Objective   To explore the clinical value of multivoxel 2D Proton magnetic resonance spectroscopy imaging (

1

H-MRSI) overlay anatomy imaging in grading the malignancy of gliomas.    Methods  

Totally 58 patients with pathologically verified gliomas were examined before operations using conventional MRI and multi-voxel 2D

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H-MRS. An attached software package Functool (2) spectroscopy-2D Brain was used to gain the H-MRSI overlay anatomy imaging

including the metabolic imaging+anatomy imaging (MIDI) color overplay map of Cho

Cr

NAA and Lip or Lac

and the distribution imaging+anatomy imaging (DIAI) color overlay map of Cho/NAA and Cho/Cr. The distributions of Cho

Cr

NAA

Lip or Lac

Cho/NAA and Cho/Cr in the lesions were observed

and the (Cho/NAA)

max

and (Cho/Cr)

max

were measured.    Results   Heterogeneous distribution of Cho

Cr

NAA

Lip or Lac

Cho/NAA and Cho/Cr were found in the tumor mass. Cho

and the ratios of Cho/NAA and Cho/Cr were increased heterogeneously

and NAA and Cr were decreased with heterogeneous display

especially in high-grade gliomas. A significant difference was found  in the ratios of (Cho/NAA)

max

and (Cho/Cr)

max

between low- and high-grade gliomas (P0.01). There was significantly positive correlation between the ratios of (Cho/NAA)

max

and (Cho/Cr)

max

with the pathological grading of gliomas (r

s

=0.923

0.802 respectively).    Conclusion   Multivoxel 2D

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H-MRSI overlay anatomy image indirectly reflects the heterogeneous of tumor tissues

and is helpful in the grading of gliomas by (Cho/NAA)

max

and (Cho/Cr)

max

through DIAI.