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Differences in Metabolism of Fiber Tract Alterations in Gliomas: A Combined Fiber Density Mapping and Magnetic Resonance Spectroscopic Imaging Study

Stadlbauer, Andreas PhD*,‡; Hammen, Thilo MD§; Buchfelder, Michael MD*; Bachmair, Johanna BSc; Dörfler, Arnd MD; Nimsky, Christopher MD; Ganslandt, Oliver MD*

doi: 10.1227/NEU.0b013e318258e332
Concepts, Innovations, and Techniques

BACKGROUND: Gliomas propagate diffusely throughout and along white matter structures. Glioma-related changes in structural integrity and metabolism are not detectable by standard magnetic resonance (MR) imaging.

OBJECTIVE: To investigate differences in the metabolism of fiber tract alterations between gliomas grade II to IV by correlation of fiber density values with metabolite concentrations measured by fiber density mapping and MR spectroscopic imaging.

METHODS: Fiber density mapping and MR spectroscopic imaging were performed in 48 patients with gliomas WHO grade II to IV. Fiber density mapping data were used to define fiber tracts in tumoral and peritumoral areas. Structural integrity of fiber tracts was assessed as fiber density ipsilateral-to-contralateral ratio (FD ICR). Metabolite concentrations for choline-containing compounds and N-acetyl-aspartate were computed and correlated to FD ICR values after coregistration with anatomic MR imaging.

RESULTS: In tumoral areas, choline-containing compound concentrations of altered fiber tracts were significantly different between low- and high-grade glioma and showed different courses for the correlations of FD ICR and choline-containing czeompounds. In high-grade glioma, increasing fiber destruction was associated with a massive progression in cell membrane proliferation. Peritumoral fiber structures showed significantly decreased N-acetyl-aspartate concentrations for all patients, but only patients with glioblastoma multiforme had significantly decreased fiber density compared with the contralateral side. Glioma grades II and III had significantly higher peritumoral FD ICR than glioblastoma multiforme.

CONCLUSION: A multiparametric MR imaging strategy providing information about both structural integrity and metabolism of the tumor is required for detailed assessment of glioma-related fiber tract alterations, which in turn is essential for treatment planning.

ABBREVIATIONS: Cho, choline-containing compound

DTI, diffusion tensor imaging

FA, fractional anisotropy

FD, fiber density

FDM, fiber density mapping

GBM, glioblastoma multiforme

1H-MRSI, proton magnetic resonance spectroscopic imaging

ICR, ipsilateral-to-contralateral ratio

NAA, N-acetyl-aspartate

NAWM, normal-appearing white matter

ROI, region of interest

WHO, World Health Organization

WM, white matter

*Department of Neurosurgery, University of Erlangen-Nuremberg, Germany

MR Physics Group, Department of Radiology, Landesklinikum St. Poelten, Austria

§Department of Neurology, Epilepsy Center, and

Department of Neuroradiology, University of Erlangen-Nuremberg, Erlangen, Germany

Department of Neurosurgery, University of Marburg, Marburg, Germany

Correspondence: Andreas Stadlbauer, PhD, Department of Neurosurgery, University of Erlangen-Nuremberg, Schwabachanlage 6, D-91054 Erlangen, Germany. E-mail:

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Received August 30, 2011

Accepted March 21, 2012

Copyright © by the Congress of Neurological Surgeons