Absolute concentrations of metabolites in human brain tumors using in vitro proton magnetic resonance spectroscopy.

Water-soluble metabolites extracted from 60 surgically excised samples of various brain tumors and four nontumorous lobectomized brains were measured quantitatively using in vitro high-resolution magnetic resonance spectroscopy. A detailed MR spectrum-histology correlation study in a glioblastoma was made, to reveal MR spectral changes in accordance with the density of glioma cells. Furthermore, three cases that had difficult preoperative diagnoses are discussed. MR spectra from gliomas exhibited characteristic patterns according to malignancy, presumably reflecting its metabolic effects. Concentrations of choline-containing compounds, inositol, alanine, glycine and phosphorylethanolamine (PEA) increased according to the degree of malignancy, but it was noteworthy that in glioblastoma the choline-containing compounds, inositol, alanine, glycine and phosphorylethanolamine increased according to the degree of malignancy. In particular, the glycine concentration was very high in glioblastoma. We also detected a large amount of taurine in medulloblastoma. Although the total creatine concentrations decreased according to the malignancy, the concentration of total creatine was relatively preserved in neuroectodermal tumors but was low in nonneuroectodermal tumors. N-acetyl-aspartate was unequivocally demonstrated in normal tissues, but could not be detected in nonneuroectodermal brain tumors such as metastatic brain tumor, meningioma, neurinoma and chordoma. In meningioma, although a high peak of choline-containing compounds has been reported uniquely by in vitro and in vivo 1H-MRS, we demonstrated that its concentration was not increased in meningioma; instead, there was an increased alanine content. 1H-MRS of neurinoma demonstrated high inositol peaks, and a large amount of inositol. The reason for the high inositol content in neurinoma is unknown, but the prominent peak of inositol on MR spectra should be useful for the differential diagnosis of neurinoma from meningioma. PEA concentration was increased four to five times in pituitary adenoma, malignant lymphoma, and medulloblastoma as compared with normal brain. Thus 1H-MRS might provide clinically useful information on tumor malignancy and characteristic tumor metabolism. Although excellent anatomical information of tumors can be readily obtained by magnetic resonance imaging. MRS provides metabolic information. MRS may provide additional information in cases in which the differential diagnosis of tumors by neuroimaging is difficult.