• Ryotaro Ikeguchi, Yuko Shimizu, Kayoko Abe, Satoru Shimizu, Takashi Maruyama, Masayuki Nitta, Koichiro Abe, Takakazu Kawamata, and Kazuo Kitagawa.
• Department of Neurology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan.
• Mult Scler Relat Disord. 2018 Nov 1; 26: 77-84.

BackgroundIt is often difficult to accurately differentiate tumefactive demyelinating lesions (TDLs) from gliomas using MRI.ObjectiveTo investigate the utility of proton magnetic resonance spectroscopy (MRS) in differentiating TDLs from gliomas.MethodsCohort 1 included 6 patients with TDLs and 5 with gliomas (3 high-grade), as assessed using a 1.5T MR unit. Cohort 2 included 6 patients with TDLs and 17 patients with gliomas (8 high-grade), as assessed using a 3.0T MR unit. Single-voxel proton MRS was performed to compare the following metabolite area ratios: choline (Cho)/creatine (Cr), N-acetylaspartate (NAA)/Cr, and Cho/NAA in both cohorts. Correlations between the target-to-normal-tissue ratio (TNR) obtained using methionine-positron emission tomography (MET-PET) and each MRS metabolite ratio were examined in a subset of cohort 2 (4 patients with TDLs and 11 with gliomas).ResultsMean Cho/NAA ratio was significantly higher in gliomas than in TDLs or MS in cohort 1 (p < 0.05). Mean Cho/NAA ratio was significantly higher in high-grade gliomas than in TDLs in both cohorts (ps < 0.05). In the receiver operating characteristic analysis, high-grade glioma rather than TDL was indicated when the Cho/NAA ratio was >1.72 (the area under the curve was 0.958, and the maximum sensitivity and specificity were 100% and 87%, respectively). A significant positive correlation was observed between Cho/NAA ratio and the MET-PET TNR (r2 = 0.35, p < 0.05).ConclusionMRS effectively differentiates TDLs from high-grade gliomas. Therefore, the clinical use of MRS is likely to enhance patient outcomes.Copyright © 2018 Elsevier B.V. All rights reserved.

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