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Preoperative prediction of 5-ALA fluorescence in gliomas: comparison of 7-Tesla magnetic resonance spectroscopic imaging, contrast-enhancement on MRI, and positron emission tomography.

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Title: Preoperative prediction of 5-ALA fluorescence in gliomas: comparison of 7-Tesla magnetic resonance spectroscopic imaging, contrast-enhancement on MRI, and positron emission tomography.
Authors: Huskic, Sara1,2 (AUTHOR), Lazen, Philipp1,2 (AUTHOR), Cadrien, Cornelius1,2 (AUTHOR), Roetzer-Pejrimovsky, Thomas3,4 (AUTHOR), Kiesel, Barbara1 (AUTHOR), Furtner, Julia5,6 (AUTHOR), Leitner, Johannes5 (AUTHOR), Kloss-Brandstätter, Anita7 (AUTHOR), Körner, Lisa1 (AUTHOR), Berghoff, Anna Sophie8 (AUTHOR), Preusser, Matthias8 (AUTHOR), Grabner, Günther7 (AUTHOR), Bogner, Wolfgang2,9 (AUTHOR), Traub-Weidinger, Tatjana10,11 (AUTHOR), Hacker, Marcus11 (AUTHOR), Trattnig, Siegfried2,9 (AUTHOR), Rössler, Karl1,9 (AUTHOR), Hangel, Gilbert1,2,9 (AUTHOR), Widhalm, Georg1 (AUTHOR) georg.widhalm@meduniwien.ac.at
Source: European Radiology. Jul2026, Vol. 36 Issue 7, p5469-5481. 13p.
Subjects: Fluorescence, Spectroscopic imaging, Computer-assisted surgery, Contrast-enhanced magnetic resonance imaging, Preoperative care, Biomarkers, Positron emission tomography, Gliomas
Abstract: Objectives: We investigated whether metabolic ratios derived from ultra-high-field 7-T 3D-FID-CRT-MRSI can predict intraoperatively visible 5-aminolevulinic acid (5-ALA) fluorescence in gliomas and compared their predictive performance to established imaging markers, including contrast enhancement (CE) on MRI and PET tumor-to-normal ratio (TNR). Materials and methods: We retrospectively analyzed 43 patients with histopathologically confirmed adult-type diffuse gliomas (CNS WHO grades 2–4) who underwent preoperative 7-T MRSI and 5-ALA-guided resection. Group differences between 5-ALA-positive and 5-ALA-negative tumors were tested for 16 metabolic ratios to either total creatine (tCr) or combined N-acetylaspartate and N-acetyl-aspartyl-glutamate (NAA + NAAG; total NAA; tNAA) using non-parametric statistics with Šidák correction. CE-MRI status and PET TNR (subcohort, n = 31) were included as reference predictors. We additionally evaluated a subgroup of non-enhancing gliomas (n = 27). Receiver operating characteristic (ROC) analysis was performed to determine diagnostic performance. Results: 5-ALA-positive gliomas demonstrated significantly altered metabolic profiles, showing lower mI/tNAA (p < 0.001) and higher Gln/tCr, Glx/tCr, Gly/tCr, and GSH/tCr ratios (all p < 0.001). These ratios achieved high predictive accuracy for fluorescence (AUCrange = 0.79–0.94), comparable or superior to PET TNR (AUC = 0.90) and CE-MRI (AUC = 0.84). In a subcohort of nonenhancing gliomas, Gly/tCr and Gln/tCr showed a high prediction accuracy (AUC = 0.90). Conclusion: 7-T MRSI metabolic ratios can predict intraoperative 5-ALA fluorescence and may serve as an alternative or adjunct to CE-MRI and PET for preoperative patient selection for 5-ALA administration. Finally, these findings could be especially beneficial in non-enhancing gliomas, where CE-MRI offers limited predictive information. Key Points: Question Does 7-T MRSI enable preoperative prediction of 5-ALA fluorescence to support patient selection for fluorescence-guided glioma surgery? Findings Several 7-T MRSI metabolic ratios (mI/tNAA, Gln/tCr, Glx/tCr, Gly/tCr and GSH/tCr) robustly predicted 5-ALA fluorescence across glioma subtypes, with diagnostic performance comparable to contrast-enhanced MRI and PET. Clinical relevance Ultra-high-field 7-T MRSI enables noninvasive preoperative prediction of intraoperative 5-ALA fluorescence in gliomas with performance comparable to PET and contrast-enhanced MRI, supporting surgical planning without the need for contrast agents or radiation exposure. [ABSTRACT FROM AUTHOR]
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Database: Engineering Source
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Abstract:Objectives: We investigated whether metabolic ratios derived from ultra-high-field 7-T 3D-FID-CRT-MRSI can predict intraoperatively visible 5-aminolevulinic acid (5-ALA) fluorescence in gliomas and compared their predictive performance to established imaging markers, including contrast enhancement (CE) on MRI and PET tumor-to-normal ratio (TNR). Materials and methods: We retrospectively analyzed 43 patients with histopathologically confirmed adult-type diffuse gliomas (CNS WHO grades 2–4) who underwent preoperative 7-T MRSI and 5-ALA-guided resection. Group differences between 5-ALA-positive and 5-ALA-negative tumors were tested for 16 metabolic ratios to either total creatine (tCr) or combined N-acetylaspartate and N-acetyl-aspartyl-glutamate (NAA + NAAG; total NAA; tNAA) using non-parametric statistics with Šidák correction. CE-MRI status and PET TNR (subcohort, n = 31) were included as reference predictors. We additionally evaluated a subgroup of non-enhancing gliomas (n = 27). Receiver operating characteristic (ROC) analysis was performed to determine diagnostic performance. Results: 5-ALA-positive gliomas demonstrated significantly altered metabolic profiles, showing lower mI/tNAA (p < 0.001) and higher Gln/tCr, Glx/tCr, Gly/tCr, and GSH/tCr ratios (all p < 0.001). These ratios achieved high predictive accuracy for fluorescence (AUCrange = 0.79–0.94), comparable or superior to PET TNR (AUC = 0.90) and CE-MRI (AUC = 0.84). In a subcohort of nonenhancing gliomas, Gly/tCr and Gln/tCr showed a high prediction accuracy (AUC = 0.90). Conclusion: 7-T MRSI metabolic ratios can predict intraoperative 5-ALA fluorescence and may serve as an alternative or adjunct to CE-MRI and PET for preoperative patient selection for 5-ALA administration. Finally, these findings could be especially beneficial in non-enhancing gliomas, where CE-MRI offers limited predictive information. Key Points: Question Does 7-T MRSI enable preoperative prediction of 5-ALA fluorescence to support patient selection for fluorescence-guided glioma surgery? Findings Several 7-T MRSI metabolic ratios (mI/tNAA, Gln/tCr, Glx/tCr, Gly/tCr and GSH/tCr) robustly predicted 5-ALA fluorescence across glioma subtypes, with diagnostic performance comparable to contrast-enhanced MRI and PET. Clinical relevance Ultra-high-field 7-T MRSI enables noninvasive preoperative prediction of intraoperative 5-ALA fluorescence in gliomas with performance comparable to PET and contrast-enhanced MRI, supporting surgical planning without the need for contrast agents or radiation exposure. [ABSTRACT FROM AUTHOR]
ISSN:09387994
DOI:10.1007/s00330-026-12430-w