Cerebral Ketones Detected by 3T MR Spectroscopy in Patients with High-Grade Glioma on an Atkins-Based Diet

BACKGROUND AND PURPOSE: Ketogenic diets are being explored as a possible treatment for several neurological diseases, but the physiologic impact on the brain is unknown. The objective of this study was to evaluate the feasibility of 3T MR spectroscopy to monitor brain ketone levels in patients with high-grade gliomas who were on a ketogenic diet (a modified Atkins diet) for 8 weeks. MATERIALS AND METHODS: Paired pre- and post-ketogenic diet MR spectroscopy data from both the lesion and contralateral hemisphere were analyzed using LCModel software in 10 patients. RESULTS: At baseline, the ketone bodies acetone and ?-hydroxybutyrate were nearly undetectable, but by week 8, they increased in the lesion for both acetone (0.06 ? 0.03 ? 0.27 ? 0.06 IU, P = .005) and ?-hydroxybutyrate (0.07 ? 0.07 ? 0.79 ? 0.32 IU, P = .046). In the contralateral brain, acetone was also significantly increased (0.041 ? 0.01 ? 0.16 ? 0.04 IU, P = .004), but not ?-hydroxybutyrate. Acetone was detected in 9/10 patients at week 8, and ?-hydroxybutyrate, in 5/10. Acetone concentrations in the contralateral brain correlated strongly with higher urine ketones (r = 0.87, P = .001) and lower fasting glucose (r = ?0.67, P = .03). Acetoacetate was largely undetectable. Small-but-statistically significant decreases in NAA were also observed in the contralateral hemisphere at 8 weeks. CONCLUSIONS: This study suggests that 3T MR spectroscopy is feasible for detecting small cerebral metabolic changes associated with a ketogenic diet, provided that appropriate methodology is used.