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Objective: Current methods of grading glioma have inherent limitations. The current grading reference standard can be inaccurate when the biopsy specimen is not taken from the most malignant area of the tumor or when the tumor is not completely removed. This is a specific problem in glioma due to the spread of tumor penetration. Therefore, the aim of this study was to evaluate the diagnostic accuracy of the approved tumor mapping protocol in the grading of glial tumors. Methods: This descriptive cross-sectional study was performed on patients aged 2–82 years with glial tumor. Patients were referred to the hospital for tumor mapping and underwent imaging with simultaneous methods of MRS & magnetic resonance (MR) perfusion and conventional MRI under the supervision of NIAG group. Then, the results of the second evaluation, including the ratios of the desired metabolites and the amount of blood flow, permeability of the target area were compared with the results of pathology. The results were analyzed by SPSS software version 24. Results: In this study, 30 patients were included. Sensitivity, specificity, positive and negative predictive value for the determination of highgrade glioma with peripheral/internal relative cerebral blood volume (rCBV) were 100/100%, 100/93%, 93/100% and 100.100%, respectively. Sensitivity, specificity, positive and negative predictive value for the diagnosis of glioma by using peripheral/internal rCBV and thresholds of 2.65 and 1.06 were 100/100%, 93/100%, 93/100% and 100/100%, respectively. Sensitivity, specificity, positive predictive value and negative predictive value were determined for diagnosis of high-grade glioma tumor using Ch + Cr / NAA Cho / Cr and Cho / NAA ratios with detection threshold of 2.97 (93.3%), 3.5 (78.9%,100%, 100%, and 73.3%), and 2.1 (100%). Threshold values of 3.5, 2.1 and 2.97 were obtained using Cho / Cr, Ch + Cr / NAA and Cho / NAA, respectively, for the detection of high-grade gliomas. The combination of rCBV, Cho / Cr, Ch + Cr / NAA and Cho / NAA had sensitivity, specificity, positive and negative predictive value of 67.7%, 80%, 77% and 70.5%, respectively. Significant differences in rCBV and Cho / Cr, Cho / NAA and NAA / Cr ratios were observed between lowand highgrade gliomas (P <0.0001). Conclusion: Pre-operative grading of glioma based on routine MR imaging is often unreliable. As a result, measuring rCBV and Cho / Cr and Cho / NAA ratios independently and somewhat together can significantly improve the sensitivity and predictive values of pre-operative

Evaluation of Diagnostic Accuracy of the Approved Tumor Mapping Protocol in Grading of Glial Tumors