AJDRAJNR - American Journal of Neuroradiology

Published ahead of print on September 24, 2007
doi: 10.3174/ajnr.A0673
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American Journal of Neuroradiology 28:1683-1689, October 2007
© 2007 American Society of Neuroradiology

BRAIN

Arterial Spin-Labeling and MR Spectroscopy in the Differentiation of Gliomas

S. Chawlaa, S. Wanga, R.L. Wolfa, J.H. Wooa, J. Wanga, D.M. O'Rourkeb, K.D. Judyb, M.S. Gradyb, E.R. Melhema and H. Poptania

a Department of Radiology, University of Pennsylvania, Philadelphia, Penn
b Department of Neurosurgery, University of Pennsylvania, Philadelphia, Penn

Please address correspondence to Harish Poptani, PhD, University of Pennsylvania, B6 Blockley Hall, 423 Guardian Dr, Philadelphia, PA 19104; e-mail: poptanih{at}uphs

BACKGROUND AND PURPOSE: 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 (1H-MRSI) to differentiate low-grade from high-grade gliomas.

MATERIALS AND METHODS: 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. 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. 1H-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.

RESULTS: Choglioma (G)/white matter (WM), GlxG/WM, and Lip+LacG/CrWM were significantly higher in the "hyperperfused" regions of high-grade gliomas compared with low-grade gliomas. ChoG/WM and Lip+LacG/CrWM 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.

CONCLUSION: The results suggest that 1H-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.




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J.M. Pollock, A.R. Deibler, J.H. Burdette, R.A. Kraft, H. Tan, A.B. Evans, and J.A. Maldjian
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