The Role of Magnetic Resonance Spectroscopy in Grading Brain Glioma
Keywords:
Magnetic Resonance Spectroscopy, Brain GliomaAbstract
Background: conventional magnetic resonance (MR) imaging are helpful in characterizing tumoraggressiveness, but grading using conventional MR imaging alone is often unreliable. Proton MR
Spectroscopy (MRS) is a well-established technique for quantifying the brain regional biochemistry
by providing valuable information on the metabolic composition within an area of tissue and
comparing the relative concentration of these metabolites. The aim of this study is to evaluate the
contribution of short and intermediate TE MRS in differentiation of high and low grade gliomas.
Patients and Methods: a prospective cross sectional study conducted on selected patients with
untreated gliomas whom were referred to the radiology department presenting with different
neurological symptoms from April 2018 to February 2019. 1.5 Tesla MRI and MRS were performed
before any interventional procedure. Histopathological diagnosis was obtained and all tumors
enrolled were graded according to the current World Health Organization criteria. The main
metabolites identified by MRS were N-acetyl-aspartate (NAA) at 2.02 ppm, creatine (Cr) at 3.0 ppm,
choline containing compounds (Cho) at 3.2 ppm. The following metabolic ratios were calculated
using standard commercial software: NAA/Cr, Cho/Cr, and Cho/NAA at both short and intermediate
TE.
Results: a total of 22 patients; (12 male and 8 females, age ranged 18–70 years). At intermediate TE,
the difference between high and low grade tumors was statistically significant in Cho metabolite
related ratios (Cho/NAA and Cho/Cr), p-value 0.001 and 0.003 respectively. At short TE, the
difference between high and low grade tumors was statistically significant in Cho metabolite related
ratios (Cho/NAA and Cho/Cr), P <0.001 and 0.01 respectively. On other hand, NAA/Cr ratio was
statistically insignificant in differentiating low and high grade tumors.
Conclusion: MRS is a non-invasive technique that provides an insight into the underlying biological
structure of brain gliomas and in turn improves the diagnostic accuracy. Cho/Cr and Cho/NAA ratios
were the most valuable indicators in assessing the tumor grade.
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