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In Vivo 3-T MR Spectroscopy in the Distinction of Recurrent Glioma versus Radiation Effects: Initial Experience¹

¹ From the Nuclear Magnetic Resonance Center (P.L.L., R.G.G.) and Departments of Radiology (J.D.R., R.G.G.), Pathology (D.N.L.), Neurosurgery (F.G.B., G.R.C., E.A.C.), Radiation Therapy (A.F.T., J.S.L.), and Neurology (J.W.H.), Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Gray 2, Boston, MA 02114; and Department of Neurosurgery, Stanford Medical Center, Calif (G.R.H.). Received June 4, 2001; revision requested July 12; final revision received May 7, 2002; accepted May 29. Supported in part by National Institutes of Health grants 1R21CA80113 and 1R01CA83159. Address correspondence to J.D.R. (e-mail: jrabinov@partners.org).

PURPOSE: To determine if 3-T magnetic resonance (MR) spectroscopy allows accurate distinction of recurrent tumor from radiation effects in patients with gliomas of grade II or higher.

MATERIALS AND METHODS: This blinded prospective study included 14 patients who underwent in vivo 3-T MR spectroscopy prior to stereotactic biopsy. All patients received a previous diagnosis of glioma (grade II or higher) and high-dose radiation therapy (>54 Gy). Prior to MR spectroscopy, conventional MR imaging was performed at 1.5 T to identify a gadolinium-enhanced region within the irradiated volume. Diagnosis was assigned by means of histopathologic analysis of the biopsy samples.

RESULTS: Sixteen of 17 biopsy locations could be classified as predominantly tumor or predominantly radiation effect on the basis of the ratio of choline at the biopsy site to normal creatine level by using a value greater than 1.3 as the criterion for tumor. The remaining case, classified as recurrent tumor on the basis of MR spectroscopy results, was diagnosed as predominantly radiation effect on the basis of histopathologic findings. Disease in this patient progressed to biopsy-proven recurrence within 3 months. Overall, the ratio of choline at the biopsy site to normal creatine level was significantly elevated (unpaired two-tailed Student t test, P < .002) in those biopsy samples composed predominantly of tumor (n = 9) compared with those containing predominantly radiation effects (n = 8). The ratio was not significantly different between the two histopathologic groups.

CONCLUSION: In vivo 3-T MR spectroscopy has sufficient spatial resolution and chemical specificity to allow distinction of recurrent tumor from radiation effects in patients with treated gliomas.

© RSNA, 2002

Index terms: Brain, biopsy, 13.1261 • Brain, effects of irradiation on, 13.47 • Brain neoplasms, diagnosis, 13.363 • Brain neoplasms, MR, 13.12145 • Brain neoplasms, MR spectroscopy, 13.12145 • Radiations, injurious effects, 13.47

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