Abstract

1 H-magnetic resonance spectroscopy (MRS) provides noninvasive metabolite profiles with the potential to aid the diagnosis of brain tumours. Prospective studies of diagnostic accuracy and comparisons with conventional MRI are lacking. The aim of the current study was to evaluate, prospectively, the diagnostic accuracy of a previously established classifier for diagnosing the three major childhood cerebellar tumours, and to determine added value compared with standard reporting of conventional imaging. Single-voxel MRS (1.5 T, PRESS, TE 30 ms, TR 1500 ms, spectral resolution 1 Hz/point) was acquired prospectively on 39 consecutive cerebellar tumours with histopathological diagnoses of pilocytic astrocytoma, ependymoma or medulloblastoma. Spectra were analysed with LCModel and predefined quality control criteria were applied, leaving 33 cases in the analysis. The MRS diagnostic classifier was applied to this dataset. A retrospective analysis was subsequently undertaken by three radiologists, blind to histopathological diagnosis, to determine the change in diagnostic certainty when sequentially viewing conventional imaging, MRS and a decision support tool, based on the classifier. The overall classifier accuracy, evaluated prospectively, was 91%. Incorrectly classified cases, two anaplastic ependymomas, and a rare histological variant of medulloblastoma, were not well represented in the original training set. On retrospective review of conventional MRI, MRS and the classifier result, all radiologists showed a significant increase (Wilcoxon signed rank test, p < 0.001) in their certainty of the correct diagnosis, between viewing the conventional imaging and MRS with the decision support system. It was concluded that MRS can aid the noninvasive diagnosis of posterior fossa tumours in children, and that a decision support classifier helps in MRS interpretation.

Highlights

  • Brain tumours are the leading cause of cancer deaths in children,[1] with a range of treatment options and outcomes depending on the tumour type, its location and the patient’s age.[2]

  • The aim of the current study was to evaluate, prospectively, the diagnostic accuracy of a previously established classifier for diagnosing the three major childhood cerebellar tumours, and to determine added value compared with standard reporting of conventional imaging

  • This study prospectively evaluated a previously published diagnostic classifier, based on magnetic resonance spectroscopy (MRS), for the three major cerebellar tumours in children and assessed its potential to add value to conventional radiological reporting

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Summary

Introduction

Brain tumours are the leading cause of cancer deaths in children,[1] with a range of treatment options and outcomes depending on the tumour type, its location and the patient’s age.[2]. Radiological diagnosis of children's brain tumours is routinely made by qualitative interpretation of conventional magnetic resonance images, such as structural T1- and T2-weighted scans.[5,6] focus is shifting to the diagnostic value of advanced, quantitative, MR techniques that provide additional information on tissue properties, such as diffusion-weighted imaging, perfusion imaging and magnetic resonance spectroscopy (MRS).[7,8,9,10]

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