The combined role of MR spectroscopy and perfusion imaging in preoperative differentiation between high- and low-grade gliomas

Abstract

Background: Brain tumors are an important health problem. The preoperative classification of gliomas by noninvasive techniques is a significant problem. Relative cerebral blood volume and spectroscopy have the ability to sample the entire lesion non-invasively. The present study aims to evaluate the combined role of dynamic susceptibility perfusion and spectroscopy in the classification of primary brain tumors. The combination of both provides overall diagnostic accuracy (100%). Relative cerebral blood volume in peritumoral region plays an important additional role in this regard. Results: On the basis of histopathology, among 50 patients with brain tumors, high-grade gliomas accounted for 58%, while low-grade gliomas accounted for 42%. The relative cerebral blood volume in the tumor had the best sensitivity, specificity, and accuracy of 96.8%, 95.3%, and 96, respectively. The use of relative cerebral blood volume and choline/N-acetyl Aspartate increased diagnostic accuracy by 100%. Conclusion: The combination of magnetic resonance spectroscopy and perfusion can increase sensitivity and positive predictive value to define the degree of glioma.

Diagnostic algorithm for glioma grading using dynamic susceptibility contrast‑enhanced magnetic resonance perfusion and proton magnetic resonance spectroscopy

“…The study was designed to analyze their DSCE-MRI and 1 H-MRS data from 3T MRI to evaluate the diagnostic value of various parameters (the AUC was utilized to evaluate the capacity of each parameter) and a diagnostic algorithm for grading gliomas was constructed. Glioblastoma accounted for the highest proportion (~28.1%) of all histopathologically confirmed subjects in the present study, consistent with a previous study showing that it is the most common glioma type ( 13 ).…”

“…A study by Law et al ( 6 ) using 1.5T MRI showed that the combination of parameters obtained from 1 H-MRS and DSCE-MRI, including the relative cerebral blood volume-(CBV) ratio of the tumor to normal white matter (NWM)-(rCBV) and tumoral choline (Cho)/creatine (Cr) and Cho/N-acetyl aspartate (NAA) ratios, increased the sensitivity of grading glioma to 93.3% compared to cMRI (72.5%), with a specificity of 60 and 65%, respectively. A study by Hasan et al ( 13 ) indicated that combining Cho/NAA and rCBV increased diagnostic accuracy to 100%. To our knowledge, no previously published study has evaluated and developed an algorithm for grading glioma using DSCE-MRI and 1 H-MRS parameters on a 3T MRI system, which has a crucial role in treatment planning, surgical strategy and predicting patients' overall prognosis and survival.…”

“…To our knowledge, no previously published study has evaluated and developed an algorithm for grading glioma using DSCE-MRI and 1 H-MRS parameters on a 3T MRI system, which has a crucial role in treatment planning, surgical strategy and predicting patients' overall prognosis and survival. Furthermore, even if various studies had been carried out, there was no specific consensus on thresholds, and imaging-based algorithms for the perfusion and spectroscopy parameters were developed to determine cutoffs for glioma classification ( 13 , 14 , 18 ). Therefore, the present study aimed to determine the diagnostic value and establish an imaging-based algorithm for differentiating between HGG and LGG using DSCE-MRI and 1 H-MRS parameters on 3T MRI.…”

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

“…The performance of MRS in the present study showed sensitivity (82.60%), specificity (85.71%), and accuracy (100%) in differentiating neoplastic from non-neoplastic brain lesions using MRS. These results were comparable to the previous studies, which reported sensitivities of (96.8%), specificity (95.3%), and accuracy (96%) [ 17 ]. Another study reported a sensitivity of 93.02%, a specificity of 70%, and diagnostic accuracy of 88.67% for spectroscopy [ 18 ].…”

Magnetic Resonance Spectroscopy in Diagnosis and Follow-Up of Gliomas: State-of-the-Art

“…This is a common diagnostic challenge, even in high-grade tumors. In the case of diagnostic uncertainty, additional information can be obtained with MRS [39,40].…”