Abstract
Noninvasive grading of gliomas remains a challenge despite its important role in the prognosis and management of patients with intracranial neoplasms. In this study, we evaluated the ability of cerebral blood flow (CBF)-guided voxel-by-voxel analysis of multivoxel proton MR spectroscopic imaging ((1)H-MRSI) to differentiate low-grade from high-grade gliomas. A total of 35 patients with primary gliomas (22 high grade and 13 low grade) underwent continuous arterial spin-labeling perfusion-weighted imaging (PWI) and (1)H-MRSI. Different regions of the gliomas were categorized as "hypoperfused," "isoperfused," and "hyperperfused" on the basis of the average CBF obtained from contralateral healthy white matter. (1)H-MRSI indices were computed from these regions and compared between low- and high-grade gliomas. Using a similar approach, we applied a subgroup analysis to differentiate low- from high-grade oligodendrogliomas because they show different physiologic and genetic characteristics. Cho(glioma (G)/white matter (WM)), Glx(G/WM), and Lip+Lac(G)/Cr(WM) were significantly higher in the "hyperperfused" regions of high-grade gliomas compared with low-grade gliomas. Cho(G/WM) and Lip+Lac(G)/Cr(WM) were also significantly higher in the "hyperperfused" regions of high-grade oligodendrogliomas. However, metabolite ratios from the "hypoperfused" or "isoperfused" regions did not exhibit any significant differences between high-grade and low-grade gliomas. The results suggest that (1)H-MRSI indices from the "hyperperfused" regions of gliomas, on the basis of PWI, may be helpful in distinguishing high-grade from low-grade gliomas including oligodendrogliomas.
Highlights
MethodsA total of 35 patients with primary gliomas (22 high grade and 13 low grade) underwent continuous arterial spin-labeling perfusion-weighted imaging (PWI) and 1H-MRSI
AND PURPOSE: Noninvasive grading of gliomas remains a challenge despite its important role in the prognosis and management of patients with intracranial neoplasms
The results suggest that 1H-MRSI indices from the “hyperperfused” regions of gliomas, on the basis of perfusion-weighted imaging (PWI), may be helpful in distinguishing high-grade from low-grade gliomas including oligodendrogliomas
Summary
A total of 35 patients with primary gliomas (22 high grade and 13 low grade) underwent continuous arterial spin-labeling perfusion-weighted imaging (PWI) and 1H-MRSI. We applied a subgroup analysis to differentiate low- from high-grade oligodendrogliomas because they show different physiologic and genetic characteristics. Patients were divided into 2 groups: highgrade (grades 3 and 4, n ϭ 22) and low-grade gliomas (grades 1 and 2, n ϭ 13). Among those with low-grade gliomas, 11 patients had oligodendrogliomas, 1 patient had an astrocytoma, and 1 had a ganglioglioma. Of the 35 patients, 16 with oligodendrogliomas were included in a separate subgroup analysis. These patients were divided into 2 groups: high-grade (grade 3, n ϭ 5) and low-grade (grade 2, n ϭ 11). 4 had mixed oligoastrocytomas (3 low-grade and 1 high-grade) with prominent composition of oligodendroglial cells and were included in this group (Table 1)
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