Correlation between choline level measured by proton MR spectroscopy and Ki-67 labeling index in gliomas.

BACKGROUND AND PURPOSE: The clinical relevance of proton MR spectroscopy needs further clarification as to its usefulness and limitations. The purpose of this study was to investigate the correlation between the semiquantitative choline-containing compound level (Cho value) measured by MR spectroscopy and the Ki-67 labeling index in gliomas. METHODS: Localized proton spectra were obtained in 26 consecutive patients with glioma who subsequently underwent surgery for tumor removal. Metabolic values in the spectra were measured semiquantitatively using an external standard of reference. The Ki-67 labeling index was measured in the surgical specimen. Because the semiquantitative metabolic values may be affected by tissue components included in the spectroscopic voxel, the MR imaging appearance of the voxel within the tumor was classed as homogeneous or heterogeneous through visual evaluation of the presence of necrosis, cyst, hemorrhage, and calcification, and pattern of enhancement. RESULTS: We found a strong linear correlation between the Cho value and the Ki-67 labeling index in the 18 homogeneous gliomas, but no correlation was found in the eight heterogeneous gliomas, which turned out to be malignant. CONCLUSION: The semiquantitative Cho value is a reliable predictor of proliferative activity of gliomas when the tumor appears homogeneous on MR images.