Radio- and chemotherapy for gliomas cause a macrophage-driven inflammation called pseudoprogression (PsP) which appears as abnormal MRI enhancement mimicking treatment response. Our quantitative NMR metabolomics in murine glioma models show a significant increase in amino acid uptake and metabolism (glutamine, glycine, methionine, and tyrosine), lactate and phospholipids in actively proliferating untreated gliomas. Iron oxide is taken up uniquely by inflammatory macrophages, as shown by decreased T2-MRI contrast and an increase in the F4/80 macrophages during treatment-induced PsP. This imaging platform may provide a promising discernment of PsP (iron oxide qT2MRI) and true progression (amino acid PET) for gliomas.
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