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Proton Magnetic Resonance Spectroscopy in Differentiating Glioblastomas From Primary Cerebral Lymphomas and Brain Metastases

Chawla, Sanjeev PhD*; Zhang, Yu MS*; Wang, Sumei MD*; Chaudhary, Sangeeta MD*; Chou, Chou BS*; O'Rourke, Donald M. MD; Vossough, Arastoo PhD, MD*; Melhem, Elias R. MD, PhD*; Poptani, Harish PhD*

Journal of Computer Assisted Tomography: November-December 2010 - Volume 34 - Issue 6 - p 836-841
doi: 10.1097/RCT.0b013e3181ec554e

Objective: To differentiate glioblastomas, primary cerebral lymphomas (PCLs), and brain metastases using multivoxel proton magnetic resonance (MR) spectroscopic imaging.

Methods: A total of 56 patients with brain neoplasms underwent MR imaging and proton MR spectroscopic imaging. The data were analyzed from contrast-enhancing and peritumoral regions (PTR). N-acetylaspartate/creatine (Cr), choline (Cho)/Cr, glutamate+glutamine/Cr, myo-inositol/Cr, and lipids+lactate/Cr ratios were computed, and pairwise comparisons between neoplasms were made using Mann-Whitney U tests.

Results: The PTR demonstrated most significant differences in metabolite ratios. The Cho/Cr ratio in glioblastomas (0.46 [0.01]) was significantly higher than that in metastases (0.38 [0.02], P = 0.01). Significantly elevated Cho/Cr levels were also noted in PCLs (0.48 [0.03]) compared with those in metastases (P = 0.04). In addition, PCLs also demonstrated significantly higher lipids+lactate/Cr levels (11.83 [2.59]) compared with glioblastomas (4.50 [0.59], P = 0.003) and metastases (2.79 [0.33], P = 0.001).

Conclusions: Proton MR spectroscopic imaging from PTR may assist in the differentiation of glioblastomas, metastases, and PCLs.

From the Departments of *Radiology, and †Neurosurgery, University of Pennsylvania, Philadelphia, PA.

Received for publication April 2, 2010; accepted June 8, 2010.

Reprints: Harish Poptani, PhD, Department of Radiology, University of Pennsylvania, B6 Blockley Hall, 423 Guardian Dr, Philadelphia, PA 19104 (e-mail:

© 2010 Lippincott Williams & Wilkins, Inc.