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AJNR - American Journal of=20 Neuroradiology

Published=20 ahead of print on November 30, 2007
doi: 10.3174/ajnr.A0810 =

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American Journal of Neuroradiology = 29:366-372,=20 February 2008
=A9 2008 American=20 Society of Neuroradiology

BRAIN

Can Proton MR Spectroscopic and Perfusion Imaging Differentiate = Between=20 Neoplastic and Nonneoplastic Brain Lesions in=20 Adults?

R. = Hourani^a^,d,=20 L.J. Brant^c, T. Rizk^e,=20 J.D. Weingart^b, P.B.=20 Barker^a^,f and A. = Horsk=E1^a=20

^a Russell H. Morgan Department of = Radiology=20 and Radiological Science, Johns Hopkins Hospital, Baltimore, = Md
^b=20 Department of Neurological Surgery, Johns Hopkins Hospital, Baltimore,=20 Md
^c National Institutes of Health/National Institute on = Aging,=20 Gerontology Research Center, Baltimore, Md
^d Department of = Radiology, American University of Beirut Medical Center, Beirut,=20 Lebanon
^e Department of Neurosurgery, Hotel Dieu Hospital, = Beirut,=20 Lebanon
^f FM Kirby Research Center, Kennedy Krieger = Institute,=20 Baltimore, Md

Please address correspondence to Alena = Horsk=E1, PhD,=20 Russell H. Morgan Department of Radiology and Radiological Science, = Johns=20 Hopkins University, 217 Traylor Bldg, 720 Rutland Ave, Baltimore, MD = 21205.=20 E-mail: ahorska{at}jhmi.edu

BACKGROUND AND PURPOSE: Noninvasive diagnosis of brain = lesions⁼²⁰is important for the correct choice of treatment. Our aims = were⁼²⁰to investigate whether 1) proton MR spectroscopic imaging=20 (¹H-MRSI)can aid in differentiating between = tumors and=20 nonneoplasticbrain lesions, and 2) perfusion MR imaging can = improve=20 the classification.

MATERIALS AND METHODS: We retrospectively examined 69 = adults⁼²⁰with untreated primary brain lesions (brain tumors, n =3D = 36;⁼²⁰benign lesions, n =3D 10; stroke, n =3D 4; = demyelination,=20 n =3D 10;and stable lesions not confirmed on = pathologic=20 examination,n =3D 9). MR imaging and = ¹H-MRSI were=20 performed at 1.5T beforebiopsy or treatment. Concentrations = of=20 N-acetylaspartate (NAA),creatine (Cr), and choline = (Cho) in=20 the lesion were expressedas metabolite ratios and were = normalized to=20 the contralateralhemisphere. Dynamic susceptibility=20 contrast-enhanced perfusionMR imaging was performed in a = subset of=20 patients (n =3D 32); relativecerebral blood volume = (rCBV) was=20 evaluated. Discriminant functionanalysis was used to = identify=20 variables that can predict inclusionin the neoplastic or=20 nonneoplastic lesion groups. Receiver operatorcharacteristic = (ROC)=20 analysis was used to compare the discriminatorycapability of = ¹H-MRSI and perfusion MR imaging.

RESULTS: The discriminant function analysis correctly = classified⁼²⁰84.2% of original grouped cases (P < .0001), on the = basis⁼²⁰of NAA/Cho, Cho_norm, NAA_norm, and NAA/Cr = ratios.=20 MRSI and perfusionMR imaging had similar discriminatory = capabilities=20 in differentiatingtumors from nonneoplastic lesions. With = cutoff=20 points of NAA/Cho $3D≤$ 0.61 and rCBV $3D≥$ 1.50 (corresponding to diagnosis of the tumors),a = sensitivity of 72.2% and specificity of 91.7% in differentiating⁼²⁰tumors from nonneoplastic lesions were achieved.

CONCLUSION: These results suggest a promising role for=20 ¹H-MRSIand perfusion MR imaging in the = distinction=20 between brain tumorsand nonneoplastic lesions in = adults.

Advanced AJNR - American Journal of=20 Neuroradiology

BRAIN

Can Proton MR Spectroscopic and Perfusion Imaging Differentiate = Between=20 Neoplastic and Nonneoplastic Brain Lesions in=20 Adults?

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AJNR - American Journal of=20 Neuroradiology