Due to the aggressive nature of gliomas, single structural MRI imaging cannot accurately reflect tumor boundaries. Numerous studies have found that the Cho/NAA index (CNI) in magnetic resonance spectral analysis imaging (MRS), can accurately show the invasive extent of glioma. Jie Zhang et al. from the Department of Neurosurgery, Huashan Hospital, Shanghai, fused multivoxel MRS images to MRI images from a navigation system to localize the metabolic border of gliomas based on the CNI index for glioma resection. The findings were published online in the December 2015 issue of Journal of Neurosurgery. Fifteen patients with primary gliomas were selected for the study, and 3D-MRS imaging was performed preoperatively, followed by fusion of CNI images with structural imaging MRI images and registration into a navigation system. In MRS imaging, three different CNI indices, 0.5, 1.0, and 1.5, were selected for metabolic boundary localization; the metabolic imaging images of gliomas obtained with different CNI indices were significantly different (P<0.05). For low-grade gliomas, the volumes shown on structural imaging mri images and metabolic imaging mrs images were significantly different (cni=0.5, p=0.0005; cni=1.5, p=0.0129); similarly for high-grade gliomas (cni=0.5, p=0.0027; cni=1.5, p=0.0497). ).Tumor resection in all 15 patients was done under mrs and dti imaging navigation. Tumors were resected along the metabolic border under the principle of maximum safe resection. The mean volume of gliomas resected along metabolic borders was greater than that resected along structural borders by 59.48%. only 1 of the 15 patients had a transient postoperative speech disorder. After 1-year follow-up, only 1 patient with high-grade glioma recurred 9 months after surgery. < span=""> The authors note that by integrating MRS imaging into intraoperative navigation techniques, the appropriate CNI index is selected to localize the metabolic border of the glioma and guide surgical resection. The simultaneous integration of DTI imaging can achieve an improved rate of total tumor resection while preserving neurological function. Figure 1. Fusion of metabolic and structural MRI images.A. MRI imaging of glioma shown with CNI indices of 0.5, 1.0, and 1.5; B. Postoperative MRI imaging of glioma; C. DTI imaging of functional MRI presenting the cone beam; D, E. The metabolic border is closest to the cone beam at a CNI index of 1.0, when a total or subtotal resection of the tumor with the greatest degree of safety is obtained ;F. MRI sagittal display of the metabolic border in relation to the cone beam.