ArticleEuropean radiology2026
Preoperative prediction of 5-ALA fluorescence in gliomas: comparison of 7-Tesla magnetic resonance spectroscopic imaging, contrast-enhancement on MRI, and positron emission tomography.
Article in European radiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesWe 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
methodsWe 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.
results5-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 (AUC
conclusion7-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.
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