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AJNR - American Journal of Neuroradiology

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American Journal of Neuroradiology 27:1412-1418, August 2006
© 2006 American Society of Neuroradiology

BRAIN

3T ¹H-MR Spectroscopy in Grading of Cerebral Gliomas: Comparison of Short and Intermediate Echo Time Sequences

J.-h. Kim^a, K.-H. Chang^b,c, D.G. Na^b, I.C. Song^b,c, B.J. Kwon^b, M.H. Han^b,c and K. Kim^c

^a Department of Radiology, Seoul Municipal Boramae Hospital, Seoul, Korea
^b Department of Radiology, Seoul National University Hospital, Seoul, Korea
^c Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea

Address correspondence to Kee-Hyun Chang, MD, Department of Diagnostic Radiology, Seoul National University Hospital, 28 Yongon-dong, Chongno-gu, Seoul 110-744, Korea; e-mail: changkh{at}radcom.snu.ac.kr

BACKGROUND AND PURPOSE: Echo time (TE) can have a large influence on the spectra in proton MR spectroscopy (¹H-MR spectroscopy). The purpose of this study was to comparatively assess the diagnostic value of 3T single-voxel ¹H-MR spectroscopy with short or intermediate TEs in grading cerebral gliomas.

METHODS: Single voxel ¹H-MR spectroscopy was performed at 3T in 35 patients with cerebral glioma. The spectra were obtained with both short (35 ms) and intermediate TEs (144 ms). Metabolite ratios of choline (Cho)/creatine (Cr), Cho/N-acetylaspartate (NAA), lipid and lactate (LL)/Cr and myo-inositol (mIns)/Cr were calculated and compared between short and intermediate TEs in each grade. After receiver operating characteristic curve analysis, diagnostic accuracy for each TE in differentiating high-grade glioma from low-grade glioma was compared.

RESULTS: At short TE, Cho/Cr and Cho/NAA ratios were significantly lower, and LL/Cr and mIns/Cr were significantly higher, compared with those at intermediate TE, regardless of tumor grade. Lactate inversion at intermediate TE was found in only 2 patients. At both TEs, there were significant differences in Cho/Cr and LL/Cr ratios between low- and high-grade gliomas. Diagnostic accuracy was slightly higher at short TE alone or combined with intermediate TE than intermediate TE alone (85.7% versus 82.9%).

CONCLUSION: Metabolite ratios were significantly different between short and intermediate TE. Cho/Cr and LL/Cr ratios at either TE were similarly useful in differentiating high-grade gliomas from low-grade gliomas. If only a single spectroscopic sequence can be acquired, short TE seems preferable because of poor lactate inversion at intermediate TE on 3T single-voxel ¹H-MR spectroscopy.