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. 2021;17(7):904-910.
doi: 10.2174/1573405617666210224112808.

Accuracy of Magnetic Resonance Spectroscopy in Discrimination of Neoplastic and Non-Neoplastic Brain Lesions

Qurain T Alshammari  1 , Mohammed Salih  1 , Moawia Gameraddin  2 , Mohamed Yousef  3 , Bushra Abdelmalik  1 , Omer Loaz  4
Affiliations

Accuracy of Magnetic Resonance Spectroscopy in Discrimination of Neoplastic and Non-Neoplastic Brain Lesions

Qurain T Alshammari et al. Curr Med Imaging. 2021.

Abstract

Background: Differentiation of brain lesions by conventional MRI alone is not enough. The introduction of sophisticated imaging methods, such as MR Spectroscopy (MRS), will contribute to accurate differentiation.

Objective: To determine the diagnostic accuracy of MRS in differentiating neoplasm and non-neoplastic brain lesion.

Methodology: This is a cross-sectional descriptive study conducted at Khartoum State from the period of 2015 to 2017. Thirty cases with brain lesions were included in the study investigated with MRS (Single-voxel spectroscopy) and conventional MRI. A comparison of MRS findings and histopathologic analysis was performed. The ratios of Cho/Cr and Cho/NAA were analyzed and compared between neoplastic and non-neoplastic brain masses. Data were analyzed using SPSS version 23.

Results: Out of the 30 patients affected with brain lesions, there were 16 females and 14 males with a mean age of 44 +- 18 years. The ratios of Cho/Cr and Cho/NAA were higher in gliomas, astrocytoma, and meningioma than non-neoplastic lesions. Kappa statistical value (K) showed a good agreement between MRS and histopathological analysis (K= 0.60). The diagnostic accuracy of MRS was 100%, with 82.60% sensitivity, 85.71% specificity, 95% PPV, and 60% NPV.

Conclusion: MRS has high diagnostic accuracy in differentiating neoplasm from non-neoplastic brain tumors. The elevation ratios of Choline-to- N-acetyl aspartate and choline-to- creatine can help neurosurgeons and clinicians differentiate benign from malignant masses.

Keywords: Brain lesions; Cho/Cr; Cho/NAA ratio; MRS; NPV.; PPV; accuracy.

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Figures

Fig. (1)
Fig. (1)
Distribution of MRS findings of brain lesions. (A higher resolution / colour version of this figure is available in the electronic copy of the article).
Fig. (2)
Fig. (2)
Comparison of MRS findings with histopathological analysis in differentiation of malignant and benign brain lesions. (A higher resolution / colour version of this figure is available in the electronic copy of the article).
Case 1
Case 1
MRS image of a 54-years-old female, shows high Cho/Cr, and Cho/NAA peaks with necrotic area reveal high lipid/lactate peak. Overall features are suggestive of neoplastic cyst-astrocytoma. (A higher resolution / colour version of this figure is available in the electronic copy of the article).
Case 2
Case 2
MRS image of a 13-years-old female, shows a significant increase in choline with a reduction of NAA and Cr associated with increase lactate. Features are suggestive of high-grade glioma. (A higher resolution / colour version of this figure is available in the electronic copy of the article).
Case 3
Case 3
MRS image of a 52-years-old female, shows enhancing of the left extra occipital lesion. It was observed fixed elevation of the creatine peak rather than choline with slightly reduced NAA. No critical changes in lactate or lipid peaks, Overall features are consistent with meningioma rather than malignant process. (A higher resolution / colour version of this figure is available in the electronic copy of the article).
Case 4
Case 4
MRS image of a 52-years-old female, shows enhancing of the left extra occipital lesion. It was observed fixed elevation of the creatine peak rather than choline with slightly reduced NAA. No critical changes in lactate or lipid peaks. Overall features are consistent with meningioma rather than malignant process. (A higher resolution / colour version of this figure is available in the electronic copy of the article).
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