Abstract
Background
Grading gliomas is essential for treatment decisions and patient prognosis. In this study we evaluated the in-phase and out-of-phase sequences for distinguishing high-grade (HGG) from low-grade glioma (LGG) and the correlation with magnetic resonance spectroscopy (MRS) results.
Methods
This observational study comprised patients with brain tumors referred to our center for brain MRS. The gold standard for diagnosis was based on the World Health Organization (WHO) glioma classification. A standard tumor protocol was accomplished using a 1.5‑T MRS scanner. Before contrast medium administration, extra in- and out-phase sequences were acquired. Three 20–30-mm2 oval regions of interest (ROIs) were placed in the solid component and the signal loss ratio (SLR) was calculated with the following formula:
SLR tumor = (SI In phase − SI Opposed phase) / SI In phase
Correlations and comparisons between groups were made using the Pearson, chi-square and, independent samples t tests. Receiver operating characteristic (ROC) curve analysis was performed to assess the diagnostic performance. Statistical significance was set at p < 0.05.
Results
In total, 20 patients were included in the LGG and 13 were included in the HGG group. The mean SLR in the HGG and LGG groups was 3.66 ± 2.12 and 1.63 ± 1.86, respectively (p = 0.01). There was a statistically significant correlation between lipid lactate (0.48, p = 0.004) and free lipid (0.44, p = 0.009) concentrations on MRS with SLR.
Conclusions
The SLR is a simple, rapid, and noninvasive marker for differentiating between LGG and HGG. There is a significant correlation with both the concentration and presence of free lipid and lipid-lactate peaks in MRS.
Zusammenfassung
Hintergrund
Die Einstufung von Gliomen ist für Therapieentscheidungen und die Patientenprognose essenziell. In der vorliegenden Studie wurden gleichphasige und phasenverschobene Sequenzen zur Unterscheidung hochgradiger (HGG) von niedriggradigen Gliomen (LGG) sowie die Korrelation mit den Ergebnissen der Magnetresonanzspektroskopie (MRS) untersucht.
Methoden
Die vorliegende Beobachtungsstudie umfasste Patienten mit Hirntumoren, die an die Klinik der Autoren zur Hirn-MRS überwiesen worden waren. Der Goldstandard für die Diagnose basierte auf der Klassifikation der Gliome seitens der Weltgesundheitsorganisation (WHO). Es wurde ein Standardtumorprotokoll unter Einsatz eines 1,5-T-MRS-Geräts durchgeführt. Vor Applikation des Kontrastmittels wurden zusätzliche gleichphasige und phasenverschobenen Sequenzen akquiriert. In die solide Komponente wurde 3 ovale Bereich von Interesse („regions of interest“, ROI) mit einer Größe von 20–30-mm2 gesetzt, und das Signal-Verlust-Verhältnis („signal loss ratio“, SLR) wurde mittels der folgenden Formel berechnet:
SLR Tumor = (SI Gleichphasig − SI Gegenphasig) / SI Gleichphasig
Korrelationen und Vergleiche zwischen den Gruppen wurden unter Verwendung des Pearson-Tests, des Chi-Quadrat-Tests und des t-Tests für unabhängige Stichproben durchgeführt. Um die diagnostische Leistungsfähigkeit zu ermitteln, erfolgte eine Receiver-Operating-Characteristic(ROC)-Kurvenanalyse. Die statistische Signifikanz wurde bei p < 0,05 festgesetzt.
Ergebnisse
In die LGG-Gruppe wurden 20 und in die HGG-Gruppe 13 Patienten eingeteilt. Der mittlere SLR in der HGG- und LGG-Gruppe betrug 3,66 ± 2,12 bzw. 1,63 ± 1,86 (p = 0,01). Eine statistische signifikante Korrelation bestand zwischen den Konzentrationen von Lipidlaktat (0,48; p = 0,004) sowie freiem Lipid (0,44; p = 0,009) in der MRS und dem SLR.
Schlussfolgerung
Der SLR ist ein einfacher, schneller und nichtinvasiver Marker zur Unterscheidung zwischen LGG und HGG. Es gibt eine signifikante Korrelation sowohl mit der Konzentration als auch mit dem Vorliegen von Peaks von freiem Lipid und Lipidlaktat in der MRS.
Data availability
The datasets generated and analyzed during this study are available from the corresponding author on reasonable request.
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This study was done with no specific funding support.
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
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B. Abbasi, A.G. Khameneh, H.Z. Soltaniye, G.D.H. Amirkhiz, E. Karimi and R. Akhavan declare that they have no competing interests.
This retrospective observation study of a prospectively collected pre-operative imaging data was approved by the Research Registrar of Mashhad University of Medical Sciences, and was conducted between September 2020 and October 2022 at Ghaem Hospital in Mashhad. Written consent was obtained from all participants.
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Abbasi, B., Ghamari Khameneh, A., Zareh Soltaniye, H. et al. Applying chemical shift images (in-phase/opposed phased) for differentiating low-grade from high-grade glioma and comparison with magnetic resonance spectroscopy. Radiologie (2024). https://doi.org/10.1007/s00117-024-01339-4
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DOI: https://doi.org/10.1007/s00117-024-01339-4