RT Journal Article
SR Electronic
T1 Can Proton MR Spectroscopic and Perfusion Imaging Differentiate Between Neoplastic and Nonneoplastic Brain Lesions in Adults?
JF American Journal of Neuroradiology
JO Am. J. Neuroradiol.
FD American Society of Neuroradiology
SP 366
OP 372
DO 10.3174/ajnr.A0810
VO 29
IS 2
A1 R. Hourani
A1 L.J. Brant
A1 T. Rizk
A1 J.D. Weingart
A1 P.B. Barker
A1 A. Horská
YR 2008
UL http://www.ajnr.org/content/29/2/366.abstract
AB BACKGROUND AND PURPOSE: Noninvasive diagnosis of brain lesions is important for the correct choice of treatment. Our aims were to investigate whether 1) proton MR spectroscopic imaging (1H-MRSI) can aid in differentiating between tumors and nonneoplastic brain lesions, and 2) perfusion MR imaging can improve the classification.MATERIALS AND METHODS: We retrospectively examined 69 adults with untreated primary brain lesions (brain tumors, n = 36; benign lesions, n = 10; stroke, n = 4; demyelination, n = 10; and stable lesions not confirmed on pathologic examination, n = 9). MR imaging and 1H-MRSI were performed at 1.5T before biopsy or treatment. Concentrations of N-acetylaspartate (NAA), creatine (Cr), and choline (Cho) in the lesion were expressed as metabolite ratios and were normalized to the contralateral hemisphere. Dynamic susceptibility contrast-enhanced perfusion MR imaging was performed in a subset of patients (n = 32); relative cerebral blood volume (rCBV) was evaluated. Discriminant function analysis was used to identify variables that can predict inclusion in the neoplastic or nonneoplastic lesion groups. Receiver operator characteristic (ROC) analysis was used to compare the discriminatory capability of 1H-MRSI and perfusion MR imaging.RESULTS: The discriminant function analysis correctly classified 84.2% of original grouped cases (P < .0001), on the basis of NAA/Cho, Chonorm, NAAnorm, and NAA/Cr ratios. MRSI and perfusion MR imaging had similar discriminatory capabilities in differentiating tumors from nonneoplastic lesions. With cutoff points of NAA/Cho ≤0.61 and rCBV ≥1.50 (corresponding to diagnosis of the tumors), a sensitivity of 72.2% and specificity of 91.7% in differentiating tumors from nonneoplastic lesions were achieved.CONCLUSION: These results suggest a promising role for 1H-MRSI and perfusion MR imaging in the distinction between brain tumors and nonneoplastic lesions in adults.