BACKGROUND AND PURPOSE:Differentiating between tumors and pseudotumoral lesions by conventional MR imaging may be a challenging question. This study aims to evaluate the potential usefulness and the added value that single-voxel proton MR spectroscopy could provide on this discrimination.

The purpose of this study was to evaluate whether single-voxel (1)H MRS could add useful information to conventional MRI in the preoperative characterisation of the type and grade of brain tumours. MRI and MRS examinations from a prospective cohort of 40 consecutive patients were analysed double blind by radiologists and spectroscopists before the histological diagnosis was known. The spectroscopists had only the MR spectra, whereas the radiologists had both the MR images and basic clinical details (age, sex and presenting symptoms). Then, the radiologists and spectroscopists exchanged their predictions and re-evaluated their initial opinions, taking into account the new evidence. Spectroscopists used four different systems of analysis for (1)H MRS data, and the efficacy of each of these methods was also evaluated. Information extracted from (1)H MRS significantly improved the radiologists' MRI-based characterisation of grade IV tumours (glioblastomas, metastases, medulloblastomas and lymphomas) in the cohort [area under the curve (AUC) in the MRI re-evaluation 0.93 versus AUC in the MRI evaluation 0.85], and also of the less malignant glial tumours (AUC in the MRI re-evaluation 0.93 versus AUC in the MRI evaluation 0.81). One of the MRS analysis systems used, the INTERPRET (International Network for Pattern Recognition of Tumours Using Magnetic Resonance) decision support system, outperformed the others, as well as being better than the MRI evaluation for the characterisation of grade III astrocytomas. Thus, preoperative MRS data improve the radiologists' performance in diagnosing grade IV tumours and, for those of grade II-III, MRS data help them to recognise the glial lineage. Even in cases in which their diagnoses were not improved, the provision of MRS data to the radiologists had no negative influence on their predictions.

In vivo proton MR spectroscopy provides useful information in clinical differentiation between PNETs and common brain tumors in adults.

Our objective was to evaluate the usefulness of proton magnetic resonance spectroscopy ( 1 H MRS) in categorizing brain tumours. In vivo single-voxel 1 H MRS at an echo time of 136 ms was performed in 108 patients with brain neoplasms that included 29 meningiomas (MEN), 15 low-grade astrocytomas (LGA), 12 anaplastic astrocytomas (AA), 25 glioblastomas (GBM) and 27 metastases (MET). Time-domain fitted areas of nine resonances were evaluated in all spectra. Twenty-five additional tumours were prospectively included as independent test set. Differences in at least two resonances were found in all pairwise comparisons of tumour groups except in GBM vs MET. Large lipid resonance at 1.30 ppm was found to be characteristic of GBM and MET, and alanine was characteristic of MEN. Significant differences were found between LGA and AA in choline-containing compounds and total creatine resonances. When implemented in a stepwise algorithm, these findings correctly classified 84% (21 of 25) tumours in the independent test set.Some additional utility was found in glycine/myo-inositol at 3.55 ppm for bilateral differentiation between GBM and MET (9 of 11, 82% correct classification in the test set). 1 H MRS provides useful information to categorize the most common brain tumours that can be implemented in clinical practice with satisfactory results.