ObjectivesWe evaluated the feasibility of using chemical shift gradient-echo (GE) in- and opposed-phase (IOP) imaging to grade glioma.MethodsA phantom study was performed to investigate the correlation of 1H MRS-visible lipids with the signal loss ratio (SLR) obtained using IOP imaging. A cross-sectional study approved by the institutional review board was carried out in 22 patients with different glioma grades. The patients underwent scanning using IOP imaging and single-voxel spectroscopy (SVS) using 3T MRI. The brain spectra acquisitions from solid and cystic components were obtained and correlated with the SLR for different grades.ResultsThe phantom study showed a positive linear correlation between lipid quantification at 0.9 parts per million (ppm) and 1.3 ppm with SLR (r = 0.79–0.99, p < 0.05). In the clinical study, we found that SLR at the solid portions was the best measure for differentiating glioma grades using optimal cut-points of 0.064 and 0.086 with classification probabilities for grade II (SII = 1), grade III (SIII = 0.50) and grade IV (SIV = 0.89).ConclusionsThe results underscore the lipid quantification differences in grades of glioma and provide a more comprehensive characterization by using SLR in chemical shift GE IOP imaging. SLR in IOP sequence demonstrates good performance in glioma grading.Key Points• Strong correlation was seen between lipid concentration and SLR obtained using IOP• IOP sequence demonstrates significant differences in signal loss within the glioma grades• SLR at solid tumour portions was the best measure for differentiation• This sequence is applicable in a research capacity for glioma staging armamentarium