Preoperative grading of gliomas using combined MR perfusion,.spectroscopy and diffusion tensor imaging

Objective To investigate the value of combined MRI using 3D-ASL perfusion, spectroscopy(MRS) and diffusion tensor imaging(DTI) in the preoperative grading of brain glioma. Methods 61 patients with suspected glioma underwent perfusion MRS and DTI. The cerebral blood flow(CBF), MRS metabolite ratios, trace imaging of white matter tracts(DTT) of the tumor and contralateral normal brain were assessed..Tumor grading by the three functional imaging parameters was compared with the histological findings. Results The ipsilateral / contralateral CBF ratios of 38 high-grade gliomas(3.24± 1.38) were significantly(P0.05) higher than that of 23 low-grade gliomas(0.91± 0.35). Decreased NAA and increased Cho with significantly(P 0.05)higher Cho / NAA and Cho / Cr in high-grade(5.3 ±2.2,3.5 ±1.5) than low-grade(1.6 ±0.3,.1.8 ±0.5) gliomas were detected on MRS..DTT diagrams showed that white matter fibers were destroyed in high-grade gliomas,.displaced and decreased in low-grade gliomas..The grading accuracy of the combined functional imaging was 90.2%(55 / 61). Conclusion Combined functional MRI using 3D-ASL, MRS and DTI can accurately grade gliomas pre-operatively.