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. 2012:2012:546171.
doi: 10.1100/2012/546171. Epub 2012 Jul 31.

Spectroscopic evaluation of glioma grading at 3T: the combined role of short and long TE

E Kousi  1 , I Tsougos, E Tsolaki, K N Fountas, K Theodorou, I Fezoulidis, E Kapsalaki, C Kappas
Affiliations

Spectroscopic evaluation of glioma grading at 3T: the combined role of short and long TE

E Kousi et al. ScientificWorldJournal. 2012.

Abstract

Purpose: To evaluate the diagnostic value of 3T (1)H-MRS in grading cerebral gliomas using short and long echo times.

Methods: 1H-MRS was performed on 71 patients with untreated cerebral gliomas. Metabolite ratios of NAA/Cr, Cho/Cr, Cho/NAA, and mI/Cr were calculated for short and long TE and compared between low and high grade gliomas. Lipids were qualitatively evaluated. ROC analysis was performed to obtain the cut-off values for the metabolic ratios presenting statistical difference between the two glioma grades.

Results: Intratumoral Cho/Cr at both TEs and long TE Cho/NAA were significantly different between low and high grade gliomas. Peritumoral NAA/Cr of both TEs, as well as long TE Cho/Cr and Cho/NAA ratios, significantly differentiated the two tumor grades. Diagnostic sensitivity of peritumoral short TE NAA/Cr proved to be superior over the other metabolic ratios, whereas intratumoral short TE Cho/Cr reached the highest levels of specificity and accuracy. Overall, short TE 1H-MRS reached higher total sensitivity in predicting glioma grade, over long TE.

Conclusion: An advantage was found in using short TE over long TE 1H-MRS in the discrimination of low versus high grade gliomas. Moreover, the results suggested that the peritumoral area of gliomas may be more valuable in predicting glioma grade than using only the intratumoral area.

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Figures

Figure 1
Figure 1
Intratumoral voxel prescription during SV (a) and 2D-MRSI (b) scan techniques, in a 77-year-old woman with a glioblastoma. For the two scan techniques, the voxel of interest has been placed in similar areas.
Figure 2
Figure 2
In vivo short TE ((a), (b)) and long TE ((c), (d)) mean spectra with their corresponding standard deviations (vertical lines) from the intratumoral area of low grade ((a), (c)) and high grade gliomas ((b), (d)).
Figure 3
Figure 3
Short TE 1H-MR spectra of a 66-years-old male (a) and a 51-year-old female (b) with glioblastoma multiform and anaplastic astrocytoma, respectively. Spectra illustrate high grade glioma intratumoral patterns of (a) dominant LL peak and (b) smaller LL peak with clear evidence of all the other metabolites.
Figure 4
Figure 4
Long TE 1H-MRSI spectra of a 54-year-old male (a) and a 47-year-old female (b) with glioblastoma multiform and anaplastic oligoastrocytoma, respectively. Spectra illustrate high grade glioma intratumoral patterns of (a) high LL peak and (b) absence of LL peak respectively.
Figure 5
Figure 5
In vivo short TE ((a), (b)) and long TE ((c), (d)) mean spectra with their corresponding standard deviations (vertical lines) from the peritumoral area of low grade ((a), (c)) and high grade gliomas ((b), (d)).
Figure 6
Figure 6
Upper graph (a) illustrates the receiver operating characteristic (ROC) curves of intratumoral short TE Cho/Cr and long TE Cho/Cr and Cho/NAA ratios. Lower graphs illustrate ROC curves of peritumoral short TE NAA/Cr, long TE NAA/Cr (b) and long TE Cho/Cr and Cho/NAA (c) ratios, for differentiating low from high grade gliomas.
See this image and copyright information in PMC

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