MRS as an Aid to Diagnose Malignant Transformation in Low-Grade Gliomas with Increasing Contrast Enhancement
- 30 July 2020
- journal article
- research article
- Published by American Society of Neuroradiology (ASNR) in American Journal of Neuroradiology
- Vol. 41 (9), 1592-1598
- https://doi.org/10.3174/ajnr.a6688
Abstract
BACKGROUND AND PURPOSE: Increased contrast enhancement has been used as a marker of malignant transformation in low-grade gliomas. This marker has been found to have limited accuracy because many low-grade gliomas with increased contrast enhancement remain grade II. We aimed to investigate whether MR spectroscopy can contribute to the diagnosis of malignant transformation in low-grade gliomas with increased contrast enhancement. MATERIALS AND METHODS: Patients with low-grade gliomas who had contemporaneous MR spectroscopy and histopathology for tumor regions with increased contrast enhancement between 2004 and 2015 were retrospectively reviewed. Clinical data collected were sex and age, Karnofsky Performance Scale, histologic subtypes, isocitrate dehydrogenase 1 mutation status, disease duration, adjuvant therapy, and post-radiation therapy duration. Imaging data collected were contrast-enhancement size, whole-tumor size, MR spectroscopy metabolite ratios, and tumor grades of regions with increased contrast enhancement. Diagnostic values of these factors on malignant transformation of low-grade gliomas were statistically analyzed. RESULTS: A total of 86 patients with 96 MR spectroscopy studies were included. Tumor grades associated with increased contrast enhancement were grade II (n = 42), grade III (n = 27), and grade IV (n = 27). On multivariate analysis, the NAA/Cho ratio was the only significant factor (P < .001; OR, 7.1; 95% CI, 3.2–16.1) diagnostic of malignant transformation. With 0.222 as the cutoff value, the sensitivity, specificity, and accuracy of NAA/Cho for diagnosing malignant transformation were 94.4%, 83.3%, and 89.6%, respectively. CONCLUSIONS: MR spectroscopy complements conventional MR imaging in the diagnosis of malignant transformation in a subgroup of low-grade gliomas with increased contrast enhancement.Funding Information
- Ministry of Science and Technology, Taiwan (NSC101-2314-B-182-084, NSC98-2314-B-182A-051-MY3)
This publication has 20 references indexed in Scilit:
- CBTRUS Statistical Report: Primary Brain and Other Central Nervous System Tumors Diagnosed in the United States in 2012–2016Neuro-Oncology, 2019
- Recent developments and future directions in adult lower-grade gliomas: Society for Neuro-Oncology (SNO) and European Association of Neuro-Oncology (EANO) consensusNeuro-Oncology, 2019
- Progressive Low-Grade Glioma: Assessment of Prognostic Importance of Histologic Reassessment and MRI FindingsWorld Neurosurgery, 2016
- Prediction of anaplastic transformation in low-grade oligodendrogliomas based on magnetic resonance spectroscopy and 1p/19q codeletion statusJournal of Neuro-Oncology, 2015
- Clinical Proton MR Spectroscopy in Central Nervous System DisordersRadiology, 2014
- Brain Proton Magnetic Resonance SpectroscopyNeuroimaging Clinics of North America, 2013
- Comparison of 3 Tesla proton MR spectroscopy, MR perfusion and MR diffusion for distinguishing glioma recurrence from posttreatment effectsJournal of Magnetic Resonance Imaging, 2011
- Response assessment in neuro-oncology (a report of the RANO group): assessment of outcome in trials of diffuse low-grade gliomasThe Lancet Oncology, 2011
- Distinction between glioma progression and post-radiation change by combined physiologic MR imagingNeuroradiology, 2009
- Prognostic value of choline and creatine in WHO grade II gliomasNeuroradiology, 2008