Application of Multivoxel 1H-Magnetic Resonance Spectroscopy in the Grading of Cerebral Glioma

Gliomas represent a considerable percentage of all diagnosed primary central nervous system tumors. A non-invasive access method, like magnetic resonance spectroscopy (MRS), is required for preoperative evaluation. So, the present study aimed to evaluate the application of Multivoxel 1H-MR Spectroscopy in the differentiation of high-grade from low-grade gliomas. 13 patients suspected of Cerebral Glioma, which already had been selected for brain surgery or biopsy, underwent a Multivoxel 1H-MR Spectroscopy. After the MRS exam, the pathology tests on specimens confirmed the grade of tumors. Then results were compared and represented as receiver operating characteristic (ROC) curves to show their sensitivity and specificity as well. Choline to creatine (Cho/Cr) and choline to N-acetyl-aspartate (Cho/NAA) were statistically lower in the low-grade group than in high-grade (p=0.007 and p=0.027, respectively) and N-acetyl-aspartate to creatine (NAA/Cr) was statistically higher in the high-grade group (p=0.037). But in border regions, only Cho/Cr and Cho/NAA were significant (P values= 0.19 and 0.22, respectively). With receiver operating characteristic (ROC) curves analysis, Cho/Cr had the best sensitivity and specificity in the differentiation of high-grade from low-grade gliomas in tumor area (92.86% sensitivity and 85.71% specificity) and this ratio had the best sensitivity and specificity in border regions of tumor (92.86% sensitivity and 78.43% specificity). Metabolite ratios of low and high-grade gliomas (HGG) were significantly different from each other. Cho/Cr and Cho/NAA ratios can use as an internal reference for grading the glioma non-invasively in the tumor area and the border area of the tumor.