{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T01:22:26Z","timestamp":1789521746189,"version":"build-2803163510"},"reference-count":40,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2024,5,9]],"date-time":"2024-05-09T00:00:00Z","timestamp":1715212800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100005972","name":"Deutsche Krebshilfe","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100005972","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003042","name":"Else Kr\u00f6ner-Fresenius-Stiftung","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100003042","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Magnetic Resonance Imaging"],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Emerging evidence suggests that fasting could play a key role in cancer treatment. Its metabolic effects on gliomas require further investigation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Purpose<\/jats:title><jats:p>To design a multi\u2010voxel <jats:sup>1<\/jats:sup>H\/<jats:sup>31<\/jats:sup>P MR\u2010spectroscopic imaging (MRSI) protocol for noninvasive metabolic monitoring of cerebral, fasting\u2010induced changes on an individual patient\/tumor level, and to assess its technical reliability\/reproducibility.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Type<\/jats:title><jats:p>Prospective.<\/jats:p><\/jats:sec><jats:sec><jats:title>Population<\/jats:title><jats:p>MRS phantom. Twenty\u2010two patients (mean age\u2009=\u200961, 6 female) with suspected WHO grade II\u2010IV glioma examined before and after 72\u2010hour\u2010fasting prior to biopsy\/resection.<\/jats:p><\/jats:sec><jats:sec><jats:title>Field Strength\/Sequence<\/jats:title><jats:p>3\u2010T, <jats:sup>1<\/jats:sup>H decoupled 3D <jats:sup>31<\/jats:sup>P MRSI, 2D <jats:sup>1<\/jats:sup>H sLASER MRSI at an echo time of 144\u2009msec, 2D <jats:sup>1<\/jats:sup>H MRSI (as water reference), T1\u2010weighted, T1\u2010weighted contrast\u2010enhanced, T2\u2010weighted, and FLAIR. sLASER and PRESS sequences were used for phantom measurements.<\/jats:p><\/jats:sec><jats:sec><jats:title>Assessment<\/jats:title><jats:p>Phantom measurements and spectral simulations were performed with various echo\u2010times for protocol optimization. In vivo spectral analyses were conducted using LCModel and AMARES, obtaining quality\/fitting parameters (linewidth, signal\u2010to\u2010noise\u2010ratio, and uncertainty measures of fitting) and metabolite intensities. The volume of glioma sub\u2010regions was calculated and correlated with MRS findings. Ex\u2010vivo spectra of necrotic tumor tissues were obtained using high\u2010resolution magic\u2010angle spinning (HR\u2010MAS) technique.<\/jats:p><\/jats:sec><jats:sec><jats:title>Statistical Tests<\/jats:title><jats:p>Wilcoxon signed\u2010rank test, Bland\u2013Altman plots, and coefficient of variation were used for repeatability analysis of quality\/fitting parameters and metabolite concentrations. Spearman <jats:italic>\u03c1<\/jats:italic> correlation for the concentration of ketone bodies with volumes of glioma sub\u2010regions was determined. A <jats:italic>P<\/jats:italic>\u2010value &lt;0.05 was considered statistically significant.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p><jats:sup>1<\/jats:sup>H and <jats:sup>31<\/jats:sup>P repeatability measures were highly consistent between the two sessions. \u03b2\u2010hydroxybutyrate and acetoacetate were detectable (fitting\u2010uncertainty &lt;50%) in glioma sub\u2010regions of all patients who completed the 72\u2010hour\u2010fasting cycle. \u03b2\u2010hydroxybutyrate accumulation was significantly correlated with the necrotic\/non\u2010enhancing tumor core volume (<jats:italic>\u03c1<\/jats:italic>\u2009=\u20090.81) and validated using ex\u2010vivo <jats:sup>1<\/jats:sup>H HR\u2010MAS.<\/jats:p><\/jats:sec><jats:sec><jats:title>Data Conclusion<\/jats:title><jats:p>We propose a comprehensive MRS protocol that may be used for monitoring cerebral, fasting\u2010induced changes in patients with glioma.<\/jats:p><\/jats:sec><jats:sec><jats:title>Evidence Level<\/jats:title><jats:p>1<\/jats:p><\/jats:sec><jats:sec><jats:title>Technical Efficacy<\/jats:title><jats:p>Stage 4<\/jats:p><\/jats:sec>","DOI":"10.1002\/jmri.29422","type":"journal-article","created":{"date-parts":[[2024,5,9]],"date-time":"2024-05-09T11:58:45Z","timestamp":1715255925000},"page":"426-438","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["<scp>2D <sup>1<\/sup>H sLASER<\/scp> Long\u2010<scp>TE<\/scp> and <scp>3D <sup>31<\/sup>P<\/scp> Chemical Shift Imaging at 3\u2009T for Monitoring Fasting\u2010Induced Changes in Brain Tumor Tissue"],"prefix":"10.1002","volume":"61","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9447-4906","authenticated-orcid":false,"given":"Seyma","family":"Alcicek","sequence":"first","affiliation":[{"name":"Institute of Neuroradiology University Hospital Frankfurt, Goethe University  Frankfurt\/Main 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C.","family":"Thomas","sequence":"additional","affiliation":[{"name":"Institute of Neuroradiology University Hospital Frankfurt, Goethe University  Frankfurt\/Main Germany"},{"name":"University Cancer Center Frankfurt (UCT)  Frankfurt\/Main Germany"},{"name":"Frankfurt Cancer Institute (FCI)  Frankfurt\/Main Germany"},{"name":"German Cancer Research Center (DKFZ) Heidelberg, Germany and German Cancer Consortium (DKTK)  Partner Site Frankfurt\/Mainz Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincent","family":"Prinz","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery University Hospital Frankfurt, Goethe University  Frankfurt\/Main Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie\u2010Th\u00e9r\u00e8se","family":"Forster","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery University Hospital Frankfurt, Goethe University  Frankfurt\/Main 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