Application of Multivoxel 1H-MR Spectroscopy in Grading of Cerebral Glioma

Document Type : Original Paper


1 medical physics, medical faculty mashhad university of medical science mashhad iran

2 Department of medical physics, Medicine Faculty, Mashhad University of Medical sciences, Mashhad, Iran

3 Department of medical imaging, Medicine Faculty, Shahid Beheshti University of Medical Sciences, Tehran, Iran


Objective: Gliomas represent a considerable percentage of all diagnosed primary central nervous system tumors. Gliomas grade plays an important role in the determination of treatment planning. A non-invasive access method, like magnetic resonance spectroscopy (MRS), is required for preoperative evaluation. So, the present study aimed to evaluate the application of Multivoxel 1H-MR Spectroscopy in the differentiation of high-grade from low-grade gliomas.

Materials and Methods: 13 patients (7 males and 6 females; 5–61 years old; mean age, 31.38±16.5 years) suspected of Cerebral Glioma, which already had been selected for brain surgery or biopsy, underwent a Multivoxel 1H-MR Spectroscopy. After the MRS exam, the pathology tests on specimens confirmed the grade of tumors. then results are compared and represented as receiver operating characteristic (ROC) curves to show their sensitivity and specificity as well.


Choline to creatine (Cho/Cr) and choline to N-acetyl-aspartate (Cho/NAA) were statistically lower in low-grade group than high-grade (p=0.007 and p=0.027, respectively) and N-acetyl-aspartate to creatine (NAA/Cr) was statistically higher in high-grade group (p=0.037). But in border regions only Cho/Cr and Cho/NAA were significant (P values= 0.19 and 0.22, respectively). With receiver operating characteristic (ROC) curves analysis, Cho/Cr had the best sensitivity and specificity in the differentiation of high-grade from low-grade gliomas in the tumor area (92.86% sensitivity and 85.71% specificity). This ratio had the best sensitivity and specificity in border regions of the tumor (92.86% sensitivity and 78.43% specificity).

Conclusion: Metabolite ratios of low and high-grade gliomas were significantly different. Cho/Cr and Cho/NAA ratios can use as an internal reference for grading the glioma non-invasively in the tumor area and the border area of the tumor.


Main Subjects

Articles in Press, Accepted Manuscript
Available Online from 25 May 2022
  • Receive Date: 02 February 2022
  • Revise Date: 23 May 2022
  • Accept Date: 25 May 2022
  • First Publish Date: 25 May 2022