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British Journal of Radiology (2003) 76, 459-463
© 2003 British Institute of Radiology
doi: 10.1259/bjr/16316438
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Could assessment of glioma methylene lipid resonance by in vivo 1H-MRS be of clinical value?

P S Murphy, PhD1, I J Rowland, PhD1, L Viviers, MBChB2, M Brada, BSc, FRCP, FRCR2, M O Leach, PhD, FinstP, FMedSci1 and A S K Dzik-Jurasz, PhD, FRCS, FRCR1

1 Cancer Research UK Clinical MR Research Group and 2 Department of Neuro-oncology, The Institute of Cancer Research and The Royal Marsden NHS Trust, Sutton, Surrey SM2 5PT, UK

Correspondence: Dr A S K Dzik-Jurasz, GlaxoSmithKline Pharmaceuticals, 891–995 Greenford Road, Building 5, Floor 3, Room 13, London UB6 0HE

The potential clinical role of in vivo 1H-MRS (1H-magnetic resonance spectroscopy) lipid methylene resonance measurements of human glioma has been assessed. 20 patients, 14 with low grade and 6 with high grade gliomas have been investigated using single voxel 1H-MRS. Three of the low grade group had undergone transformation by clinical and imaging criteria. Short echo time (TE=20 ms, TR=2500 ms) single voxel Stimulated Echo Acquisition (STEAM) spectra with (acquisitions=64) and without (acquisitions=4) water suppression were acquired. Additionally, T1 weighted (T1W) water spectra (TE=20 ms, TR=888 ms) were acquired pre- and post-injection of Gd-DTPA (0.2 mmol kg-1). The T1W water spectra were used to determine the water proton enhancement occurring within the spectroscopic voxel. The enhancement expressed as a percentage was compared with the lipid methylene peak. All the high grade tumours had significantly higher levels of lipid than low grade tumours (p=0.002). Low grade tumours had significantly less water proton enhancement than transformers (p=0.04) and high grade tumours (p=0.001). The lipid methylene signal correlated strongly with the voxel water enhancement (r2=0.74, p<0.0001). The data support the view that the spectroscopically detected lipid methylene signal may be a useful criterion in grading glioma. The correlation of the lipid methylene signal with blood–brain barrier breakdown suggests that detection of a previously absent 1H-MRS lipid methylene signal in low grade tumours might be an early indicator of transformation.




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