{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,14]],"date-time":"2026-02-14T11:37:39Z","timestamp":1771069059925,"version":"3.50.1"},"reference-count":61,"publisher":"Cambridge University Press (CUP)","issue":"6","license":[{"start":{"date-parts":[[2014,12,2]],"date-time":"2014-12-02T00:00:00Z","timestamp":1417478400000},"content-version":"unspecified","delay-in-days":1857,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Can. j. neurol. sci."],"published-print":{"date-parts":[[2009,11]]},"abstract":"<jats:sec id=\"S0317167100008301_abs1\"><jats:title>Background:<\/jats:title><jats:p>Assessing the impact of glioma location on prognosis remains elusive. We approached the problem using multivoxel proton magnetic resonance spectroscopic imaging (<jats:sup>1<\/jats:sup>H-MRSI) to define a tumor \u201cmetabolic epicenter\u201d, and examined the relationship of metabolic epicenter location to survival and histopathological grade.<\/jats:p><\/jats:sec><jats:sec id=\"S0317167100008301_abs2\"><jats:title>Methods:<\/jats:title><jats:p>We studied 54 consecutive patients with a supratentorial glioma (astrocytoma or oligodendroglioma, WHO grades II-IV). The metabolic epicenter in each tumor was defined as the<jats:sup>1<\/jats:sup>H-MRSI voxel containing maximum intra-tumoral choline on preoperative imaging. Tumor location was considered the X-Y-Z coordinate position, in a standardized stereotactic space, of the metabolic epicenter. Correlation between epicenter location and survival or grade was assessed.<\/jats:p><\/jats:sec><jats:sec id=\"S0317167100008301_abs3\"><jats:title>Results:<\/jats:title><jats:p>Metabolic epicenter location correlated significantly with patient survival for all tumors (r<jats:sup>2<\/jats:sup>= 0.30, p = 0.0002) and astrocytomas alone (r<jats:sup>2<\/jats:sup>= 0.32, p = 0.005). A predictive model based on both metabolic epicenter location and histopathological grade accounted for 70% of the variability in survival, substantially improving on histology alone to predict survival. Location also correlated significantly with grade (r<jats:sup>2<\/jats:sup>= 0.25, p = 0.001): higher grade tumors had a metabolic epicenter closer to the midpoint of the brain.<\/jats:p><\/jats:sec><jats:sec id=\"S0317167100008301_abs4\"><jats:title>Conclusions:<\/jats:title><jats:p>The concept of the metabolic epicenter eliminates several problems related to existing methods of classifying glioma location. The location of the metabolic epicenter is strongly correlated with overall survival and histopathological grade, suggesting that it reflects biological factors underlying glioma growth and malignant dedifferentiation. These findings may be clinically relevant to predicting patterns of local glioma recurrence, and in planning resective surgery or radiotherapy.<\/jats:p><\/jats:sec>","DOI":"10.1017\/s0317167100008301","type":"journal-article","created":{"date-parts":[[2014,12,12]],"date-time":"2014-12-12T15:13:05Z","timestamp":1418397185000},"page":"696-706","source":"Crossref","is-referenced-by-count":3,"title":["The Metabolic Epicenter of Supratentorial Gliomas: A<sup>1<\/sup>H-MRSI Study"],"prefix":"10.1017","volume":"36","author":[{"given":"Tejas","family":"Sankar","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yevgeniy E.","family":"Kuznetsov","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert W.","family":"Ryan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zografos","family":"Caramanos","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samson B.","family":"Antel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Douglas L.","family":"Arnold","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark C.","family":"Preul","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"56","published-online":{"date-parts":[[2014,12,2]]},"reference":[{"key":"S0317167100008301_ref059","doi-asserted-by":"publisher","DOI":"10.1227\/00006123-198905000-00005"},{"key":"S0317167100008301_ref037","first-page":"189","article-title":"Prognostic factors for patients with brain tumors","volume":"46","author":"Gehan","year":"1977","journal-title":"Natl Cancer Inst Monogr."},{"key":"S0317167100008301_ref054","doi-asserted-by":"publisher","DOI":"10.3171\/jns.1987.67.2.0177"},{"key":"S0317167100008301_ref048","doi-asserted-by":"publisher","DOI":"10.1227\/01.neu.0000318159.21731.cf"},{"key":"S0317167100008301_ref046","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.20297"},{"key":"S0317167100008301_ref055","first-page":"636","article-title":"Treatment and survival of low-grade astrocytoma in adults\u20141977-1988","volume":"31","author":"McCormack","year":"1992","journal-title":"Neurosurgery."},{"key":"S0317167100008301_ref035","doi-asserted-by":"publisher","DOI":"10.1016\/0360-3016(93)90203-8"},{"key":"S0317167100008301_ref058","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(19900701)66:1<6::AID-CNCR2820660103>3.0.CO;2-F"},{"key":"S0317167100008301_ref036","doi-asserted-by":"publisher","DOI":"10.1007\/BF00172709"},{"key":"S0317167100008301_ref024","doi-asserted-by":"publisher","DOI":"10.1016\/S0887-8994(00)00141-7"},{"key":"S0317167100008301_ref033","doi-asserted-by":"publisher","DOI":"10.1016\/S0167-8140(99)00029-8"},{"key":"S0317167100008301_ref045","doi-asserted-by":"publisher","DOI":"10.1215\/15228517-2007-016"},{"key":"S0317167100008301_ref022","doi-asserted-by":"publisher","DOI":"10.1159\/000056467"},{"key":"S0317167100008301_ref061","first-page":"424","article-title":"Relationship of glioblastoma multiforme to neural stem cell regions predicts invasive and multifocal tumor phenotype","volume":"9","author":"Lim","year":"2007","journal-title":"Neurooncol."},{"key":"S0317167100008301_ref042","doi-asserted-by":"publisher","DOI":"10.3171\/jns.1989.71.4.0487"},{"key":"S0317167100008301_ref002","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(89)91873-4"},{"key":"S0317167100008301_ref060","doi-asserted-by":"publisher","DOI":"10.1227\/00006123-199104000-00002"},{"key":"S0317167100008301_ref006","doi-asserted-by":"publisher","DOI":"10.1016\/0360-3016(90)90534-Q"},{"key":"S0317167100008301_ref044","doi-asserted-by":"publisher","DOI":"10.1023\/A:1010624504311"},{"key":"S0317167100008301_ref041","doi-asserted-by":"publisher","DOI":"10.3171\/jns.1967.27.5.0388"},{"key":"S0317167100008301_ref027","doi-asserted-by":"publisher","DOI":"10.3171\/jns.1997.87.4.0516"},{"key":"S0317167100008301_ref040","doi-asserted-by":"publisher","DOI":"10.1001\/archneur.1969.00480080061007"},{"key":"S0317167100008301_ref038","first-page":"181","article-title":"Long-term survival in malignant glioma. 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