SpringerLink - Journal Article

Diagnostic Neuroradiology

Prognostic = value of=20 choline and creatine in WHO grade II gliomas

Elke Hattingen¹, Peter Raab^{1, 3}, = Kea Franz²,=20 Heiner Lanfermann³,=20 Matthias Setzer²,=20 R=C3=BCdiger Gerlach²,=20 Friedhelm E. Zanella¹ and=20 Ulrich Pilatus¹

(1)	Institute of = Neuroradiology,=20 Johann Wolfgang Goethe University of = Frankfurt/Main,=20 Schleusenweg 2-16, 60528 Frankfurt/Main,=20 Germany

(2)	Department of = Neurosurgery,=20 Johann Wolfgang Goethe University of = Frankfurt/Main,=20 Frankfurt/Main, = Germany

(3)	Institute of = Neuroradiology,=20 Medizinische Hochschule Hannover (MHH), = Hannover,=20 Germany

Received:=20 = 11 March 2008 Accepted:=20 = 30 April 2008 Published=20 online: 4 June 2008

Abstract

Introduction The = purpose of=20 this study was to evaluate whether proton magnetic = resonance=20 spectroscopy (¹H-MRS) predicts survival = time, tumor=20 progression, and malignant transformation in patients = with WHO=20 grade II gliomas.

Materials and = methods =20 ¹H-MRS and MR imaging (MRI) were performed = before=20 surgery in 45 patients with histologically proven WHO = grade II=20 gliomas. Metabolite concentrations of = choline-containing=20 compounds (Cho) and creatine/phosphocreatine (tCr) = were=20 normalized to contralateral brain tissue. = Spectroscopic data=20 as well as the extent of tumor resection, contrast=20 enhancement, size and histopatholocical type of the = tumor,=20 age, sex, and first neurological symptoms of the = patients were=20 analyzed for survival, tumor progression, and = malignant=20 transformation for a follow-up period of 1 to = 5 years.=20

Results The = normalized tCr of=20 WHO grade II gliomas was a significant predictor for = tumor=20 progression (p=E2=80=89=3D=E2=80=890.011) and = for malignant tumor=20 transformation (p=E2=80=89=3D=E2=80=890.016). = Further, contrast=20 enhancement of the tumor = (p=E2=80=89=3D=E2=80=890.014) at the time of=20 diagnosis was significant for malignant tumor = transformation=20 and extent of tumor resection for the tumor = progression=20 (p=E2=80=89=3D=E2=80=890.007). All other = parameters failed to predict any=20 of the three endpoints.

Conclusion Normalized values=20 of tCr in WHO grade II gliomas may have prognostic=20 implications for this group of gliomas. As a rule of = the=20 thumb, low-grade gliomas with decreased tCr (relative = tCr=20 values below 1.0) may show longer progression-free = times and=20 later malignant transformation than low-grade gliomas = with=20 regular or increased tCr values.

Keywords =20 ¹H-MR spectroscopy - WHO grade II = = gliomas - Creatine - Choline - Progression&= nbsp;- Malignant=20 transformation

This study = was supported=20 by the Federal Ministry of Education and Research = (Brain=20 Imaging Center Frankfurt, DLR 01GO0203) and the German = Research Foundation (ZA 233/1-1).

= =

Elke Hattingen
Email:=20 elke.hattingen@kgu.de

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