Proton magnetic resonance spectroscopy (1h-magnetic resonance spectroscopy) in assessing metabolic changes in the perifocal zone in high-grade gliomas (literature review)

Background. High-grade gliomas are characterized by infiltrative growth with possible presence of tumor cells in the perifocal zone, which creates difficulties in determining the true tumor boundaries when using standard MRI diagnostic methods. Objective: To present a review of current publications on the application of proton magnetic resonance spectroscopy (¹H-MRS) in assessing metabolic changes in the perifocal zone in high-grade gliomas. Materials and methods. A systematic analysis of publications in PubMed, Scopus, eLibrary and Google Scholar databases for the period 2015-2024 was conducted using keywords: "¹H-MRS", "high-grade glioma", "glioblastoma", "peritumoral zone", "metabolic changes". Results. Proton MR spectroscopy allows detection of metabolic disorders in the perifocal zone of gliomas, including increased choline (Cho) levels, decreased N-acetylaspartate (NAA) and appearance of lactate (Lac). The most significant prognostic markers are elevated Cho/NAA ratios >1.99 and Cho/Cr ratios >1.73, which correlate with early tumor recurrence and presence of infiltrating tumor cells in noncontrast enhancing zones. Conclusion. Integration of ¹H-MRS into the clinical protocol for evaluating high-grade gliomas improves diagnostic accuracy, enhances surgical and radiation therapy planning, and allows optimization of personalized treatment approaches for patients