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Current Medical Imaging

Author(s): Qurain T. Alshammari*, Mohammed Salih, Moawia Gameraddin, Mohamed Yousef, Bushra Abdelmalik and Omer Loaz

DOI: 10.2174/1573405617666210224112808

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

Page: [904 - 910] Pages: 7

  • * (Excluding Mailing and Handling)

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, accuracy, MRS, Cho/Cr, Cho/NAA ratio, PPV, NPV.

Graphical Abstract

[1]
Sharma V, Prabhash K, Noronha V, Tandon N, Joshi A. A systematic approach to diagnosis of cystic brain lesions. South Asian J Cancer 2013; 2(2): 98-101.
[http://dx.doi.org/10.4103/2278-330X.110509] [PMID: 24455569]
[2]
Seano G, Nia HT, Emblem KE, et al. Solid stress in brain tumours causes neuronal loss and neurological dysfunction and can be reversed by lithium. Nat Biomed Eng 2019; 3(3): 230-45.
[http://dx.doi.org/10.1038/s41551-018-0334-7] [PMID: 30948807]
[3]
Nikmaneshi MR, Firoozabadi B, Mozafari A, Munn LL. A multi-scale model for determining the effects of pathophysiology and metabolic disorders on tumor growth. Sci Rep 2020; 10(1): 3025.
[http://dx.doi.org/10.1038/s41598-020-59658-0] [PMID: 32080250]
[4]
Nandu H, Wen PY, Huang RY. Imaging in neuro-oncology. Ther Adv Neurol Disorder 2018; 11: 1756286418759865.
[http://dx.doi.org/10.1177/1756286418759865] [PMID: 29511385]
[5]
Falk Delgado A, Van Westen D, Nilsson M, et al. Diagnostic value of alternative techniques to gadolinium-based contrast agents in MR neuroimaging-a comprehensive overview. Insights Imaging 2019; 10(1): 84.
[http://dx.doi.org/10.1186/s13244-019-0771-1] [PMID: 31444580]
[6]
Pope WB. Brain metastases: Neuroimaging. Handbook of Clinical Neurology 2018; 149: 89-112.
[7]
Peek AL, Rebbeck T, Puts NA, Watson J, Aguila MR, Leaver AM. Brain GABA and glutamate levels across pain conditions: A systematic literature review and meta-analysis of 1H-MRS studies using the MRS-Q quality assessment tool. Neuroimage 2020; 210: 116532.
[http://dx.doi.org/10.1016/j.neuroimage.2020.116532] [PMID: 31958584]
[8]
Pedrosa de Barros N, Meier R, Pletscher M, et al. Analysis of metabolic abnormalities in high-grade glioma using MRSI and convex NMF. NMR Biomed 2019; 32(8): e4109.
[http://dx.doi.org/10.1002/nbm.4109] [PMID: 31131943]
[9]
Cecil KM. Proton magnetic resonance spectroscopy: Technique for the neuroradiologist. Neuroimaging Clin N Am 2013; 23(3): 381-92.
[http://dx.doi.org/10.1016/j.nic.2012.10.003] [PMID: 23928195]
[10]
Rehman L, Rehman UL, Azmat SK, Hashim AS. Magnetic resonance spectroscopy: Novel non-invasive technique for diagnosing brain tumors. J Coll Physicians Surg Pak 2015; 25(12): 863-6.
[PMID: 26691358]
[11]
Surur A, Cabral JF, Marangoni A, Marchegiani S, Palaciose C, Herrera E, et al. Contributions of magnetic resonance spectroscopy in brain lesions. RAR 2010; 74: 239-49.
[12]
Sherbeny AEE, El-Shafey MH, Biomy SL, Shakal AA, Hefeda MM, Seiam AHR. Diagnostic yield of combined magnetic resonance spectroscopy and diffusion weighted imaging in intracranial neoplasms. Egypt J Radiol Nucl Med 2014; 45: 849-58.
[http://dx.doi.org/10.1016/j.ejrnm.2014.05.001]
[13]
Kousi E, Tsougos I, Tsolaki E, et al. Spectroscopic evaluation of glioma grading at 3T: the combined role of short and long TE. Scientific World J 2012; 2012: 546171.
[http://dx.doi.org/10.1100/2012/546171] [PMID: 22919334]
[14]
Faghihi R, Zeinali-Rafsanjani B, Mosleh-Shirazi MA, et al. Magnetic Resonance Spectroscopy and its Clinical Applications: A Review. J Med Imaging Radiat Sci 2017; 48(3): 233-53.
[http://dx.doi.org/10.1016/j.jmir.2017.06.004] [PMID: 31047406]
[15]
Elshafey R, Hassanein O, Shakal A, Mokbel E. 1H proton MR spectroscopy and diffusion-weighted imaging in discrimination between pyogenic brain abscesses 15 and necrotic brain tumors. Egypt J Radiol Nucl Med 2014; 45: 889-96.
[http://dx.doi.org/10.1016/j.ejrnm.2014.01.010]
[16]
Lai PH, Hsu SS, Ding SW, et al. Proton magnetic resonance spectroscopy and diffusion-weighted imaging in intracranial cystic mass lesions. Surg Neurol 2007; 68(Suppl. 1): S25-36.
[http://dx.doi.org/10.1016/j.surneu.2007.07.080] [PMID: 17963918]
[17]
Hasan AMS, Hasan AK, Megally HI, Khallaf M, Haseib A. The combined role of MR spectroscopy and perfusion imaging in preoperative differentiation between high and low grade gliomas. Egypt J Radiol Nucl Med 2019; 50.
[18]
Alam MS, Sajjad Z, Hafeez S, Akhter W. Magnetic resonance spectroscopy in focal brain lesions. J Pak Med Assoc 2011; 61(6): 540-3.
[PMID: 22204206]
[19]
Aydın ZB, Aydın H, Birgi E, Hekimoğlu B. Diagnostic value of diffusion-weighted magnetic resonance (MR) imaging, MR perfusion, and MR spectroscopy in addition to conventional mr imaging in intracranial space-occupying lesions. Cureus 2019; 11(12): e6409.
[http://dx.doi.org/10.7759/cureus.6409] [PMID: 31970039]