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

Abstract

Purpose: Our aim was to determine the diagnostic performance of the combined usage of diffusion-weighted imaging (DWI), magnetic resonance spectroscopy (MRS) and perfusion MR (MRP) imaging for the differential diagnosis of benign and malignant intracranial lesions. Materials and methods: A total of 30 patients with intracranial lesions who were prospectively evaluated with contrast-enhanced magnetic resonance imaging (MRI), DWI, MRS, and MRP were included in this study. The lesions were classified as benign and malignant according to the radiologic findings. All imaging data were compared with the histopathologic results and follow-up of the patients. We used the Pearson chi-square test and Fischer's exact t-test for statistical analysis. Results: For the differentiation of benign and malignant brain lesions, CBV and choline/creatine (Cho/Cr) ratio at short echo time (TE) had the highest sensitivity (87%-88%), Cho/N-acetyl aspartate (NAA) at short TE had the highest specificity (86%). DWI predicted 77% sensitivity, 75% specificity; MRP presented 91% sensitivity, 88% specificity; MRS yielded 77% sensitivity, 63% specificity. The combination of either DWI and MRS, MRP and MRS or DWI+MRS+MRP revealed 100% sensitivity, 100% specificity. Conclusion: For the differentiation of benign and malignant brain lesions, the combination of DWI, MRS, and MRP predicted 100% sensitivity. Invasive procedures like transcranial biopsy were not required via the usage of these advanced MRI techniques.

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

“…Importantly, the diagnostic accuracy of MRS in our study was very high (100%), while Aydın et al . [ 19 ] reported an accuracy of 77% of MRS, and they reported diagnostic accuracy of 100% when MRS combined with diffuse weighted imaging (DWI) or perfusion MR (MRP). The strength of this study that MRS performed diagnostic accuracy of 100% without a combination of DWI or MRP.…”

How SARS-CoV-2 is forcing us to reconsider and reorganize our daily neurosurgical practice

“…This was agreed by all the members of our multidisciplinary neuro-oncology team and discussed with our ethics board. The scientific literature shows that biosignatures and 3-Tesla MRI with spectroscopic analysis of multiple regions of interest can be highly reliable [3][4][5], but no randomized studies have ever compared their safety and effectiveness versus standardof-care surgical biopsy, and no proof of validity for this approach exists. This said, our approach is in keeping with the preliminary experience and suggestions made by colleagues in the United States and Canada [6][7][8].…”