Abstract
BackgroundMagnetic Resonance Spectroscopy (MRS) can measure in vivo brain tissue metabolism that exhibits unique biochemical characteristics in brain tumors. For clinical application, an efficient and versatile quantification method of MRS would be an important tool for medical research, particularly for exploring the scientific problem of tumor monitoring. The objective of our study is to propose an automated MRS quantitative approach and assess the feasibility of this approach for glioma grading, prognosis and boundary detection.MethodsAn automated quantitative approach based on a convex envelope (AQoCE) is proposed in this paper, including preprocessing, convex-envelope based baseline fitting, bias correction, sectional baseline removal, and peak detection, in a total of 5 steps. Some metabolic ratios acquired by this quantification are selected for statistical analysis. An independent sample t-test and the Kruskal-Wallis test are used for distinguishing low-grade gliomas (LGG) and high-grade gliomas (HGG) and for detecting the tumor, peritumoral and contralateral areas, respectively. Seventy-eight cases of pre-operative brain gliomas with pathological reports are included in this study.ResultsCho/NAA, Cho/Cr and Lip-Lac/Cr (LL/Cr) calculated by AQoCE in the tumor area differ significantly between LGG and HGG, with p≤0.005. Using logistic regression combining Cho/NAA, Cho/Cr and LL/Cr to generate a ROC curve, AQoCE achieves a sensitivity of 92.9%, a specificity of 72.2%, and an area under ROC curve (AUC) of 0.860. Moreover, both Cho/NAA and Cho/Cr in the AQoCE approach show a significant difference (p≤0.019) between tumoral, peritumoral, and contralateral areas. The comparison between the results of AQoCE and Siemens MRS processing software are also discussed in this paper.ConclusionsThe AQoCE approach is an automated method of residual water removal and metabolite quantification. It can be applied to multi-voxel 1H-MRS for evaluating brain glioma grading and demonstrating characteristics of brain glioma metabolism. It can also detect infiltration in the peritumoral area. Under the limited clinical data used, AQoCE is significantly more versatile and efficient compared to the reference approach of Siemens.
Highlights
Gliomas are a type of tumor arising from glial cells
An automated quantitative approach based on a convex envelope (AQoCE) is proposed in this paper, including preprocessing, convex-envelope based baseline fitting, bias correction, sectional baseline removal, and peak detection, in a total of 5 steps
Using logistic regression combining Cho/ N-Acetyl Aspartate (NAA), Cho/Cr and LL/Cr to generate a receiver operating characteristic curve (ROC) curve, AQoCE achieves a sensitivity of 92.9%, a specificity of 72.2%, and an area under ROC curve (AUC) of 0.860
Summary
Gliomas are a type of tumor arising from glial cells. Gliomas constitute about 80% of all malignant primary brain tumors [1,2]. The main biochemical characteristics can provide useful information on brain tumor type and grade noninvasively [3]. In vivo Proton Magnetic Resonance Spectroscopy, abbreviated as 1H-MRS, has been shown to determine tumors type and grade [4,5,6]. Low- and high-grade gliomas differ significantly with respect to biological behavior, growth pattern, growth rate, prognosis and other attributes. Differentiating between low- and high-grade gliomas accurately is extremely important, when judging the grade of pre-operative brain tumors [8]. Magnetic Resonance Spectroscopy (MRS) can measure in vivo brain tissue metabolism that exhibits unique biochemical characteristics in brain tumors. An efficient and versatile quantification method of MRS would be an important tool for medical research, for exploring the scientific problem of tumor monitoring. The objective of our study is to propose an automated MRS quantitative approach and assess the feasibility of this approach for glioma grading, prognosis and boundary detection.
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