Magnetic resonance spectroscopy (MRS) provides useful information regarding metabolic composition in the tissues, and advanced spectroscopic methods are used to quantify markers of tumor membrane turnover and proliferation (e.g., choline (Cho)), energy homoeostasis (e.g., creatine (Cr)), intact glioneuronal structures (e.g., N-acetylaspartate (NAA)), and necrosis (e.g., lactate (Lac) or lipids). Results are usually expressed as metabolite ratios rather than absolute metabolite concentrations. Because glial tumors have some specific metabolic characteristics that differ according to the grade of tumor, there is a potential for MR spectroscopy to increase the sensitivity of routinely used diagnostic imaging. MRS also has many diagnostic applications in neurosciences to support the diagnosis in conditions like demyelination, infections, and dementia and in postradiotherapy cases. Biochemical changes in the metabolism of tumor cells related to malignant transformation are reflected in changes of particular metabolite concentration in the tumor tissue. Our prospective study aimed to analyze the usefulness of proton MR spectroscopy in grading of glioma and to correlate various metabolite ratios like choline/creatine, choline/N-acetylaspartate, N-acetylaspartate/creatine, and lactate/creatine with the histopathological grades of glioma.
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