[1H-MR Spectroscopy of brain tumors in the course of radiation therapy: Use of fast spectroscopic imaging and single-voxel spectroscopy for diagnosing recurrence]

Rofo. 2002 Jan;174(1):33-42. doi: 10.1055/s-2002-19541.
[Article in German]


Purpose: To improve differential diagnosis of residual or recurrent tumor vs. tissue necrosis in the course of radiation therapy of neurosurgically-treated brain tumors by application of fast (1)H-MR spectroscopic imaging in combination with single-voxel spectroscopy (SVS).

Methods: 54 patients after with malignant brain tumor (44 cases of glioblastoma, 10 other high-grade gliomas) were examined post-surgically in a total of 140 proton MRS examinations in the course of radiotherapy and in follow-up controls. Fast SI acquisition was performed as single-slice or double-slice TSI sequence with 32 x 32 phase encodings within 11 or 15 minutes, respectively. SVS with TR/TE 2000/272 ms yielded relative metabolite ratios, and in 15 patients the time courses of the absolute concentrations of brain metabolites were also determined.

Results: In the group of 44 patients that could be tracked by MRS until therapy completion, TSI localized in 23 patients a persistent or newly arisen distinct choline accumulation indicating residual or recurrent tumor after radiation therapy. In all these cases MRS diagnosis was confirmed histologically or by short-term follow-up. However, in 6 of 15 patients showing a normal choline pattern in the TSI acquisition, tumor recurrence appeared within three months. SVS provided early recognition of recurrent tumor when detecting characteristic alterations of metabolite concentrations oin therapy follow-up.

Conclusion: TSI and SVS represent complementary MRS techniques and are able to diagnose tumor recurrence early and unambiguously in cases where focal choline accumulation is detected.

Publication types

  • English Abstract

MeSH terms

  • Adult
  • Aged
  • Brain / physiopathology
  • Brain / radiation effects
  • Brain / surgery
  • Brain Neoplasms / physiopathology
  • Brain Neoplasms / radiotherapy*
  • Brain Neoplasms / surgery
  • Choline / metabolism*
  • Combined Modality Therapy
  • Cranial Irradiation*
  • Energy Metabolism / physiology
  • Energy Metabolism / radiation effects*
  • Female
  • Follow-Up Studies
  • Glioblastoma / physiopathology
  • Glioblastoma / radiotherapy*
  • Glioblastoma / surgery
  • Glioma / physiopathology
  • Glioma / radiotherapy*
  • Glioma / surgery
  • Humans
  • Magnetic Resonance Imaging*
  • Magnetic Resonance Spectroscopy*
  • Male
  • Middle Aged
  • Neoplasm Recurrence, Local / diagnosis
  • Neoplasm Recurrence, Local / physiopathology
  • Neoplasm, Residual / diagnosis
  • Neoplasm, Residual / physiopathology
  • Radiotherapy, Adjuvant
  • Sensitivity and Specificity
  • Treatment Outcome


  • Choline