Proton spectroscopy can noninvasively provide useful information on brain tumor type and grade. Short- (30 ms) and long- (136 ms) echo time (TE) (1)H spectra were acquired from normal white matter (NWM), meningiomas, grade II astrocytomas, anaplastic astrocytomas, glioblastomas, and metastases. Very low myo-Inositol ([mI]) and creatine ([Cr]) were characteristic of meningiomas, and high [mI] characteristic of grade II astrocytomas. Tumor choline ([Cho]) was greater than NWM and increased with grade for grade II and anaplastic astrocytomas, but was highly variable for glioblastomas. Higher [Cho] and [Cr] correlated with low lipid and lactate (P < 0.05), indicating a dilution of metabolite concentrations due to necrosis in high-grade tumors. Metabolite peak area ratios showed no correlation with lipids and mI/Cho (at TE = 30 ms), and Cr/Cho (at TE = 136 ms) best correlated with tumor grade. The quantified lipid, macromolecule, and lactate levels increased with grade of tumor, consistent with progression from hypoxia to necrosis. Quantification of lipids and macromolecules at short TE provided a good marker for tumor grade, and a scatter plot of the sum of alanine, lactate, and delta 1.3 lipid signals vs. mI/Cho provided a simple way to separate most tumors by type and grade.

A computer-based decision support system to assist radiologists in diagnosing and grading brain tumours has been developed by the multi-centre INTERPRET project. Spectra from a database of 1 H single-voxel spectra of different types of brain tumours, acquired in vivo from 334 patients at four different centres, are clustered according to their pathology, using automated pattern recognition techniques and the results are presented as a two-dimensional scatterplot using an intuitive graphical user interface (GUI). Formal quality control procedures were performed to standardize the performance of the instruments and check each spectrum, and teams of expert neuroradiologists, neurosurgeons, neurologists and neuropathologists clinically validated each case. The prototype decision support system (DSS) successfully classified 89% of the cases in an independent test set of 91 cases of the most frequent tumour types (meningiomas, low-grade gliomas and high-grade malignant tumours-glioblastomas and metastases). It also helps to resolve diagnostic difficulty in borderline cases. When the prototype was tested by radiologists and other clinicians it was favourably received. Results of the preliminary clinical analysis of the added value of using the DSS for brain tumour diagnosis with MRS showed a small but significant improvement over MRI used alone. In the comparison of individual pathologies, PNETs were significantly better diagnosed with the DSS than with MRI alone.

Concerns about vitamin D status in the United States have resurfaced due to increasing reports of insufficiency and deficiency. Few foods contain vitamin D naturally, and currently few foods are fortified in the United States. Intakes of vitamin D in the United States from food and food plus supplements by age, sex, and race/ethnicity group were estimated. Individuals > or = 1 y old who participated in the 1999-2000 National Health and Nutrition Examination Survey (NHANES 1999-2000) were included in the analysis. Vitamin D intake by non-Hispanic (NH) white, NH black, Mexican American, and all individuals in the United States was estimated and compared with recommended levels. Vitamin D intakes were highest among children and teenagers, and lowest in the oldest age categories. Among children age 1-8 y, adequate intake (AI) levels for vitamin D from food were met or exceeded by 69% of Mexican American, 59% of NH white, and 48% of NH black subpopulations. Among adults > or = 51 y old, only 4% met or exceeded the AI from food alone. Few women 19-50 y old or men and women > or = 51 y old were estimated to consume recommended vitamin D levels from food. Mean dietary intakes of vitamin D from food plus supplements were consistently highest among NH white populations, although only small proportions of all those > or = 51 y old had intakes above the recommended levels. The large discrepancy between vitamin D intake by older individuals from food plus supplements and recommended levels, especially for NH black and Mexican American adults, warrants intervention.

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Lipid and macromolecule (LM) signals can dominate (1)H spectra of high-grade tumors and have characteristics that allow significant discrimination of metastases from glioblastomas. Work is now needed to determine the source and biophysical characteristics of these LM signals to further improve differentiation by optimizing the data acquisition and analysis protocol.

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