Advances in in vivo MR spectroscopy for brain tumour diagnosis and therapy guidance

Proton MRS and MRSI aid brain tumour characterisation, glioma grading, and differentiate recurrence from treatment effects. 2-hydroxyglutarate detection enables non-invasive IDH mutation assessment. AI and automated quantification improve reproducibility, but protocol harmonisat…

• MRSI maps metabolic heterogeneity to define infiltrative tumour regions for biopsy targeting, surgical planning, and radiotherapy guidance.
• Established patterns (elevated choline, reduced N-acetylaspartate) support diagnosis and grading; emerging markers alanine and glycine require further validation.
• Hyperpolarised 13C and deuterium MRS remain primarily research tools for dynamic metabolic assessment.

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