Developments in MRI have made it possible to use diffusion-weighted MRI, perfusion MRI and
proton MR spectroscopy (MRS) to study lesions in the brain. We evaluated whether these techniques provide useful, complementary information for grading
gliomas, in comparison with conventional MRI. We studied 17 patients with histologically verified
gliomas, adding multivoxel
proton MRS, echoplanar diffusion and perfusion MRI the a routine MRI examination. The maximum relative cerebral blood volume (CBV), minimum apparent diffusion coefficient (ADC) and metabolic peak area ratios in
proton MRS were calculated in solid parts of tumours on the same slice from each imaging data set. The mean minimum ADC of the 13 high-grade
gliomas (0.92+/-0.27 x 10(-3) mm(2)/s) was lower than that of the four low-grade
gliomas (1.28+/-0.15 x 10(-3) mm(2)/s) ( P<0.05). Means of maximum
choline (Cho)/
N-acetylaspartate (NAA), Cho/
creatine (Cr), Cho/Cr in normal brain (Cr-n) and minimum NAA/Cr ratios were 5.90+/-2.62, 4.73+/-2.22, 2.66+/-0.68 and 0.40+/-0.06, respectively, in the high-grade
gliomas, and 1.65+/-1.37, 1.84+/-1.20, 1.61+/-1.29 and 1.65+/-1.61, respectively, in the low-grade
gliomas. Significant differences were found on spectroscopy between the high- and low-grade
gliomas ( P<0.05). Mean maximum relative CBV in the high-grade
gliomas (6.10+/-3.98) was higher than in the low-grade
gliomas (1.74+/-0.57) ( P<0.05). Echoplanar diffusion, perfusion MRI and multivoxel
proton MRS can offer diagnostic information, not available with conventional MRI, in the assessment of
glioma grade.