Increased choline signal coinciding with malignant degeneration of cerebral gliomas: a serial proton magnetic resonance spectroscopy imaging study

J Neurosurg. 1997 Oct;87(4):516-24. doi: 10.3171/jns.1997.87.4.0516.


The authors tested the hypothesis that proton magnetic resonance spectroscopy (1H-MRS) imaging can be used as a supportive diagnostic tool to differentiate clinically stable brain tumors from those progressing as a result of low- to high-grade malignant transformation or posttherapeutic recurrence. Twenty-seven patients with cerebral gliomas verified on histological examination were studied repeatedly with 1H-MRS imaging over a period of 3.5 years. At the time of each 1H-MRS imaging study, clinical examination, MR imaging, positron emission tomography with 18F-fluorodeoxyglucose, and biopsy findings (when available) were used to categorize each patient as having either stable or progressive disease. Measures of the percentage changes in the choline (Cho) 1H-MRS imaging signal intensity between studies, which were obtained without knowledge of the clinical categorization, allowed the investigators to segregate the groups with a high degree of statistical significance. All progressive cases showed a Cho signal increase between studies of more than 45%, whereas all stable cases showed an elevation of less than 35%, no change, or even a decreased signal. The authors conclude that increased Cho levels coincide with malignant degeneration of cerebral gliomas and therefore may possibly be used as a supportive indicator of progression of these neoplasms.

MeSH terms

  • Adult
  • Aged
  • Aspartic Acid / analogs & derivatives
  • Aspartic Acid / analysis
  • Biomarkers, Tumor / analysis
  • Biopsy
  • Brain Neoplasms / metabolism
  • Brain Neoplasms / pathology*
  • Brain Neoplasms / therapy
  • Cell Transformation, Neoplastic / metabolism
  • Cell Transformation, Neoplastic / pathology
  • Choline / analysis*
  • Creatine / analysis
  • Deoxyglucose / analogs & derivatives
  • Disease Progression
  • Female
  • Fluorine Radioisotopes
  • Fluorodeoxyglucose F18
  • Follow-Up Studies
  • Glioma / metabolism
  • Glioma / pathology*
  • Glioma / therapy
  • Humans
  • Hydrogen
  • Lactic Acid / analysis
  • Magnetic Resonance Imaging
  • Magnetic Resonance Spectroscopy*
  • Male
  • Middle Aged
  • Neoplasm Recurrence, Local / metabolism
  • Neoplasm Recurrence, Local / pathology
  • Phosphocreatine / analysis
  • Prognosis
  • Protons
  • Radiopharmaceuticals
  • Tomography, Emission-Computed


  • Biomarkers, Tumor
  • Fluorine Radioisotopes
  • Protons
  • Radiopharmaceuticals
  • Phosphocreatine
  • Fluorodeoxyglucose F18
  • Aspartic Acid
  • Lactic Acid
  • Hydrogen
  • N-acetylaspartate
  • Deoxyglucose
  • Creatine
  • Choline