Increased choline signal coinciding with malignant degeneration of cerebral gliomas: a serial proton magnetic resonance spectroscopy imaging study

The authors tested the hypothesis that proton magnetic resonance spectroscopy (H-1-MRS) imaging can be used as a supportive diagnostic tool to differentiate clinically stable brain tumors from those progressing as a result of low-to high-grade malignant transformation or posttherapeutic recurrence. Twenty-seven patients with cerebral gliomas verified on histological examination were studied repeatedly with H-1-MRS imaging over a period of 3.5 years. At the time of each H-1-MRS imaging study, clinical examination, MR imaging, positron emission tomography with F-18-fluorodeoxyglucose, and biopsy findings (when available) were used to categorize each patient as having tither stable or progressive disease. Measures of the percentage changes in the choline (Cho) H-1-MRS imaging signal intensity between studies, which were obtained without knowledge of the clinical categorization, allowed the investigators to segregate the groups with a high degree of statistical significance. All progressive cases showed a Cho signal increase between studies of more than 45%, whereas all stable cases showed an elevation of less than 35%, no changer or even a decreased signal. The authors conclude that increased Cho levels coincide with malignant degeneration of cerebral gliomas and therefore may possibly be used as a supportive indicator of progression of these neoplasms.