High-grade glioma and solitary metastasis: differentiation by spectroscopy and advanced magnetic resonance techniques

Abstract

Background The differentiation by means of magnetic resonance between high-grade gliomas and intracranial solitary single metastasis is of the utmost importance since they condition both surgical and complementary treatment. Results Retrospective study that analyzes the parameters of advanced magnetic resonance imaging: spectroscopy, diffusion and perfusion, specifically focused on the differences in the coefficients of the metabolites Cho/Cr, Cho/NAA and NAA/Cr in peritumoral edema between high-grade gliomas and metastases. The data have been statistically analyzed using ROC (receiver operating characteristic) curves, and cutoff values were obtained. A total of 79 patients with histologically analyzed tumors were analyzed: 49 high-grade gliomas (40 multiform glioblastomas and 9 anaplastic astrocytomas) and 30 metastases. A statistically significant mean difference was obtained in the three metabolite ratios. The area under the curve for the Cho/NAA ratio was 0.958 (CI: 0.903–1), for Cho/Cr 0.922 (CI: 0.859–0.985) and for NAA/Cr 0.163 (CI: 0.068–0.258; p < 0.001). The cutoff values were 1.115 for Cho/NAA (sensitivity 93.87%, specificity 93.33%, global precision 93.67%); 1.18 for the Cho/Cr ratio (sensitivity 89.79%, specificity 93.33% and precision 91.13%) and 1.155 for the NAA/Cr ratio (sensitivity 67.34%, specificity 93.33%, global precision 44.30%). Conclusion The results of the study support the premise that spectroscopy at the level of peritumoral edema is able to differentiate between high-grade gliomas and metastases by showing tumor infiltration in peritumoral edema.

The role of 3-Tesla magnetic resonance perfusion and spectroscopy in distinguishing glioblastoma from solitary brain metastasis

“…We simultaneously calculated the average value of the ratio of Cho to Cr in the tumor region (tCho/Cre) and peritumor area (pCho/Cre) of the GBM group and the SBM group; the results showed that the GBM group had higher tCho/Cre and pCho/Cre ratios than the SBM group. This result is similar to the findings of Arévalo-Sáenz [ 28 ] and Server et al . [ 29 ]…”

“…The cutoff of 1.115 for pCho/NAA in Arévalo-Sáenz’s study had higher sensitivity and specificity (93.87% and 93.33%, respectively). [ 28 ] In addition, the pCho/NAA cutoff of 1.10 in Tsougos et al .’s study had lower sensitivity (78%) but higher specificity (93%) than that in our study. [ 26 ]…”