Cerebral gliomas: prospective comparison of multivoxel 2D chemical-shift imaging proton MR spectroscopy, echoplanar perfusion and diffusion-weighted MRI

Developments in MRI have made it possible to use diffusion-weighted MRI, perfusion MRI and proton MR spectroscopy (MRS) to study lesions in the brain. We evaluated whether these techniques provide useful, complementary information for grading gliomas, in comparison with conventional MRI. We studied 17 patients with histologically verified gliomas, adding multivoxel proton MRS, echoplanar diffusion and perfusion MRI the a routine MRI examination. The maximum relative cerebral blood volume (CBV), minimum apparent diffusion coefficient (ADC) and metabolic peak area ratios in proton MRS were calculated in solid parts of tumours on the same slice from each imaging data set. The mean minimum ADC of the 13 high-grade gliomas (0.92 +/- 0.27x10(-3) mm(2)/s) was lower than that of the four low-grade gliomas (1.28 +/- 0.15x10(-3) mm(2)/s) (P < 0.05). Means of maximum choline (Cho)/N-acetylaspartate (NAA), Cho/creatine (Cr), Cho/Cr in normal brain (Cr-n) and minimum NAA/Cr ratios were 5.90 +/- 2.62, 4.73 +/- 2.22, 2.66 +/- 0.68 and 0.40 +/- 0.06, respectively, in the high-grade gliomas, and 1.65 +/- 1.37, 1.84 +/- 1.20, 1.61 +/- 1.29 and 1.65 +/- 11.61, respectively, in the low-grade gliomas. Significant differences were found on spectroscopy between the high- and low-grade gliomas (P < 0.05). Mean maximum relative CBV in the high-grade,gliomas (6.10 +/- 3.98) was higher than in the low-grade gliomas (1.74 +/- 0.57) (P < 0.05). Echoplanar diffusion, perfusion MRI and multivoxel proton MRS can offer diagnostic information, not available with conventional MRI, in the assessment of glioma grade.