In vivo detection of citrate in brain tumors by ¹H magnetic resonance spectroscopy at 3T

Purpose To test whether citrate is elevated in adult patients with gliomas using ¹H magnetic resonance spectroscopy (MRS) at 3T in vivo. Methods Thirty-four adult patients were enrolled in the study, including six subjects with glioblastomas, eight subjects with astrocytomas (World Health Organization grade 3, n=5; grade 2, n=3), and 20 subjects with oligodendrogliomas (grade 3, n=5; grade 2, n=15). Five healthy volunteers were studied for baseline citrate data. Single-voxel localized spectra were collected with point-resolved spectroscopy (PRESS) echo times of 35 and 97 ms and were analyzed with LCModel software using numerically calculated basis spectra that included the effects of the PRESS radiofrequency and gradient pulses. Results Citrate was not measurable by MRS in healthy brain but was detected in tumor patients at both echo times. The citrate concentration was estimated to be as high as 1.8 mM with reference to water at 42 M, with Cramér-Rao lower bounds (CRLB) as low as 5%. The mean citrate level was 0.7±0.4 mM (mean±SD, n=32) with a median CRLB of ∼12%. No correlation was identified between citrate concentration and tumor grade or histological type. Conclusion Citrate was increased in the majority of gliomas in adult patients. The elevated citrate in our data indicates an altered metabolic state of tumor relative to healthy brain. Magn Reson Med 72:316-323, 2014. © 2013 Wiley Periodicals, Inc.