Tissue characterization of glioma by proton magnetic resonance spectroscopy and perfusion-weighted magnetic resonance imaging: glioma grading and histological correlation


      Background and Purpose

      Our intent was to clarify the usefulness of proton magnetic resonance spectroscopy (MRS) and perfusion-weighted magnetic resonance imaging (PW-MRI) in the grading of glioma.


      Twenty-three consecutive patients with gliomas were investigated by both proton MRS and PW-MRI. For quantitative analysis, the metabolite data of the gliomas were estimated using the LCModel software. Receiver operating characteristic (ROC) curve analyses were also performed to assess which metabolite parameter was optimal for discrimination of glioma grade. From the PW-MRI data, the value of blood volume was measured on the parametric map corresponding to the location of MRS analysis. We then compared tumor blood volume with the amount of choline (Cho).


      The mean Cho/creatine (Cre) ratio was useful to discriminate between Grades II and III, and the mean lactate (Lac)/Cre ratio was found to be significantly different between Grades III and IV. ROC curve analysis showed that measurements involving Cho were superior indices for grading glioma compared with blood volume information. Furthermore, the correlation between tumor blood volume and the amount of choline was statistically significant.


      MRS may provide valuable information for glioma grading.


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      1. Kleihues P Cavenee W World Health Organization classification of tumours: pathology and genetics of tumours of the nervous system. International Agency for Research on Cancer (IARC) Press, Lyon, France2000: 9-54
        • Kleihues P
        • Louis DN
        • Scheithauer BW
        • Rorke LB
        • Reifenberger G
        • Burger PC
        • Cavenee WK
        The WHO classification of tumors of the nervous system.
        J Neuropathol Exp Neurol. 2002; 61 ([discussion 219–26]): 215-225
        • Sugahara T
        • Korogi Y
        • Kochi M
        • Ikushima I
        • Hirai T
        • Okuda T
        • Shigematsu Y
        • Liang L
        • Ge Y
        • Ushio Y
        • Takahashi M
        Correlation of MR imaging-determined cerebral blood volume maps with histologic and angiographic determination of vascularity of gliomas.
        Am J Roentgenol. 1998; 171: 1479-1486
        • Knopp EA
        • Cha S
        • Johnson G
        • Mazumdar A
        • Golfinos JG
        • Zagzag D
        • Miller DC
        • Kelly PJ
        • Kricheff II
        Glial neoplasms: dynamic contrast-enhanced T2low asterisk-weighted MR imaging.
        Radiology. 1999; 211: 791-798
        • Uematsu H
        • Maeda M
        • Sadato N
        • Matsuda T
        • Ishimori Y
        • Koshimoto Y
        • Kimura H
        • Yamada H
        • Kawamura Y
        • Yonekura Y
        • Itoh H
        Blood volume of gliomas determined by double-echo dynamic perfusion-weighted MR imaging: a preliminary study.
        Am J Neuroradiol. 2001; 22: 1915-1919
        • Uematsu H
        • Maeda M
        • Sadato N
        • Ishimori Y
        • Matsuda T
        • Koshimoto Y
        • Kimura H
        • Yamada H
        • Kawamura Y
        • Takeuchi H
        • Yonekura Y
        • Itoh H
        Measurement of the vascularity and vascular leakage of gliomas by double-echo dynamic magnetic resonance imaging: a preliminary study.
        Invest Radiol. 2002; 37: 571-576
        • Boxerman JL
        • Schmainda KM
        • Weisskoff RM
        Relative cerebral blood volume maps corrected for contrast agent extravasation significantly correlate with glioma tumor grade, whereas uncorrected maps do not.
        Am J Neuroradiol. 2006; 27: 859-867
        • Poptani H
        • Gupta RK
        • Roy R
        • Pandey R
        • Jain VK
        • Chhabra DK
        Characterization of intracranial mass lesions with in vivo proton MR spectroscopy.
        Am J Neuroradiol. 1995; 16: 1593-1603
        • Shimizu H
        • Kumabe T
        • Tominaga T
        • Kayama T
        • Hara K
        • Ono Y
        • Sato K
        • Arai N
        • Fujiwara S
        • Yoshimoto T
        Noninvasive evaluation of malignancy of brain tumors with proton MR spectroscopy.
        Am J Neuroradiol. 1996; 17: 737-747
        • Meyerand ME
        • Pipas JM
        • Mamourian A
        • Tosteson TD
        • Dunn JF
        Classification of biopsy-confirmed brain tumors using single-voxel MR spectroscopy.
        Am J Neuroradiol. 1999; 20: 117-123
        • Bendszus M
        • Warmuth-Metz M
        • Klein R
        • Burger R
        • Schichor C
        • Tonn JC
        • Solymosi L
        MR spectroscopy in gliomatosis cerebri.
        Am J Neuroradiol. 2000; 21: 375-380
        • Law M
        • Cha S
        • Knopp EA
        • Johnson G
        • Arnett J
        • Litt AW
        High-grade gliomas and solitary metastases: differentiation by using perfusion and proton spectroscopic MR imaging.
        Radiology. 2002; 222: 715-721
        • Bulakbasi N
        • Kocaoglu M
        • Ors F
        • Tayfun C
        • Ucoz T
        Combination of single-voxel proton MR spectroscopy and apparent diffusion coefficient calculation in the evaluation of common brain tumors.
        Am J Neuroradiol. 2003; 24: 225-233
        • Majos C
        • Alonso J
        • Aguilera C
        • Serrallonga M
        • Perez-Martin J
        • Acebes JJ
        • Arus C
        • Gili J
        Proton magnetic resonance spectroscopy ((1)H MRS) of human brain tumours: assessment of differences between tumour types and its applicability in brain tumour categorization.
        Eur Radiol. 2003; 13: 582-591
        • Rand SD
        • Prost R
        • Haughton V
        • Mark L
        • Strainer J
        • Johansen J
        • Kim TA
        • Chetty VK
        • Mueller W
        • Meyer G
        • Krouwer H
        Accuracy of single-voxel proton MR spectroscopy in distinguishing neoplastic from nonneoplastic brain lesions.
        Am J Neuroradiol. 1997; 18: 1695-1704
        • Butzen J
        • Prost R
        • Chetty V
        • Donahue K
        • Neppl R
        • Bowen W
        • Li SJ
        • Haughton V
        • Mark L
        • Kim T
        • Mueller W
        • Meyer G
        • Krouwer H
        • Rand S
        Discrimination between neoplastic and nonneoplastic brain lesions by use of proton MR spectroscopy: the limits of accuracy with a logistic regression model.
        Am J Neuroradiol. 2000; 21: 1213-1219
        • Negendank WG
        • Sauter R
        • Brown TR
        • Evelhoch JL
        • Falini A
        • Gotsis ED
        • Heerschap A
        • Kamada K
        • Lee BC
        • Mengeot MM
        • Moser E
        • Padavic-Shaller KA
        • Sanders JA
        • Spraggins TA
        • Stillman AE
        • Terwey B
        • Vogl TJ
        • Wicklow K
        • Zimmerman RA
        Proton magnetic resonance spectroscopy in patients with glial tumors: a multicenter study.
        J Neurosurg. 1996; 84: 449-458
        • Tamiya T
        • Kinoshita K
        • Ono Y
        • Matsumoto K
        • Furuta T
        • Ohmoto T
        Proton magnetic resonance spectroscopy reflects cellular proliferative activity in astrocytomas.
        Neuroradiology. 2000; 42: 333-338
        • Castillo M
        • Smith JK
        • Kwock L
        Correlation of myo-inositol levels and grading of cerebral astrocytomas.
        Am J Neuroradiol. 2000; 21: 1645-1649
        • Provencher SW
        Estimation of metabolite concentrations from localized in vivo proton NMR spectra.
        Magn Reson Med. 1993; 30: 672-679
        • Yang D
        • Korogi Y
        • Sugahara T
        • Kitajima M
        • Shigematsu Y
        • Liang L
        • Ushio Y
        • Takahashi M
        Cerebral gliomas: prospective comparison of multivoxel 2D chemical-shift imaging proton MR spectroscopy, echoplanar perfusion and diffusion-weighted MRI.
        Neuroradiology. 2002; 44: 656-666
        • Law M
        • Yang S
        • Wang H
        • Babb JS
        • Johnson G
        • Cha S
        • Knopp EA
        • Zagzag D
        Glioma grading: sensitivity, specificity, and predictive values of perfusion MR imaging and proton MR spectroscopic imaging compared with conventional MR imaging.
        Am J Neuroradiol. 2003; 24: 1989-1998
        • Ricci PE
        • Pitt A
        • Keller PJ
        • Coons SW
        • Heiserman JE
        Effect of voxel position on single-voxel MR spectroscopy findings.
        Am J Neuroradiol. 2000; 21: 367-374
        • Henry RG
        • Vigneron DB
        • Fischbein NJ
        • Grant PE
        • Day MR
        • Noworolski SM
        • Star-Lack JM
        • Wald LL
        • Dillon WP
        • Chang SM
        • Nelson SJ
        Comparison of relative cerebral blood volume and proton spectroscopy in patients with treated gliomas.
        Am J Neuroradiol. 2000; 21: 357-366
        • Fayed N
        • Modrego PJ
        The contribution of magnetic resonance spectroscopy and echoplanar perfusion-weighted MRI in the initial assessment of brain tumours.
        J Neurooncol. 2005; 72: 261-265
        • Vonken EJ
        • van Osch MJ
        • Bakker CJ
        • Viergever MA
        Measurement of cerebral perfusion with dual-echo multi-slice quantitative dynamic susceptibility contrast MRI.
        J Magn Reson Imaging. 1999; 10: 109-117