On the relation between MR spectroscopy features and the distance to MRI-visible solid tumor in GBM patients

To improve the detection of peritumoral changes in GBM patients by exploring the relation between MRSI information and the distance to the solid tumor volume (STV) defined using structural MRI (sMRI).

Twenty-three MRSI studies (PRESS, TE 135 ms) acquired from different patients with untreated GBM were used in this study. For each MRSI examination, the STV was identified by segmenting the corresponding sMRI images using BraTumIA, an automatic segmentation method. The relation between different metabolite ratios and the distance to STV was analyzed. A regression forest was trained to predict the distance from each voxel to STV based on 14 metabolite ratios. Then, the trained model was used to determine the expected distance to tumor (EDT) for each voxel of the MRSI test data. EDT maps were compared against sMRI segmentation.

The features showing abnormal values at the longest distances to the tumor were: %NAA, Glx/NAA, Cho/NAA, and Cho/Cr. These four features were also the most important for the prediction of the distances to STV. Each EDT value was associated with a specific metabolic pattern, ranging from normal brain tissue to actively proliferating tumor and necrosis. Low EDT values were highly associated with malignant features such as elevated Cho/NAA and Cho/Cr.

The proposed method enables the automatic detection of metabolic patterns associated with different distances to the STV border and may assist tumor delineation of infiltrative brain tumors such as GBM.