Journal of Neuro-Oncology

, Volume 84, Issue 1, pp 63–69 | Cite as

Multivoxel 3D proton MR spectroscopy in the distinction of recurrent glioma from radiation injury

  • Qing-Shi ZengEmail author
  • Chuan-Fu Li
  • Kai Zhang
  • Hong Liu
  • Xiao-Shui Kang
  • Jun-Hui Zhen
Original Paper



To explore the usefulness of multivoxel 3D proton MR spectroscopy (1H-MRS) in assessing the recurrent contrast-enhancing areas at the site of the previously treated gliomas.

Materials and methods

In 28 patients who had new contrast-enhancing lesions in the vicinity of the previously resected and irradiated high-grade glioma, 3D 1H-MRS examinations were performed on a 3.0T MR scanner. Spectral data for N-acetylaspartate (NAA), choline (Cho), and creatine (Cr) were analyzed in all patients. Receiver operating characteristic analysis was performed, and the threshold value for tumor differentiation was determined. Diagnosis of these lesions was assigned by means of histopathology and follow-up.


Diagnostic-quality 3D 1H-MRS with quantifiable Cho, Cr, and NAA peaks was obtained in 92.9% of the cases. The Cho/NAA and Cho/Cr ratios were significantly higher in recurrent tumor than in radiation injury (P < 0.01), whereas the NAA/Cr ratios were lower in recurrent tumor than in radiation injury (P = 0.02). The Cho/Cr and Cho/NAA ratios were significantly higher in radiation injury than in normal-appearing white matter (P < 0.01), however, the NAA/Cr ratios were lower in radiation injury than in normal-appearing white matter (P = 0.01). Using receiver operating characteristic analysis, the resulting sensitivity, specificity and diagnostic accuracy of 3D 1H-MRS were 94.1%, 100%, and 96.2%, respectively, based on the cut-off values of 1.71 for Cho/Cr or 1.71 for Cho/NAA or both as tumor criterion.


3D 1H-MRS could differentiate recurrent tumor from radiation injury in patients with recurrent contrast-enhancing lesions in the vicinity of the previously treated gliomas.


3D-MRS Brain Glioma Neoplasm recurrence Proton MRS 


  1. 1.
    Mullins ME, Barest GD, Schaefer PW, Hochberg FH, Gonzalez RG, Lev MH (2005) Radiation necrosis versus glioma recurrence: conventional MR imaging clues to diagnosis. AJNR Am J Neuroradiol 26:1967–1972PubMedGoogle Scholar
  2. 2.
    Kumar AJ, Leeds NE, Fuller GN (2000) Malignant gliomas: MR imaging spectrum of radiation therapy- and chemotherapy-induced necrosis of the brain after treatment. Radiology 217:377–384PubMedGoogle Scholar
  3. 3.
    Schlemmer HP, Bachert P, Herfarth K (2001) Proton MR spectroscopic evaluation of suspicious brain lesions after stereotactic radiotherapy. AJNR Am J Neuroradiol 22:1316–1324PubMedGoogle Scholar
  4. 4.
    Rabinov JD, Lee PL, Barker FG (2002) In vivo 3-T MR spectroscopy in the distinction of recurrent glioma versus radiation effects: initial experience. Radiology 225:871–879PubMedCrossRefGoogle Scholar
  5. 5.
    Schlemmer HP, Bachert P, Henze M, Buslei R, Herfarth KK, Debus J (2002) Differentiation of radiation necrosis from tumor progression using proton magnetic resonance spectroscopy. Neuroradiology 44:216–222PubMedCrossRefGoogle Scholar
  6. 6.
    Weybright P, Sundgren PC, Maly P (2005) Differentiation between brain tumor recurrence and radiation injury using MR spectroscopy. AJR Am J Roentgenol 185:1471–1476PubMedCrossRefGoogle Scholar
  7. 7.
    Nelson SJ (2003) Multivoxel magnetic resonance spectroscopy of brain tumors. Mol Cancer Ther 2:497–507PubMedGoogle Scholar
  8. 8.
    McKnight TR, von dem Bussche MH, Vigneron DB (2002) Histopathological validation of a three-dimensional magnetic resonance spectroscopy index as a predictor of tumor presence. J Neurosurg 97:794–802PubMedGoogle Scholar
  9. 9.
    Gonen O, Gruber S, Li BS, Mlynarik V, Moser E (2001) Multivoxel 3D proton spectroscopy in the brain at 1.5 versus 3.0 T: signal-to-noise ratio and resolution comparison. AJNR Am J Neuroradiol 22:1727–1731PubMedGoogle Scholar
  10. 10.
    Inglese M, Liu S, Babb JS, Mannon LJ, Grossman RI, Gonen O (2004) Three-dimensional proton spectroscopy of deep gray matter nuclei in relapsing-remitting MS. Neurology 63:170–172PubMedGoogle Scholar
  11. 11.
    Li BS, Regal J, Gonen O (2001) SNR versus resolution in 3D 1H MRS of the human brain at high magnetic fields. Magn Reson Med 46:1049–1053PubMedCrossRefGoogle Scholar
  12. 12.
    Kreth FW, Berlis A, Spiropoulou V (1999) The role of tumor resection in the treatment of glioblastoma multiforme in adults. Cancer 86:2117–2123PubMedCrossRefGoogle Scholar
  13. 13.
    Herfarth KK, Gutwein S, Debus J (2001) Postoperative radiotherapy of astrocytomas. Semin Surg Oncol 20:13–23PubMedCrossRefGoogle Scholar
  14. 14.
    Kallen K, Burtscher IM, Holtas S, Ryding E, Rosen I (2000) 201Thallium SPECT and 1H-MRS compared with MRI in chemotherapy monitoring of high-grade malignant astrocytomas. J Neurooncol 46:173–185PubMedCrossRefGoogle Scholar
  15. 15.
    Li BS, Babb JS, Soher BJ, Maudsley AA, Gonen O (2002) Reproducibility of 3D proton spectroscopy in the human brain. Magn Reson Med 47:439–446PubMedCrossRefGoogle Scholar
  16. 16.
    Plotkin M, Eisenacher J, Bruhn H (2004) 123I-IMT SPECT and 1HMR-spectroscopy at 3.0T in the differential diagnosis of recurrent or residual gliomas: a comparative study. J Neurooncol 70:49–58PubMedCrossRefGoogle Scholar
  17. 17.
    Isobe T, Matsumura A, Anno I (2003) Changes in 1H-MRS in glioma patients before and after irradiation: the significance of quantitative analysis of choline-containing compounds. No Shinkei Geka 31:167–172PubMedGoogle Scholar
  18. 18.
    Chan YL, Yeung DK, Leung SF, Cao G (1999) Proton magnetic resonance spectroscopy of late delayed radiation-induced injury of the brain. J Magn Reson Imaging 10:130–137PubMedCrossRefGoogle Scholar
  19. 19.
    Esteve F, Rubin C, Grand S, Kolodie H, Le Bas JF (1998) Transient metabolic changes observed with proton MR spectroscopy in normal human brain after radiation therapy. Int J Radiat Oncol Biol Phys 40:279–286PubMedCrossRefGoogle Scholar
  20. 20.
    McGirt MJ, Woodworth GF, Coon AL (2005) Independent predictors of morbidity after image-guided stereotactic brain biopsy: a risk assessment of 270 cases. J Neurosurg 102:897–901PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Qing-Shi Zeng
    • 1
    Email author
  • Chuan-Fu Li
    • 1
  • Kai Zhang
    • 1
  • Hong Liu
    • 2
  • Xiao-Shui Kang
    • 1
  • Jun-Hui Zhen
    • 3
  1. 1.Department of RadiologyQilu Hospital of Shandong UniversityJinanChina
  2. 2.Department of RadiotherapyQilu Hospital of Shandong UniversityJinanChina
  3. 3.Department of PathologyQilu Hospital of Shandong UniversityJinanChina

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