Employing mouse models of radiation necrosis (one that displays the histologic hallmarks of the clinical condition) and glioblastoma (GL261), deuterium (2H) MR spectroscopy, in concert with infusion of 2H-labelled glucose, was employed to ascertain whether the 2H MRS signatures could differentiate the two lesions, an unmet clinical need. The 2H MR metabolic profiles of the two lesions were markedly different. In the tumor, the Warburg effect (aerobic glycolysis, fermentation) converted glucose nearly exclusively to lactate. In radiation necrosis, oxidative phosphorylation (respiration) dominated, with glucose converting to TCA cycle intermediates glutamate and glutamine. Thus, 2H MR distinguishes glioblastoma vs. radiation necrosis.
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