Share this content in WeChat
Experience Exchang
Application of 1H-MRS and DTI in the differential diagnosis of high-grade gliomas and metastatic tumors
SUO Hongna  LI Yancui  PENG Ruchen 

Cite this article as: SUO H N, LI Y C, PENG R C. Application of 1H-MRS and DTI in the differential diagnosis of high-grade gliomas and metastatic tumors[J]. Chin J Magn Reson Imaging, 2023, 14(12): 103-108, 120. DOI:10.12015/issn.1674-8034.2023.12.017.

[Abstract] Objective The ratio of related metabolites in magnetic resonance spectroscopy (1H-MRS) and the relative apparent diffusion coefficient (rADC), and relative fractional anisotropy (rFA) in diffusion tensor imaging (DTI) were evaluated. And the application value in high-grade gliomas (HGG) and brain metastatic tumors (BMT).Materials and Methods The MR Data of 43 patients with gliomas and brain metastases confirmed by histopathology and clinical follow-up were collected from October 2016 to February 2023, including 25 cases of high-grade glioma and 18 cases of brain metastases. All patients were examined by routine brain MRI, MRS, DTI and T1WI enhanced scan. Obtaining the choline (Cho)/N-acetyl aspartate (NAA), Cho/creatine (Cr), NAA/Cr ratio of the tumor parenchyma, peritumoral edema (<3 cm), and the ADC and FA values of the tumor parenchyma, peritumoral edema (<3 cm), and contralateral white matter in the workstation. Calculating the relative ADC (rADC) values and relative FA (rFA) values to eliminate the influence of individual differences. Comparing the ages, genders and permeability parameters (Cho/NAA, Cho/Cr, NAA/Cr, rADC, rFA ) of patients. In addition, the diagnostic values of each parameter were evaluated by the receiver operating characteristic (ROC) curve analysis, and the optimal cut-off values of each parameter as well as the corresponding sensitivity and specificity were calculated. The difference was statistically significant when P<0.05.Results There were no statistically significant differences in gender and age between HGG and BMT (P>0.05). In the area of the tumor parenchyma, the values of Cho/NAA, NAA/Cr, and rFA between the two groups were significantly different (P<0.05). There were no significant differences in Cho/Cr and rADC (P>0.05). In the area of peritumoral edema, there were significant differences in quantitative parameters of Cho/NAA and Cho/Cr (P<0.05). There were no significant differences in NAA/Cr, rFA, and rADC (P>0.05). ROC curve showed that the quantitative quantitative parameters (Cho/NAA, NAA/Cr, and rFA) of the tumor parenchyma and the quantitative parameters (Cho/NAA, Cho/Cr) of the peritumoral edema were the most effective in the differential diagnosis of HGG and BMT. rFA was more efficient than other quantitative parameters. The diagnostic efficiency of combined quantitative parameters was the most significant with the maximum AUC of 0.934, and the corresponding sensitivity and specificity were 81.3% and 95.0%, respectively.Conclusions The quantitative parameters (Cho/NAA, NAA/Cr, Cho/Cr, and rFA) measured by 1H-MRS and DTI were all helpful in distinguishing high-grade brain gliomas from brain metastases, and rFA was more efficient than other parameters. The combination of the quantitative parameters can further improve the diagnostic efficiency between high-grade glioma and brain metastatic tumor.
[Keywords] high grade glioma;metastatic tumor;magnetic resonance imaging;magnetic resonance spectroscopy;diffusion tensor imaging;differential diagnosis

SUO Hongna   LI Yancui   PENG Ruchen*  

Department of Radiology, Beijing Luhe Hoapital, Captital Medical University, Beijing 101199, China

Corresponding author: PENG R C, E-mail:

Conflicts of interest   None.

Received  2023-07-27
Accepted  2023-12-07
DOI: 10.12015/issn.1674-8034.2023.12.017
Cite this article as: SUO H N, LI Y C, PENG R C. Application of 1H-MRS and DTI in the differential diagnosis of high-grade gliomas and metastatic tumors[J]. Chin J Magn Reson Imaging, 2023, 14(12): 103-108, 120. DOI:10.12015/issn.1674-8034.2023.12.017.

LI R, ZHANG M B, LI Z B, et al. Value of combined application of blood oxygen level-dependent functional MRI and diffusion tensor imaging in brain tumor surgery[J]. Journal of Clinical Neurosurgery, 2021, 18(6): 601-605, 610. DOI: 10.3969/j.issn.1672-7770.2021.06.001.
CARAVAN I, CIORTEA C A, CONTIS A, et al. Diagnostic value ofapparent diffusion coefficient in differentiating between high—grade gliomas and brain metastases[J].Acta Radiol, 2018, 59(5): 599-605. DOI: 10.1177/0284185117727787.
SEKIGUCHI M, KONNO S. Magnetic resonance spectroscopy in patients with low back pain[J]. Pain Research, 2022, 37(2): 82-88. DOI: 10.11154/pain.37.82.
ONYAMBU C K, WAJIHI M N, ODHIAMBO A O. Clinical application of magnetic resonance spectroscopy in diagnosis of intracranial mass lesions[J]. Radiol Res Pract, 2021, 2021(5): 1-10. DOI: 10.1155/2021/6673585.
GUISADO D I, SINGH R, MINKOWITZ S, et al. A novel methodology for applying multivoxel MR spectroscopy to evaluate convection-enhanced drug delivery in diffuse intrinsic pontine gliomas[J]. AJNR Am J Neuroradiol, 2016, 37(7): 1367-1373. DOI: 10.3174/ajnr.A4713.
TRAVERS S, JOSHI K, MILLER D, et al. Reliability of magnetic resonance spectroscopy and positron emission tomography computed tomography in differentiating metastatic brain tumor recurrence from radiation necrosis[J/OL]. World Neurosurg, 2021, 151: e1059-e1068 [2023-07-27]. DOI: 10.1016/j.wneu.2021.05.064.
YOO C H, BAEK H M, SONG K H, et al. An in vivo proton magnetic resonance spectroscopy study with optimized echo-time technique for concurrent quantification and T2 measurement targeting glutamate in the rat brain[J]. MAGMA, 2020, 33(5): 735-746. DOI: 10.1007/s10334-020-00840-w.
LI H, TIAN G. Application of multivoxel magnetic resonance proton spectroscopy in the diagnosis of brain glioma[J]. Chinese Journal of Laboratory Diagnosis, 2011, 15(7): 1223-1225. DOI: 10.3969/j.issn.1007-4287.2011.07.083.
BRUENING R, BERCHTENBREITER C, HOLZKNECHT N, et al. Effects of three different doses of a bolus injection of gadodiamide: assessment of regional cerebral blood volume maps in a blinded reader study[J]. AJNR Am J Neuroradiol, 2000, 21(9): 1603-1610.
WANG S H, WANG L, LI P L, et al. The value of cMRI and MRS in diagnosis and differential diagnosis of single brain metastases and localized high grade gliomas[J]. J Pract Radiol, 2018, 34(3): 351-354. DOI: 10.3969/j.issn.1002-1671.2018.03.006.
ZHU Z F, LI J, SHAO Y, et al. The value of MRI DWI combined with MRS In classifying glioma and differentiating high-grade glioma from single brain metastases[J]. Chin J CT MRI, 2019, 17(7): 1-4. DOI: 10.3969/j.issn.1672-5131.2019.07.001.
LUO X L, PENG J H, LI L, et al. Value of MRS combined with multiple b-value DWI in the differential diagnosis of high-grade glioma and single brain metastases[J]. Radiol Pract, 2020, 35(11): 1396-1402. DOI: 10.13609/j.cnki.1000-0313.2020.11.006.
WU G Y, LEI H, SUN J M. Study on proton magnetic resonance spectroscopy of annular enhanced lesions in brain[J]. Chin J Med Imag Technol, 2005, 21(4): 526-529. DOI: 10.3321/j.issn:1003-3289.2005.04.011.
FALINI A, CALABRESE G, ORIGGI D, et al. Proton magnetic resonance spectroscopy and intracranial tumours: clinical perspectives[J]. J Neurol, 1996, 243(10): 706-714. DOI: 10.1007/bf00873976.
ZHOU G F, WANG X Y, LIAO W H, et al. Clinical application value of hydrogen proton magnetic resonance spectroscopy in differentiating isolated brain metastases from high-grade brain gliomas[J]. J Pract Radiol, 2007, 23(1): 1-5. DOI: 10.3969/j.issn.1002-1671.2007.01.001.
KIMURA T, SAKO K, GOTOH T, et al. In vivo single-voxel proton MR spectroscopy in brain lesions with ring-like enhancement[J]. NMR Biomed, 2001, 14(6): 339-349. DOI: 10.1002/nbm.711.
CROTEAU D, SCARPACE L, HEARSHEN D, et al. Correlation between magnetic resonance spectroscopy imaging and image—guided biopsies: semiquantitative and qualitative histopathological analyses of patientswith untreated glioma[J]. Neurosurgery, 2001, 49(4): 823-829. DOI: 10.1227/00006123-200110000-00008.
FAN G, SUN B, WU Z, et al. In vivo single-voxel proton MR spectroscopy in the differentiation of high-grade gliomas and solitary metastases[J]. Clin Radiol, 2004, 59(1): 77-85. DOI: 10.1016/j.crad.2003.08.006.
SUN G X, LUO B N, ZHANG B. Value of 1H MRS in differential diagnosis of brain metastases and glioblastoma[J]. J Clin Radiol, 2005, 24(11): 955-959.
YOSHIOKA Y. Noninvasive human brain temperature measurement by magnetic resonance spectroscopy and clinical applications of brain temperature[J]. Netsu Sokutei, 2020, 47(4): 135-141. DOI: 10.11311/jscta.47.4_135.
LEE S, CHUNG M, LEE S R, et al. 3D brain angiogenesis model to reconstitute functional human blood-brain barrier in vitro[J]. Biotechnol Bioeng, 2020, 117(3): 748-762. DOI: 10.1002/bit.27224.
LAW M, CHA S, KNOPP E A, et al. High—grade gliomas and solitary metastases: differentiation by using perfusion and proton spectroscopic MR imaging[J]. Radiology, 2002, 222(3): 715-721. DOI: 10.1148/radiol.|2223010558.
TOH C H, SIOW T Y, CASTILLO M. Peritumoral brain edema in metastases may be related to glymphatic dysfunction[J]. Front Oncol, 2021, 11(13): 4144-4144. DOI: 10.3389/fonc.2021.725354.
MAI Z H, LI J L, FENG Y Q, et al. Diffusion tensor field estimation based on 3D U-Net and diffusion tensor imaging model constraint[J]. Journal of Southern Medical University, 2023, 43(7): 1224-1232. DOI: 10.12122/j.issn.1673-4254.2023.07.19.
CASTAO-LEON A M, CICUENDEZ M, NAVARRO-MAIN B, et al. Traumatic axonal injury: is the prognostic information produced by conventional MRI and DTI complementary or supplementary[J]. J Neurosurg, 2022, 136(1): 242-256. DOI: 10.3171/2020.11.JNS203124.
KANG K M, KIM K M, KIM I S, et al. Functional magnetic resonance imaging and diffusion tensor imaging for language mapping in brain tumor surgery: Validation with direct cortical stimulation and cortico-cortical evoked potential[J]. Korean J Radiol, 2023, 24(6): 553-563. DOI: 10.3348/kjr.2022.1001.
LONGO D, BOTTINO F, LUCIGNANI G, et al. DTI parameters in neonates with hypoxic-ischemic encephalopathy after total body hypothermia[J]. J Matern Fetal Neonatal Med, 2022, 35(21): 4035-4042. DOI: 10.1080/14767058.2020.1846180.
KIM M, LEIGH J H. Diffusion-tensor imaging as a prognostic biomarker for motor recovery in patients with pontine infarction[J/OL]. Annals of Physical and Rehabilitation Medicine, 2018, 61: e192 [2023-07-27]. DOI: 10.1016/
WITWER B P, MORAKHAR R, HASAN K M, et al. Diffusion-tensor imaging of white matter tracts in patients with cerebral neoplasm[J]. J Neurosurg, 2002, 97(3): 568-575. DOI: 10.3171/jns.2002.97.3.0568.
PRICE S J, JENA R, BURNER N G, et al. Improved delineation of glioma margins and regions of infiltration with the use of diffusion tensor imaging: an image-guided biopsy study[J]. AJNR Am J Neuroradiol, 2006, 27(9): 1969-1974. DOI: 10.1016/j.amjsurg.2008.06.006.
AKAI H, MORI H, AOKI S, et al. Diffusion tensor tractography of gliomatosis cerebri: fiber tracking through the tumor[J]. J Comput Assist Tomogr, 2005, 29(1): 127-129. DOI: 10.1097/01.rct.0000148453.29579.51.

PREV Study of ReHo and fALFF in patients with obstructive sleep apnea hypopnea syndrome
NEXT Duodenal plexiform angiomyxoid myofibroblastic tumor: One case report

Tel & Fax: +8610-67113815    E-mail: