Proton MR Spectroscopy Improves Discrimination between Tumor and Pseudotumoral Lesion in Solid Brain Masses

Abstract

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 value of proton mr-spectroscopy in the differentiation of brain tumours from non-neoplastic brain lesions

“…NAA/Cr ratio more than 2 was presented as non-malignant (p < 0.05) and elevated NAA/Cr ratio was highly specific for the demyelinating diseases (2,4,7,17). In our experience; NAA/Cr ratio was the highest in demyelinating group and the lowest in brain masses.…”

“…The primary results of our study presented that MR-Spectroscopy had a good sensitivity and specificity among the non-neoplastic brain ders and differentiation of them from the brain tumours based on the NAA/Cr, Cho/ NAA ratios (1,2,4,7,10). NAA/Cr ratio more than 2 was presented as non-malignant (p < 0.05) and elevated NAA/Cr ratio was highly specific for the demyelinating diseases (2,4,7,17).…”

“…For GBM group, the Cho peak was extremely high. The second best discriminator between low-grade glial tumours and malignant gliomas was the amount of lipids while changes of Cr and NAA peaks were less helpful for the analysis of potential malignancy of cerebral tumours (2)(3)(4)12). In addition to high-grade gliomas, metastases were also assumed to have extremely increased Cho, significantly reduced NAA and Cr (2-4, 9, 15).…”

“…Lip was seen in all brain masses except for the low-grade gliomas and might be the dominant metabolite in the high-grade glial tumour group, was also consistent in the ischemic lesions. According to Lac and Lip peaks by using chisquare test; There was a significant provide additional metabolic information to improve pre-surgical diagnosis, disease extension and direct anatomical replacement of surgical biopsy if needed (2,4,10). MRSI can also help to identify the tumour type and grade, grading of brain tumour and histopathologic classification of brain lesions which has important also provides wider anatomical coverage and better spatial resolution, for the assessment of lesion heterogeneity (1, 2, 7, 10).…”

Utility of Proton MR Spectroscopy for Differentiating Typical and Atypical Primary Central Nervous System Lymphomas from Tumefactive Demyelinating Lesions

“…1 H-MR spectroscopy can provide noninvasive biochemical information regarding in vivo tissue. Some authors have suggested that 1 H-MR spectroscopy is helpful for discriminating tumors and pseudotumors, 11,12 whereas others argue that it may not be so, because there is some overlap of the metabolites. 13,14 …”