Role Of Magnetic Resonance Spectroscopy Research Articles

The Role of Magnetic Resonance Spectroscopy, Magnetic Resonance Perfusion and Positron Emission Tomography-Computed Tomography in Post-Radiotherapy Evaluation of Gliomas to Detect Recurrence

Abstract Background and Aim: In this article, the findings of magnetic resonance spectroscopy (MRS), magnetic resonance (MR) perfusion, and positron emission tomography (PET) will be compared and finally correlated with the histopathological examination in all patients having positive imaging findings. The sensitivity and specificity of MRS, MR perfusion, and PET in diagnosing residual/recurrent glioma would be estimated using the histopathological diagnosis as a gold standard. Materials and Methods: Twenty-nine cases of intracranial glioma that had undergone surgery, followed by adjuvant radiotherapy were enrolled in the study. All 29 patients underwent MRS, MR perfusion, and fluorodeoxyglucose (FDG) PET. Results: The sensitivity of MRS to detect recurrence was found to be 83.3% and specificity was 100%. The positive predictive value (PPV) and negative predictive value (NPV) were 100% and 33.3%, respectively. The diagnostic accuracy of MRS was found to be 84.6%. The sensitivity and specificity of MR perfusion to detect recurrence were 91.7% and 100%, respectively. The diagnostic accuracy of MR perfusion is 92.3%. The NPV of MR perfusion was found to be 50%. The sensitivity of PET scans to detect recurrence was 83.3% and specificity was 100%. The PPV of PET was 100% and the NPV was 33.3%. The diagnostic accuracy of the PET scan was found to be 84.6%. Conclusions: Our study shows that all three modalities are useful, however, MR perfusion study is better than MRS and FDG PET in detecting recurrence. MR contrast with perfusion and spectroscopy and FDG PET scan should be included in the protocol for radiotherapy-treated gliomas to differentiate between radiation necrosis, postradiotherapy gliosis, and recurrent/residual tumor.

The role of MR spectroscopy in the differential diagnosis of anaplastic glioma

The role of biomarkers for detecting tumors has aroused interest in their use for diagnostics as well. Biomarkers can be isolated from biological fluids, such as blood, cerebrospinal fluid, and urine. Apparently, the most promising is the study of blood plasma and serum, which are isolated from whole blood and are the most studied biological resources for the potential detection of molecular markers. This direction includes studies to identify immunological or biochemical biomarkers of the presence of tumors in the cerebrospinal fluid or in the blood of patients. Infrared spectroscopy of plasma and blood serum of patients with tumors is more promising in terms of identifying not only individual mRNAs as markers of gliomas, but also fats, proteins, and carbohydrates. The study of the profile of metabolites in blood plasma by methods of the recently emerged science of "metabolomics" has good prospects. This gives information about the biochemical processes occurring in tumors and provides knowledge for determining the treatment tactics for recurrent growth.

Role of Magnetic Resonance Spectroscopy in Supratentorial Brain Lesions

Aim: To identify the specificity and the sensitivity of MRS in diagnosing supratentorial brain lesions and will help the surgeons to rely on the respective diagnostic modality Method: A cross-sectional study was conducted in the Neurosurgery Department, at Jinnah Postgraduate Medical Center. The patients with conventional MR imaging showing space-occupying lesions which show a malignant diffusion restriction and enhancement were included. The histopathological diagnosis and the metabolites of the brain were detected by MR Spectroscopy were recorded. To find the association of the ratios of the brain metabolites, the chi-square test was used where a p-value of <0.05 was considered significant. The sensitivity and specificity of the MRS were evaluated then. Result: Overall, 112 patients were included in our study. 76(67.9%) patients were male. Headache (34.8%) was found to be the most common symptom. 39(34.8%) patients were diagnosed with Oligodendroglioma on histopathology. The Cho/Cr ratio >2 was found in 70(82.4%) patients diagnosed with neoplastic lesions. In 62(72.9%) patients diagnosed to have a neoplastic lesion on histopathology reported increased lipid peak and 67(78.8%) with the neoplastic lesion showed to have increased Cho/NAA ratio on MRS. The Cho/Cr ratio was found to be significantly associated with the neoplastic lesions with a significant p-value of <0.001. The MRS was determined to be 82.4% sensitive and 70.4% specific in the diagnosis of supratentorial brain lesions. This study will be quite beneficial as it will help surgeons rely on the more accurate method of diagnosing brain lesions and provide an outlook of a non-invasive method to diagnose the lesions. Conclusion: The study concludes that MRS has high diagnostic accuracy in diagnosing neoplastic and inflammatory lesions and is Keywords: Spectroscopy, brain lesions, medical resonance imaging

Role of MR Spectroscopy in Evaluation of Posterior Fossa Tumors in Children

Role of MR Spectroscopy in Evaluation of Posterior Fossa Tumors in Children

Single-Voxel Proton Magnetic Resonance Spectroscopy of the Thalamus in Idiopathic Epileptic Dogs and in Healthy Control Dogs.

The role of magnetic resonance spectroscopy (MRS) in the investigation of brain metabolites in epileptic syndromes in dogs has not been explored systematically to date. The aim of this study was to investigate metabolites in the thalamus in dogs affected by idiopathic epilepsy (IE) with and without antiepileptic drug treatment (AEDT) and to compare them to unaffected controls. Our hypothesis is that similar to humans with generalized epilepsy and loss of consciousness, N-acetyl aspartate (NAA) would be reduced, and glutamate–glutamine (Glx) would be increased in treated and untreated IE in comparison with the control group. In this prospective case–control study, Border Collie (BC) and Greater Swiss Mountain dog (GSMD) were divided into three groups: (1) healthy controls, IE with generalized tonic–clonic seizures with (2) and without (3) AEDT. A total of 41 BC and GSMD were included using 3 Tesla single-voxel proton MRS of the thalamus (PRESS localization, shortest TE, TR = 2000 ms, NSA = 240). After exclusion of 11 dogs, 30 dogs (18 IE and 12 healthy controls) remained available for analysis. Metabolite concentrations were estimated with LCModel using creatine as reference and compared using Kruskal–Wallis and Wilcoxon rank-sum tests. The Kruskal–Wallis test revealed significant differences in the NAA-to-creatine (p = 0.04) and Glx-to-creatine (p = 0.03) ratios between the three groups. The Wilcoxon rank-sum test further showed significant reduction in the NAA/creatine ratio in idiopathic epileptic dogs under AEDT compared to epileptic dogs without AEDT (p = 0.03) and compared to healthy controls (p = 0.03). In opposite to humans, Glx/creatine ratio was significantly reduced in dogs with IE under AEDT compared to epileptic dogs without AEDT (p = 0.03) and controls (p = 0.02). IE without AEDT and healthy controls did not show significant difference, neither in NAA/creatine (p = 0.60), nor in Glx-to-creatine (p = 0.55) ratio. In conclusion, MRS showed changes in dogs with IE and generalized seizures under AEDT, but not in those without AEDT. Based upon these results, MRS can be considered a useful advanced imaging technique for the evaluation of dogs with IE in the clinical and research settings.

Role of Magnetic Resonance Spectroscopy in Differentiating Benign From Malignant Nodules of Thyroid Gland, Using Tissue Diagnosis as Gold Standard

Objective: To analyze the diagnostic accuracy role of Magnetic Resonance Spectroscopy in differentiating benign from malignant nodules of thyroid gland by using tissue diagnosis as a gold standard. Study Design: Co-relational Analytical study. Place and Duration: At Department of Radiology, Children Hospital and Institute of Child Health, Multan from 1st October 2017 to 1st October 2018. Methodology: A total of seventy patients (of both genders) were recruited for this study who clinically presented with palpable thyroid nodule. The patients who had any previous surgery of thyroid, thyroid malignancy (proven by biopsy), claustrophobic and with contraindications to Magnetic Resonance Spectroscopy that is cardiovascular implanted electronic devices were excluded. Magnetic Resonance Spectroscopy was done for Choline Peak and Choline/Creatine ratio to assess thyroid nodule and results were then compared with tissue diagnosis. Results: among total of 70 patients, malignant thyroid nodules diagnosed in 51 (72.85%) and Magnetic Resonance Spectroscopy shows true positive in 96.07% (n=49) patients and with and among them 93.87% (n=46) were found to be true positive while 6.13% were false positive. Among 24 Magnetic Resonance Spectroscopy negative patients, 16 were true negative while 05 were false negative patients (p=0.0001). Overall sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of Magnetic Resonance Spectroscopy in diagnosing malignant thyroid nodule taking tissue diagnosis as gold standard was 93.51%, 84.35%, 95.24%, 79.51% 91.40% respectively. Conclusion: Magnetic Resonance Spectroscopy is an extremely sensitive and noninvasive tool which gives accurate method for diagnosing malignant thyroid nodules. Keywords: Magnetic Resonance Spectroscopy, Thyroid Nodules, Benign, Malignant, Tissue, Diagnosis, Sensitivity

THE ROLE OF MAGNETIC RESONANCE SPECTROSCOPY FOR PROSTATE CANCER DIAGNOSIS

Prostate cancer (PC) is the most common malignancy among men and is the fifth leading cause of cancer-related death in men worldwide. The present study aims to systematically review the ability of magnetic resonance spectroscopy (MRS) to differentiate between benign and malignant prostate lesions. According to the 06-PRISMA guideline, we searched in five English databases, including Scopus, PubMed, Web of Science, EMBASE, and Google Scholar without time limitation for publications related to the role of magnetic resonance spectroscopy for prostate cancer diagnosis. The searched words and terms were: “prostate cancer”, “prostatitis”, “magnetic resonance spectroscopy”, “benign prostate hyperplasia”, “malignant prostate hyperplasia”, “comparison”. Totally 1927 papers were identified by database searching. Out of these papers, 261 papers were discarded because of duplication. Of the remaining 1666 papers, 1604 papers were discarded because of the inadequate information and the ones in which the abstract was submitted in congresses as preceding papers, conferences, and editorials without full text. Out of the remaining 62 papers which were studied for eligibility, 52 papers were removed for a number of reasons including inconsistency between methods with results, incorrect interpretation of the results, poor methodology, etc. Finally, 10 papers were included in this present study. In general, based on the results of the review of articles, MRS has optimal sensitivity, specificity and accuracy in diagnosing prostate cancer and differentiating it from benign prostate hyperplasia in comparison with other diagnostic and pathological methods. Due to the small number of studies related to the sensitivity and specificity of MRS, further checking was not possible to confirm these results. Therefore, further studies in this regard are recommended.

Role of magnetic resonance spectroscopy in the evaluation of prostatic tumors.

Role of magnetic resonance spectroscopy in the evaluation of prostatic tumors.

Role of magnetic resonance spectroscopy in differential diagnosis of solitary pulmonary lesions.

The aim of our study was to evaluate the availability of magnetic resonance spectroscopy (MRS) for the differentiation of benign or malignant pulmonary nodules and masses. A total of 59 patients (45 male, 14 female) with pulmonary nodules and masses were included in this prospective study. MRS was applied to the pulmonary lesions of the patients and choline levels were determined. Afterwards CT-guided percutaneous needle biopsy was performed. According to the biopsy results, pulmonary lesions were benign in 25 patients and malignant in 34 patients. Choline levels were significantly higher in malignant lesions compared with benign lesions (p < 0.001). When the other conditions were kept constant, the probability of malignancy significantly increased by 17.38-fold (95% CI, 3.78-79.93) in those with choline levels >1.65 µmol/g compared to those with choline levels ≤1.65 µmol/g (p < 0.001). MRS is a noninvasive method that can be used in the differential diagnosis of pulmonary nodules and masses.

Magnetic resonance imaging and spectroscopy in evaluation of hypoxic ischemic encephalopathy in pediatric age group

BackgroundHypoxic ischemic encephalopathy is a major cause of pediatric mortality and morbidity, with possible long-term neurologic sequel, such as cerebral palsy. With improvements in care of at-risk neonates, more children survive. This makes it increasingly important to assess, soon after birth, the prognosis of children with hypoxic-ischemic encephalopathy. The aim of the study was to assess the additive role of magnetic resonance spectroscopy over conventional MRI in diagnosis and early prediction of pathological motor development in neonates with hypoxic ischemic encephalopathy.ResultsMRS ratios showed significant difference between unfavorable and normal outcome infants. MRS ratios as Lac/Cr, NAA/Cr and NAA/Cho within basal ganglia, thalamus and white matter can significantly differentiate between patients with normal and pathological outcome at 1 year.Lac/Cr positively correlates with the severity of HIE. Both NAA/Cr and NAA/Cho negatively correlate with the severity of the disease. Ratios cutoff values as Lac/Cr above 0.38 and 0.42 in basal ganglia and white matter, respectively, NAA/Cr below 0.9 and 0.8 in basal ganglia and occipital white matter, respectively, and NAA/Cho below 0.29 and 0.31 in basal ganglia and frontal white matter, respectively, were significantly predictive of pathological outcome.ConclusionHigh Lac/Cr, low NAA/Cr and low NAA/Cho ratios within examined regions of the brain including deep grey matter nuclei as well as white matter are associated with an adverse outcome in infants with perinatal asphyxia. MRS is an accurate quantitative MR biomarker within the neonatal period for prediction of neurodevelopmental outcome after perinatal HIE. MRS may be useful in early clinical management decisions, and counseling parents thereby ensuring appropriate early intervention and rehabilitation.

The role of magnetic resonance spectroscopy in differentiation of neoplastic from non-neoplastic pediatric intracerebral brain lesions

Background Pediatric brain tumors are considered a significant health problem and present several imaging challenges. The role of imaging is no longer limited to merely providing anatomical details. In this research, we explained the role of magnetic resonance spectroscopy (MRS) in the differentiation of neoplastic from non-neoplastic intracerebral brain lesions in pediatric patients. The aim was to assess the role of MRS in pediatric brain tumors by discrimination between tumors and tumor-like lesions, differentiation between primary and secondary neoplasms, differentiation between high-grade and low-grade tumors, and determination of tumor extension. Patients and methods A total of 30 pediatric patients with cerebral lesions were examined by MRS. Choline (Cho), creatine (cr), N-acetylaspartate (NAA), and lipid-lactate peaks were evaluated. Of the 30 patients, 26 underwent stereotactic biopsy. Histopathological results were compared with the MRS results. Results Diagnostic accuracy of spectroscopic data for prediction of neoplastic lesions in the current study was assessed. Regarding Cho/NAA, a cutoff point greater than 2 had 88% sensitivity and 75% specificity for prediction of neoplastic lesions, with areas under the curve (AUC) of 0.91 (P = 0.01). Regarding Cho/Cr, a cutoff point greater than 1.86 had 85% sensitivity and 75% specificity for prediction of neoplastic lesions, with AUC of 0.85 (P = 0.02). Regarding Cho/NAA+Cr, a cutoff point greater than 0.8 had 88% sensitivity and 100% specificity for prediction of neoplastic lesions, with AUC of 0.91 (P = 0.009). Conclusion MRS can potentially overcome the limitations of sampling errors with histopathologic grading of the tumor for determining the most optimal therapy regimen and regularity and aggressiveness of postoperative follow-up and treatment.

Role of MR Spectroscopy in differentiating benign from malignant ovarian tumors.

Background: Ovarian cancer stands as a greatly dangerous gynecological malignancy with elevated mortality rate. Imaging plays a pivotal role in identification and planning of treatment of accidentally detected ovarian lesions, as earlier diagnosis of ovarian malignancy has strong relation with good prognosis. Objectives: This study goal is assessment of the effectiveness of proton magnetic resonance spectroscopy to discriminate malignancy & benign ovarian neoplasms. Patients & Method: Twenty cases with histopathologically determined complex and solid ovarian tumors (10 benign ,8 malignant and 2 borderline) had traditional MRI and magnetic resonance spectroscopy. The integrals of the peak of creatine, choline, lipid and (NAA) N-acetyl aspartate evaluated. The choline to creatine, lipid to creatine and NAA to Creatine ratios had been detected and then compared among the groups of malignant and benign neoplasms. Results: Our study showed mean of choline to creatine ratio was 4.29 ±1.7 in benign tumors in contrast to 8.06±1.4 in malignant ones, with significant differences in statics (PV of 0.000). There have been no significant statics differences of the malignancy or the benign neoplasms as regard NAA to creatine (PV of 0.12) and lipid to creatine ratio (PV of 0.19). An edge of 4.29 of choline to creatine for characterizing benign and malignant tumors had 91.7% sensitivity, 100% specificity and 95% accuracy. Conclusion: This experimental research reached that proton magnetic resonance spectroscopy is different in malignancy and in benign complex and solid ovarian neoplasms and that choline to creatine ratio will help to differ malignant and benign ovarian neoplasms.

Abstract PS1-38: Role of MR spectroscopy in evaluation of axilla in breast cancer

Abstract The role of surgery for women with breast cancer presenting with clinically negative axilla is being questioned. Trials are underway to evaluate axillary ultrasound (AUS) for non-invasive evaluation of axilla instead of sentinel node biopsy. However, AUS has a sensitivity of 50-59%. Thus, there is a need for non-invasive test to complement AUS. MR Spectoroscopy (MRS) identifies metabolites, viz. glycerophosphocholine (GPC), phosphocholine (PC), threonine (Thr), lactate (Lac), Choline (Cho) etc that are associated with presence of metastasis in axillary lymph nodes (LN) . Biochemical changes in tumor infiltrated LNs occur earlier than morphological changes and MRS can detect these chemical changes, it can be a useful investigation in evaluation of axilla. Aim: To evaluate the role of MR Spectroscopy (MRS) in identifying biochemical changes in axillary lymph nodes in breast cancer and correlate the findings with Histopathology (HP) to predict presence of metastasis.Methods: Axillary lymph nodes were obtained from 59 patients with early breast cancer with clinically negative axilla who underwent surgery. Each LN was bisected into two equal halves. One half of LN was snap frozen in liquid nitrogen (-196°C) and then stored at −80°C until perchloric acid extraction was carried out. Other half of LN was subjected to HP evaluation with standard Eosin and Hematoxylin staining . METHOD OF MR Spectroscopy: Water-soluble metabolites from the tissue samples were extracted using PCA extraction procedure (Seenu et al Magn Reson Imaging 2005 doi: 10.1016/j.mri.2005.10.004). Proton (1H) NMR spectroscopy of specimen was performed. Concentrations of GPC, PC, Thr, Lac, Cho and other metabolites were determined by comparing the integrated intensity of isolated resonances of the compounds of interest with that of the TSP signal, correcting for the number of contributing protons and with the tissue weight . Intensity ratio for metabolites, GPC, PC and Thr (GPC+PC/Thr) was also determined.Statistical Analyses: Levels of concentrations of various metabolites were compared between involved and non-involved lymph nodes using Wilcoxon rank sum test. Diagnostic indices of MRS were assessed in terms of sensitivity, specificity, positive predictive value, negative predictive value, likelihood ratios and overall accuracy taking final histopathology as ‘gold standard’ with 95% confidence intervals.Results: Mean concentrations of GPC, PC and Thr were significantly increased in involved as compared to non-involved node (table 1). Cho and Lac were not significantly increased. A cut-off value of 0.80 for the GPC-PC/Thr ratio was chosen to obtain a maximum accuracy of 89% based on previous study. MRS accurately predicted metastasis in 21 of the 24 patients who had LN metastasis on HP. Out of 35 patients with no LN metastasis, MRS correlated accurately with HP in 30 of them. Sensitivity, specificity, PPV, NPV and overall accuracy for MRS in detecting LN metastasis were 87.5%; 88%; 80.7%; 90.9%; and 86.4% respectively. Likelihood ratio for positive test and negative test for MRS to detect LN metastasis were 6.1 and 0.14 respectively.Conclusion: MRS can accurately predict presence of metastasis in axillary lymph nodes in vitro. In vivo studies are essential to corroborate these findings. Mean concentrations of metabolites in axillary lymph nodesInvolvedNon involvedP valueGPC0.5923(SD=0.5726)0.3648(SD=0.6774)0.02PC0.7347(SD=0.9466)0.5286(SD=1.1111)0.03Cho0.6930(SD=0.6756)0.8435(SD=0.5030)0.21Thr2.9656(SD=2.2397)1.1674(SD=1.2274)0.02Lac4.5515(SD=2.3271)3.2907(SD=1.3296)0.31 Citation Format: Srineil Vuthaluru, Anurag Srivastava. Role of MR spectroscopy in evaluation of axilla in breast cancer [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS1-38.

The Role Of Magnetic Resonance Spectroscopy in Diagnosis of Multiple Sclerosis .

This study aims at emphasizing the role of MRS in management of post therapeutic response of different stages of the disease of multiple sclerosisBackground : Multiple Sclerosis is a chronic inflammatory, and degenerative autoimmune disorder of the CNS that is characterized by unpredictable clinical relapses and remissions and by progression of disability over time. MRS has the ability to characterize the chemical pathology of brain, as well as regions of the brain that are not associated with structural abnormalities on conventional MRI. So it can help to define the natural history of the disease process and it can help in monitoring metabolic responses to therapy Patients and Methods : A study, included 40 patients who presented with clinically diagnosed multiple sclerosis followed by conventional MRI and referred for further assessment by MR spectroscopy study .Results : The age of included patients ranged from 18 to 45 years with a mean age of 34.67±8.23 years. 60% of the patients were females and 40% of them were males, the sensitivity, specificity and positive predictive value of H-MRS in the diagnosis of MS were 94.4%, 76.2%, 71.5% respectively compared to 87.3%, 69.2%, and 65.8% in case of c-MRI.Conclusion Adding MR spectroscopy to conventional MRI increases the specificity and accuracy of MRI study in diagnosis and follow up of therapeutic response of Multiple sclerosis

The Role of Magnetic Resonance Spectroscopy in Diagnosis of Multiple Sclerosis

The Role of Magnetic Resonance Spectroscopy in Diagnosis of Multiple Sclerosis

Role of magnetic resonance spectroscopy in adequately differentiating neoplastic from non-noplastic and low-grade from high-grade lesions in brain masses

Objective: The aim of this study was to provide objective data on the clinical utility of MRS in difference diagnosis of brain lesion and also to provide metabolite ratios neoplastic from non-neoplastic lesion and low-grade from high-grade neoplasms. Method: A prospective study conducted at Sri Aurobindo Institute of Medical Sciences and PG Institute, Indore and Department of Radiology after approval from the ethical and research committee. The duration of this study was June 2018 to July 2020. A total of 102 patients (age range 21-60 years) Who were found to have cerebral mass lesion by computed tomography (CT) and convention MRI and from whom high quality MRS imaging data were obtained, were prospectively assessed and included in this study.Result: The mean age was 53.5±3.15 (range 28-70 years). Majority of the patients in the study were males forming 70 (68.6%) and females 32 (31.3%). Various spectroscopy ratios like Cho/Cr, Cho/NAA, Cho+Cr/NAA, NAA/Cr were calculated with the help of MRS. Conclusion: MRS gives information about the biochemical changes in tissues, which appear earlier than the structural changes, and so, in recent times, MRS has been used as a noninvasive method for the diagnosis and grading of brain tumors. All neoplastic lesion showed increase Cho and decreased NAA and this was more prominent in high-grade neoplasms. While we did not detect any LL peak in all 27 low-grade neoplasms, but 60 high-grade neoplasms showed an LL peak.

The impact of magnetic resonance imaging spectroscopy parameters on differentiating between paediatric medulloblastoma and ependymoma.

IntroductionThe distinction of medulloblastomas and ependymomas plays an important role in the care plans and prognosis of children. We aimed to investigate the role of magnetic resonance spectroscopy (MRS) in the differentiation between medulloblastomas and ependymomas in children.Materials and methodsThe institutional review board approved this prospective study. The brain magnetic resonance imaging protocol including axial multivoxel spectroscopy with a TE of 144 ms was assessed in 49 patients, who were divided into 2 groups: 40 patients with medulloblastomas and 9 patients with ependymomas. Receiver operating characteristic (ROC) curve analysis and the Youden index were utilized to determine the best cut-off, sensitivity, specificity, and area under the curve (AUC) values of the independent spectroscopy parameters.ResultsThe choline level (Cho) and the choline/creatine (Cho/Cr) and choline/N-acetyl aspartate (Cho/NAA) ratios of medulloblastomas were significantly higher than those of ependymomas (p < 0.05). A Cho/NAA cut-off value of 1.24 to predict the diagnosis of medulloblastoma yielded the highest AUC and sensitivity of 80.3% and 97.5%, respectively, while a Cho cut-off value of 4.64 produced the highest specificity value of 88.9%.ConclusionsOur findings suggest that Cho and Cho/NAA derived from MRS could serve as differential factors between paediatric medulloblastomas and ependymomas. Among those, a Cho/NAA cut-off value of 1.24 to predict the diagnosis of medulloblastoma generated the highest accuracy.

Role of Magnetic Resonance Spectroscopy in Evaluation of Cerebral Metabolic Status Before and After Carotid Endarterectomy/Thromboendarterectomy and Carotid Artery Stenting in Patients with Asymptomatic Critical Internal Carotid Artery Stenosis.

BackgroundThe relative efficacy of carotid endarterectomy (CEA)/thromboendarterectomy (TEA) and carotid artery stenting (CAS) already has been compared in randomized controlled trials and a meta-analysis, but only limited data exist describing the status of cerebral metabolism before and after these interventions.The aim of the present study was to compare metabolic changes before and after treatment of carotid stenosis and assess their potential clinical implications.Material/MethodsPatients with asymptomatic unilateral critical internal CAS were imaged with proton 3T magnetic resonance spectroscopy (H-MRS) because the technique is more sensitive than regular magnetic resonance imaging for detection of the early signs of ischemic events. Abnormal metabolite ratios detected with H-MRS may precede actual morphological changes associated with hypoperfusion as well as reperfusion changes. Ipsilateral and contralateral middle cerebral artery vascular territories were both evaluated before and after vascular intervention. H-MRS was performed within 24 h before and after surgery. Correlations in the metabolic data from H-MRS for N-acetylaspartic acid (NAA)+N-acetylaspartylglutamate, creatinine (Cr)+phosphocreatinine, and phosphocholine+glycerophosphocholine (Cho) were sought.ResultsH-MRS voxels from 11 subjects were analyzed. Values for dCho/CrI, dCho/CrC and Cho/Naal (P<0.001) were significantly higher ipsilaterally than contralaterally. Ratios for dNaa/ChoC and Cho/NaaC were significantly higher on the non-operated side (P<0.001).ConclusionsH-MRS may be helpful for assessment of patients with CAS, particularly because unlike other modalities, it reveals postoperative changes in metabolic brain status. Initial results indicate the important role of perioperative neuroprotective treatment.

Role of Magnetic Resonance Spectroscopy in Differentiating Neoplastic From Non- Neoplastic Ring Enhancing Brain Lesions Taking Surgical Findings as Gold Standard

Objective: To evaluate the diagnostic accuracy of Magnetic Resonance spectroscopy (MRS) in distinguishing neoplastic from non-neoplastic ring enhancing brain lesions taking histopathological findings as gold standard. Study Design and Setting: The cross sectional study was conducted at Radiology department of Jinnah Postgraduate Medical Centre. Methodology: Total 102 patients with ring enhancing lesions detected on MRI brain contrast studies were selected for this study. Cases were referred from Outpatient Department of Neurology Clinics who were suspected of having space occupying lesions in brain. Full history, clinical examination and laboratory investigations (Complete Blood Count and ESR) were carried out. The patients having claustrophobia, metallic implants, cardiac pacemaker and having metallic foreign body in situ were excluded from the study. Informed consent was taken from the research and MRS was performed. On MRS, lesion was categorized and final diagnosis was taken based on histopathology results. All the information was recorded into predesigned proforma. Patients Data was scrutinized by using Statistical Package for Social Sciences (SPSS 21.0). Mean + SD was calculated for age, gender, duration of symptoms and size of the lesion. Results: The average age of the patients was 35.45±10.36 years. Sensitivity, specificity, PPV, NPV and accuracy of MRS was 87.5%, 93.3%, 95.5%, 89.7% and 92.1% respectively. Conclusion: Magnetic resonance spectroscopy can be effective in discerning neoplastic from non-neoplastic ring enhancing cerebral lesions, thus avoiding an invasive procedure like brain biopsy

The Privilege of Proton Magnetic Resonance Spectroscopy in Evaluating Ovarian Tumors

Abstract Background Exclusion of malignancy in ovarian mass is of paramount importance. It is the most crucial step after identification of a mass and it has a profound effect on the patient's management. So, a reliable method with which to differentiate a benign from a malignant ovarian mass would provide a basis for optimal preoperative planning and may also reduce the number of unnecessary laparotomies for patients undergoing treatment for benign disease. Objective The aim of our study is to highlight the role of magnetic resonance spectroscopy as a non-invasive technique which may effectively assist in differentiating benign from malignant ovarian masses. Patients and Methods This study included 20 patients with adnexal masses as suggested by preliminary pelvic ultrasound examination. referred from the Gynecology Department to the Radiology Department at Ain shams university hospitals. nine were benign, two were borderline, and six were malignant tumors and 3 were hemorrhagic cyst. Endometriosis, tubo-ovarian abscess. Results Our study revealed sharp choline peak in some benign as well as some malignant cases and so Cho peak could not help in the differential diagnosis between benign and malignant tumors, creatine, lipid and NAA were detected in both benign and malignant tumors, also Choline/Creatine Ratio fairly can differentiate between benign and malignant tumors with cut off point = 3.750 at sensitivity = 75.0% &amp; specificity = 100.0% . Conclusion Our study had some factors that affect the results. First, the sample size were not enough to achieve a good results, second, diversity of samples and the complicated tumor histopathologic and morphologic features.