• World Neurosurg · Apr 2022

    Glutamic acid and total creatine as predictive markers for epilepsy in glioblastoma by using magnetic resonance spectroscopy prior to surgery.

    • Mitsuru Hashiguchi, Kazuhiro Tanaka, Hiroaki Nagashima, Yuichi Fujita, Hirotomo Tanaka, Masaaki Kohta, Tomoaki Nakai, Yoichi Uozumi, Masahiro Maeyama, Yuichiro Somiya, Eiji Kohmura, and Takashi Sasayama.
    • Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Japan.
    • World Neurosurg. 2022 Apr 1; 160: e501-e510.

    ObjectiveEpilepsy in glioblastoma patients significantly reduces their quality of life; however, little is known about the association between predicting epilepsy and metabolites in tumors. In this study, we used 3.0-T magnetic resonance imaging and 1H-magnetic resonance spectroscopy (MRS) to quantify metabolite concentrations in patients with varying epilepsy histories.MethodsFifty-one patients with glioblastoma underwent pretreatment 3.0-T MRI/1H-MRS scanning. Single-voxel (1.5 cm3) MRS, in an enhanced lesion, was acquired using a double-echo point-resolved spectroscopic sequence with chemical-shift selective water suppression. MRS data were quantified with linear combination model (LC-Model) software. We compared the MRS data between groups with and without epilepsy during the postoperative course (EP).ResultsThe ratios of glutamate (Glu) and glutamate + glutamine (Glx) to total creatine (Glu/tCr and Glx/tCr) in the tumor were associated with epilepsy history. The receiver operating characteristic curve analysis showed that a Glu/tCr value of 1.81 was 70% sensitive and 90% specific for the prediction of EP (area under curve: 0.82). In the analysis excluding patients with preoperative epilepsy, a Glu/tCr value of 1.81 was 75% sensitive and 88% specific for the prediction (area under curve: 0.87).ConclusionsIntratumoral metabolite concentrations measured using pretreatment 3.0-T MRI/1H-MRS changed characteristically in the group with EP. Our study suggests that the Glu/tCr ratio in tumors has adequate reliability in predicting EP. Pretreatment MRS is a minimally invasive and simple procedure that can provide useful information on glioblastoma patients.Copyright © 2022 Elsevier Inc. All rights reserved.

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