Comparison of Proton Magnetic Resonance Spectroscopy with Fluorine-18 2-Fluoro-Deoxyglucose Positron Emission Tomography for Assessment of Brain Tumor Progression

OBJECTIVES We investigated the accuracy of high-field proton magnetic resonance spectroscopy (H-1 MRS) and fluorine-18 2-fluoro-deoxyglucose positron emission tomography (F-18-FDG-PET) for diagnosis of glioma progression following tumor resection, stereotactic radiation, and chemotherapy. METHODS Twelve post-therapy patients with histology proven gliomas (six grade II and six grade III) presented with magnetic resonance imaging (MRI) and clinical symptoms suggestive but not conclusive of progression were entered into the study. H-1 MRS data were acquired and 3-dimensional volumetric maps of choline (Cho) over creatine (Cr) were generated. Intensity of F-18-FDG uptake was evaluated on a semiquantitative scale. RESULTS The accuracy of H-1 MRS and F-18-FDG-PET imaging for diagnosis of glioma progression was 75% and 83%, respectively. Classifying the tumors by grade improved accuracy of F-18-FDGPET to 100% in high-grade gliomas and accuracy of H-1 MRS to 80% in low-grade tumors. Spearman's analysis demonstrated a trend between F-18-FDG uptake and tumor grading (rho =.612, P-value =.272). The results of F-18-FDG-PET and H-1 MRS were concordant in 75% (9/12) of cases. CONCLUSION The combination of H-1 MRS data and F-18-FDG-PET imaging can enhance detection of glioma progression. H-1 MRS imaging was more accurate in low-grade gliomas and F-18-FDG-PET provided better accuracy in high-grade gliomas.