title: Comparison between magnetic resonance spectroscopy and diffusion weighted imaging in the evaluation of gliomas response after treatment.
abstract: OBJECTIVE
  To compare magnetic resonance spectroscopy (MRS) and diffusion weighted imaging (DWI) in the assessment of progression and regression of brain tumors in order to assess whether there is correlation between MRS and DWI in the monitoring of patients with primary tumors after therapy.
  
  
  METHODS
  Magnetic resonance imaging (MRI) has been performed in 80 patients, 48 affected by high grade gliomas (HGG) and 32 affected by low grade gliomas (LGG). The variation of apparent diffusion coefficient (ADC) value and metabolite ratios before and after treatment has been used to test DWI sequences and MRS as predictor to response to therapy. Comparison between post contrast-enhancement sequences, MRS and DWI has been done in terms of accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Moreover statistical correlation of ADC deviations with MRS metabolites variations before and after therapy have been studied.
  
  
  RESULTS
  In the case of HGG, MRS shows better sensitivity, specificity, PPV, NPV and accuracy compared to DWI, especially when considering the Choline/N-acetylaspartate (Cho/NAA) ratio. Regarding the LGG, the technique that better evaluates the response to treatment appears to be the DWI. A moderate correlation between ADC deviations and Cho, Lipide (Lip) and Lactate (Lac) has been found in LGG; while NAA revealed to be weakly correlated to ADC variation. Considering HGG, a weak correlation has been found between ADC deviations and MRS metabolites.
  
  
  CONCLUSIONS
  Combination of DWI and MRS can help to characterize different changes related to treatment and to evaluate brain tumor response to treatment.
authors.affiliation: IRCCS-CROB, Rionero in Vulture, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Lotumolo
authors.affiliation: IRCCS-CROB, Rionero in Vulture, Italy. Electronic address: rocchina.caivano@gmail.com.
authors.forename: Rocchina
authors.initials: R
authors.lastname: Caivano
authors.affiliation: IRCCS-CROB, Rionero in Vulture, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Rabasco
authors.affiliation: IRCCS-CROB, Rionero in Vulture, Italy.
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Iannelli
authors.affiliation: IRCCS-CROB, Rionero in Vulture, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Villonio
authors.affiliation: IRCCS-CROB, Rionero in Vulture, Italy.
authors.forename: Felice
authors.initials: F
authors.lastname: D' Antuono
authors.affiliation: IRCCS-CROB, Rionero in Vulture, Italy.
authors.forename: Matilde
authors.initials: M
authors.lastname: Gioioso
authors.affiliation: IRCCS-CROB, Rionero in Vulture, Italy.
authors.forename: Alexis
authors.initials: A
authors.lastname: Zandolino
authors.affiliation: University of Foggia, Radiology, Foggia, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Macarini
authors.affiliation: IRCCS-Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Guglielmi
authors.affiliation: IRCCS-CROB, Rionero in Vulture, Italy.
authors.forename: Aldo
authors.initials: A
authors.lastname: Cammarota
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001224:Aspartic Acid / Q000031:analogs & derivatives / Q000378:metabolism; D001932:Brain Neoplasms / Q000378:metabolism / Q000473:pathology* / Q000628:therapy; D002794:Choline / Q000378:metabolism; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D005910:Glioma / Q000378:metabolism / Q000473:pathology* / Q000628:therapy; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D009682:Magnetic Resonance Spectroscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
chemical_list: D001224:Aspartic Acid; C000179:N-acetylaspartate; D002794:Choline
keywords: Brain neoplasm; Diffusion magnetic resonance imaging; Glioma