grade glioma (= 0.81 ± 0.90), and control subjects (0.061 ± 0.026, P = 0.000), while there was no significantly difference in low-grade glioma and control subjects.


CONCLUSIONS
Dynamic 1H-MRS can be useful for differential diagnosis between high-grade and low-grade gliomas as well as insight into the heterogeneity within the tumor.
Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China.
Tong
T
Tong
Department of Radiology, Fudan University Huashan Hospital, Shanghai, China.
Zhong
Z
Yang
Institute for Innovation in Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
John W
JW
Chen
Department of Radiation Oncology, The University of North Carolina, Chapel Hill, NC, USA.
Jianming
J
Zhu
Department of Radiology, Fudan University Huashan Hospital, Shanghai, China.
Zhenwei
Z
Yao
D001224:Aspartic Acid / Q000031:analogs & derivatives* / Q000378:metabolism; D014408:Biomarkers, Tumor / Q000378:metabolism*; D001932:Brain Neoplasms / Q000378:metabolism* / Q000473:pathology; D016022:Case-Control Studies; D002794:Choline / Q000378:metabolism*; D003937:Diagnosis, Differential; D005910:Glioma / Q000378:metabolism* / Q000473:pathology; D006801:Humans; D055432:Metabolomics / Q000379:methods*; D060787:Neoplasm Grading; D011237:Predictive Value of Tests; D011446:Prospective Studies; D066244:Proton Magnetic Resonance Spectroscopy; D013997:Time Factors
D014408:Biomarkers, Tumor; D001224:Aspartic Acid; C000179:N-acetylaspartate; D002794:Choline
Clinical Section; differential diagnosis; glioma; magnetic resonance imaging; magnetic resonance spectroscopy