Proton Magnetic Resonance Spectroscopy in Differential Diagnosis of Brain Tumors

The aim of the investigation was to assess the informativity of proton magnetic resonance spectroscopy (PMRS) data in differentiation of brain tumors and nonneoplastic diseases with similar signal characteristics on standard MRI scans, as well as glioma grade determination.

Materials and Methods. We examined 45 patients aged from 25 to 56 years with suspected expansive process of brain using proton magnetic resonance spectroscopy. The study was performed on MRI scanner “Magnetom Symphony 1.5 Т” (Siemens, Germany) using software package Spectroscopy Evaluation. The examination included routine brain investigations (MRI), as well as diffusion weighted images with diffusion factors of b=0, b=500, b=1000 with the following ADC-mapping. To receive graphic spectra and parametrical maps, there was used SE impulse sequence. To assess the grade of gliomas and metabolic changes in peritumoral area we studied peak height of choline, creatine, N-acetyl aspartate and their ratio.

Results. According to histologically confirmed PMRS, 18 from 30 patients with cerebral gliomas were found to have low-grade gliomas (grade II), 12 patients — high-grade gliomas (grade III–IV). The results of the examination indicated high informative value of proton MR spectrometry as an important diagnostic technique in neuro-oncology. The modality is the most valuable and informative in the differentiation of cerebral gliomas, metastatic lesions, lymphomas, as well as in tumor grade determination of gliomas.

1. Hourani R., Brant L.J., Rizk T., Weingart J.D., Barker P.B., Horska A. Can proton MR spectroscopic and perfusion imaging differentiate between neoplastic and nonneoplastic brain lesions in adults? AJNR Am J Neuroradiol 2008 Feb; 29: 366–372.
2. Trufanov G.E., Tyutin L.A. Magnitno-rezonansnaya spektroskopiya [Magnetic resonance spectroscopy]. Saint Petersburg: “ELBI-SPb”; 2008; 239 p.
3. Nail Bulakbasi, Murat Kocaoglu, Fatih Ors, Cem Tayfun, Taner Uçöz. Combination of single-voxel proton MR spectroscopy and apparent diffusion coefficient calculation in the evaluation of common brain tumors. AJNR Am J Neuroradiol 2003 Feb; 23: 225–233.
4. Amit M. Saindane, Soonmee Cha, Meng Law, Xiaonan Xue, Edmond A. Knopp, David Zagzagi. Proton MR spectroscopy of tumefactive demyelinating lesions. AJNR Am J Neuroradiology 2002 Sept; 23: 1378–1386.
5. Ozan Karatağ, Gülden Yenice Karatağ, Ender Uysal, Meltem Can S., Mehmet Ertürk, Muzaffer Başak. Can magnetic resonance spectroscopy adequately differentiate neoplastic from non-neoplastic and low-grade from high grade lesions in brain masses? Marmara Medical Journal 2010; 23(3): 326–338.
6. Majos C., Aguilera C., Alonso J., Julia-Sape M., Castaner S., Sanchez J.J., Samitier A., Leon A., Rovira A., Arus C. Proton MR spectroscopy improves discrimination between tumor and pseudotumoral lesion in solid brain masses. AJNR Am J Neuroradiol 2009 Mar; 30(3): 544–551.
7. Kyousuke Kamada, Martin Müller, Mark Saguer, Oliver Ganslandt, Martin Kaltenhäuser, Helmut Kober, Jürgen Vieth. A combined study of tumor-related brain lesions using MEG and proton MR spectroscopic imaging. Journal of the Neurological Sciences 2001; 186(1): 13–21.
8. Tyutin L.A., Pozdnyakov A.V., Berezhnev S.A., Neronov Yu.A., Stukov L.A. Protonnaya magnitno-rezonansnaya spektroskopiya v diagnostike narusheniy mozgovogo krovoobrashcheniya [Proton magnetic resonance spectroscopy in the diagnosis of cerebrovascular diseases]. Тerra Medica 2000; 4. URL: http: //www.terramedica.spb.ru/4_2000/tyutin.htm (submission date 20.05.2012).
9. Odinak M.M., Trufanov A.G., Tzigan N.V., Fokin V.A., Voznjouk I.A. Magnitno-rezonansnaya spektroskopiya v ostreyshey stadii ishemicheskogo insul’ta [Magnetic resonance spectroscopy in acute ischemic stroke]. Medline.ru 2009; 10. URL: http: //www.medline.ru/public/art/tom10/art011pdf.phtml (submission date 20.05.2012).
10. Law M., Cha S., Knopp E.A., et al. High-grade gliomas and solitary metastases: differentiation by using perfusion and proton spectroscopic MR imaging. Radiology 2002; 222: 715–721.
11. Podoprigora A.E., Pronin I.N., Fadeeva L.M. Protonnaya magnitno-rezonansnaya spektroskopiya v neyrorentgenologii [Proton magnetic resonance spectroscopy in neuroradiology]. Meditsinskaya vizualizatsiya — Medical Imaging 2000; 4: 86–91.

Lobanov I.А., Shakhov B.Е., Medyanik I.А., Fraerman А.P. Proton Magnetic Resonance Spectroscopy in Differential Diagnosis of Brain Tumors. Sovremennye tehnologii v medicine 2013; 5(2): 72