Role of Magnetic Resonance Spectroscopy in Differentiating Neoplastic From Non- Neoplastic Ring Enhancing Brain Lesions Taking Surgical Findings as Gold Standard
DOI:
https://doi.org/10.51985/JBUMDC2019078Keywords:
Brain lesions, Magnetic resonance spectroscopy, Neoplastic, Non-neoplastic, Ring EnhancingAbstract
Objective: To evaluate the diagnostic accuracy of Magnetic Resonance spectroscopy (MRS) in distinguishing neoplastic
from non-neoplastic ring enhancing brain lesions taking histopathological findings as gold standard.
Study Design and Setting: The cross sectional study was conducted at Radiology department of Jinnah Postgraduate
Medical Centre.
Methodology: Total 102 patients with ring enhancing lesions detected on MRI brain contrast studies were selected for this
study. Cases were referred from Outpatient Department of Neurology Clinics who were suspected of having space occupying
lesions in brain. Full history, clinical examination and laboratory investigations (Complete Blood Count and ESR) were
carried out. The patients having claustrophobia, metallic implants, cardiac pacemaker and having metallic foreign body
in situ were excluded from the study. Informed consent was taken from the research and MRS was performed. On MRS,
lesion was categorized and final diagnosis was taken based on histopathology results. All the information was recorded
into predesigned proforma. Patients Data was scrutinized by using Statistical Package for Social Sciences (SPSS 21.0).
Mean + SD was calculated for age, gender, duration of symptoms and size of the lesion.
Results: The average age of the patients was 35.45±10.36 years. Sensitivity, specificity, PPV, NPV and accuracy of MRS
was 87.5%, 93.3%, 95.5%, 89.7% and 92.1% respectively.
Conclusion: Magnetic resonance spectroscopy can be effective in discerning neoplastic from non-neoplastic ring enhancing
cerebral lesions, thus avoiding an invasive procedure like brain biopsy.
References
Rehman L, Rehman UL, Azmat SK, Hashim AS. Magnetic
Resonance Spectroscopy: Novel Non-invasive Technique for
Diagnosing Brain Tumors. J Coll Physicians Surg Pak.
;25(12):863–66.
Alam MS, Sajjad Z, Hafeez S, Akhter W. Magnetic resonance
spectroscopy in focal brain lesions. J Pak Med Assoc
;61:540-3.
Rezvanizadeh A, Firouznia K, Salehi-Sadaghiani M, Mohseni
M, Gharaei D, Ghanaati H, Rad SH, Masoudnia M. The
effects of voxel localization and time of echo on the diagnostic
accuracy of cystic brain tumors in 3 tesla magnetic resonance
spectroscopy. Iran J .Radiol. 2012;9:195–201
Chiang IC, Hsieh TJ, Chiu ML, Liu GC, Kuo YT, Lin WC.
Distinction between pyogenic brain abscess and necrotic brain
tumour using 3-tesla MR spectroscopy, diffusion and perfusion
imaging. Br J Radiol. 2009;82(982):813-20
MRS findings in a patient with juvenile-onset Alexander's
leukodystrophy. Nelson A, Kelley R, Nguyen J, Palacios E,
Neitzschman HR. J La State Med Soc. 2013;165:14–17.
Gupta R, Vastal D, Husain N, Chawla S, Prasad K, Roy R,
et al. Differentiation of tuberculous from pyogenic brain
abscesses with in vivo proton MR spectroscopy and
magnetization transfer MR imaging. AJNR Am J Neuroradiol
; 22: 1503-9.
Möller-Hartmann W, Herminghaus S, Krings T, Marquardt
G, Lanfermann H, Pilatus U et.al. Clinical application of
proton magnetic resonance spectroscopy in the diagnosis of
intracranial mass lesions. Neuroradiology. 2002 ;44(5):371-
Ostrom QT, Gittleman H, Fulop J, Liu M, Blanda R, Kromer
Cet al CBTRUS Statistical Report: Primary Brain and Central
Nervous System Tumors Diagnosed in the United States in
-2012. Neuro Oncol 2015;17 Suppl 4:iv1.
Rakesh KGupta, Jobanputra, Kamlesh J, Yadav, Abhishek.MR
Spectroscopy in Brain Infections.Neuroimaging Clinics of
North America August 2013; 23(3):475-498
Débora Bertholdo, Arvemas Watcharakorn, Mauricio Castillo.
Brain Proton Magnetic Resonance Spectroscopy.
Neuroimaging Clinics of North America. 2013;23(3):359-80.
Chris D, Andrew WB, Susan MN, Michael WM, Nicholas
MB, Mark RD, et al. Pre-operative proton MR spectroscopic
imaging of brain tumors: correlation with histopathologic
analysis of resection specimens. AJNR Am J Neuroradiol
;22:604-12.
Usenius T, Usenius JP, Tenhunen M. Radiation-induced
changes in human brain metabolites as studied by 1H nuclear
magnetic resonance spectroscopy in vivo. Int J Rad Oncol
Biol Phys 1995;33:719-24.
Majós C, Aguilera C, Alonso J, Julià M, Castañer S, Sánchez
JJ, et al. Proton MR spectroscopy improves discrimination
between tumor and pseudotumoral lesion in solid brain masses.
AJNR Am J Neuroradiol 2009; 30:544-51.
Tate AR, Underwood J, Acosta D. Development of a decision
support system for diagnosis and grading of brain tumors
using in vivo magnetic resonance single voxel spectra. NMR
Biomed. 2006;19:411-34.
Crisi G, Orsingher L, Filice S. Lipid and macromolecules
quantitation in differentiating glioblastoma from solitary
metastasis: a short-echo time single-voxel magnetic resonance
spectroscopy study at 3 T. J Comput Assist Tomor. 2013;
:265-71.
Negendank WG, Sauter R, Brown TR. Proton magnetic
resonance spectroscopy in patients with glial tumors: a
multicenter study. J Neurosurg. 1996; 84:449-58.
Surur A, Cabral JF, Marangoni A, Marchegiani S, Palacios
C, Herrera E. Contributions of magnetic resonance
spectroscopy in brain lesions. RAR. 2010;74:239-249.
Hölzer T, Herholz K, Jeske J, Heiss WD. FDG-PET as a
prognostic indicator in radiochemotherapy of glioblastoma.
J Comput Assist Tomogr 1993;17:681-7.
Server A, Josefsen R, Kulle B. Proton magnetic resonance
spectroscopy in the distinction of high-grade cerebral gliomas
from single metastatic brain tumors. Acta Radiol. 2010;51:316-
Naz F, Mirza WA, Hashmani N. Combining Magnetic
Resonance Spectroscopy and Magnetic Resonance Imaging
in Diagnosing Focal Brain Lesions in Children. Cureus
;9(8):e1541.
Alam MS et al. Magnetic Resonance Spectroscopy of
enhancing brain lesions: Analysis of 78 histopathology proven
cases. Journal of Pakistan Medical Association.2014;64(10):
-5.
Alam MS., et al. “Magnetic resonance spectroscopy in focal
brain lesions”. Journal of Pakistan Medical Association 61.6
(2011): 540-543.
Ha DH, Choi S, Oh JY, Yoon SK, Kang MJ, Kim KU.
Application of (31)P MR spectroscopy to the brain tumors.
Korean J Radiol. 2013;14:477-86.
Bulik M, Jancalek R, Vanicek J, Skoch A, Mechl M. Potential
of MR spectroscopy for assessment of glioma grading. Clin
Neurol Neurosurg 2013;115:146-53
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2020 Ameet Jesrani; Marya Hameed; Seema Nayab, Asma Javed, Sehrish Sethar
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Journal of Bahria University Medical & Dental College is an open access journal and is licensed under CC BY-NC 4.0. which permits unrestricted non commercial use, distribution and reproduction in any medium, provided the original work is properly cited. To view a copy of this license, visit https://creativecommons.org/licenses/by-nc/4.0