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AJNR - American Journal of Neuroradiology

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American Journal of Neuroradiology 27:1404-1411, August 2006
© 2006 American Society of Neuroradiology

BRAIN

A Systematic Literature Review of Magnetic Resonance Spectroscopy for the Characterization of Brain Tumors

W. Hollingworth^a, L.S. Medina^c, R.E. Lenkinski^d, D.K. Shibata^a, B. Bernal^c, D. Zurakowski^e, B. Comstock^b and J.G. Jarvik^a

^a Departments of Radiology, University of Washington, Seattle, Wash
^b General Internal Medicine, University of Washington, Seattle, Wash
^c Department of Radiology, Miami Children’s Hospital, Miami, Fla
^d Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass
^e Departments of Orthopaedic Surgery and Biostatistics, Harvard Medical School, Boston, Mass

Address correspondence to William Hollingworth, PhD, Department of Radiology, Box 359960, 325 Ninth Ave, Seattle, WA 98104-2499; e-mail: willh{at}u.washington.edu

BACKGROUND AND PURPOSE: Proton MR spectroscopy (¹H-MR spectroscopy) is a potentially useful adjunct to anatomic MR imaging in the characterization of brain tumors. We performed an updated systematic review of the evidence.

METHODS: We employed a standardized search strategy to find studies published during 2002–2004. We reviewed studies measuring diagnostic accuracy and diagnostic, therapeutic, or health impact of ¹H-MR spectroscopy. We abstracted information on study design, ¹H-MR spectroscopy technique, and methodologic quality. We categorized studies into 5 subgroups: (1) metastasis versus high-grade tumor; (2) high-versus low-grade tumor; (3) recurrent tumor versus radiation necrosis; (4) tumor extent; and (5) tumor versus non-neoplastic lesion.

RESULTS: We identified 26 studies evaluating diagnostic performance, diagnostic impact, or therapeutic impact. No articles evaluated patient health or cost-effectiveness. Methodologic quality was mixed; most used histopathology as the reference standard but did not specify blinded interpretation of histopathology. One large study demonstrated a statistically significant increase in diagnostic accuracy for indeterminate brain lesions from 55%, based on MR imaging, to 71% after analysis of ¹H-MR spectroscopy. Several studies have found that ¹H-MR spectroscopy is highly accurate for distinguishing high- and low-grade gliomas, though the incremental benefit of ¹H-MR spectroscopy in this setting is less clear. Interpretation for the other clinical subgroups is limited by the small number of studies.

CONCLUSION: The current evidence on the accuracy of ¹H-MR spectroscopy in the characterization of brain tumors is promising. However, additional high-quality studies are needed to convince policy makers. We present guidelines to help focus future research in this area.

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