Surgery Outcome and Adjuvant Chemo-Radiotherapy Response Evaluation in High-grade Glioma with Magnetic Resonance Spectroscopy (MRS)

Introduction: Accurately identifying the remaining tumor extent following glioma near-total or subtotal resection is crucial for determining appropriate treatment options. We aimed to evaluate the surgery outcome and responses to chemoradiation therapy (CRT) in glioma patients with multiparametric magnetic resonance imaging (MRI). Material and Methods: This prospective study involved 12 patients diagnosed with High-grade glioma. Magnetic resonance spectroscopy (MRS) parameters (Cho/Cr and Cho/NAA) and structural parameters (enhanced lesion volume, non-enhanced lesion volume) were measured to evaluate the surgery outcome with the residual tumor and response to CRT. The imaging process was performed in two stages: once after surgery, before radiotherapy, and once one month after radiotherapy. Results: The study found that the ROI centers of the Cho/NAA > 1.7 regions had the highest level of agreement and the least separation from the structural ROI. In the case of Cho/Cr, the most significant similarity was seen at a value above 1.5. In the second stage of the study, by comparing metabolic and structural data before and after chemo-radiotherapy treatment, no significant changes in metabolites were observed alongside a substantial decrease in structural parameters in the group with high conformity of structural ROI and metabolic ROI. Still, a significant increase in metabolic ratios was observed in the group with low conformity. Conclusion: The study's results suggest that employing MRS mapping is a suitable approach for detecting residual tumors and predicting the effectiveness of chemoradiation therapy in glioma patients, in contrast to relying exclusively on conventional MR imaging features.