Qualitative 3-T Proton MR Spectroscopy for the Characterization of Musculoskeletal Neoplasms: Update on Diagnostic Performance and Indications

Abstract

Qualitative 3-T H-MRS cannot be used to characterize bone tumors. This technique has good sensitivity but poor specificity for the characterization of soft-tissue lesions.

Magnetic resonance imaging biomarkers in musculoskeletal soft tissue tumors: Review of conventional features and focus on nonmorphologic imaging

“…MRS is a technique that is used to noninvasively detect and distinguish metabolite activity in a tissue of interest, such as a soft tissue tumor, based on the intrinsic resonant frequencies of various metabolites, and analyze its biochemical composition . MRS enables the detection of metabolic markers of malignancy, including the trimethyl aluminium (TMA) compounds, which present as a composite spectral resonance consisting of free choline, phosphocholine, and glycerophosphocholine; TMA is typically elevated in malignancies, including malignant soft tissue tumors.…”

MRI biomarkers in osseous tumors

“…Most previous studies, although including some soft‐tissue tumors, have demonstrated a high tendency for choline peaks to be present in malignant osseous tumors (Fig. ).…”

“…A choline peak tends to be found in GCT with aggressive radiographic features like cortical breaches and associated soft‐tissue masses . Some malignant osseous tumors can fail to show a choline peak . Slow‐growing low‐grade chondrosarcoma is representative; in one report only one of six cases (16.7%) had a choline peak (Fig.…”

“…Some malignant osseous tumors can fail to show a choline peak . Slow‐growing low‐grade chondrosarcoma is representative; in one report only one of six cases (16.7%) had a choline peak (Fig. ).…”

“…An analysis of multivoxel MRS by Fayad et al included only osseous tumors and showed significantly different peak choline SNRs in malignant bone tumors (9.8 ± 5.1) compared with nonmalignant tissue (2.7 ± 1.4) . Essentially, the lesion was likely to be benign if there was no detectable choline, because of its high negative predictive value, but GCT is an example of benign tumors that can show elevated choline levels . These levels can be explained by the tumor's invasive biological behavior.…”