title: Proton MR spectroscopy and preoperative diagnostic accuracy: an evaluation of intracranial mass lesions characterized by stereotactic biopsy findings.
abstract: OBJECTIVE
  MR imaging has made it easier to distinguish among the different types of intracranial mass lesions. Nevertheless, it is sometimes impossible to base a diagnosis solely on clinical and neuroradiologic findings, and, in these cases, biopsy must be performed. The purpose of this study was to evaluate the hypothesis that proton MR spectroscopy is able to improve preoperative diagnostic accuracy in cases of intracranial tumors and may therefore obviate stereotactic biopsy.
  
  
  METHODS
  Twenty-six patients with intracranial tumors underwent MR imaging, proton MR spectroscopy, and stereotactic biopsy. MR spectroscopic findings were evaluated for the distribution pattern of pathologic spectra (NAA/Cho ratio < 1) across the lesion and neighboring tissue, for signal ratios in different tumor types, and for their potential to improve preoperative diagnostic accuracy.
  
  
  RESULTS
  Gliomas and lymphomas showed pathologic spectra outside the area of contrast enhancement while four nonastrocytic circumscribed tumors (meningioma, pineocytoma, metastasis, and germinoma) showed no pathologic spectra outside the region of enhancement. No significant correlation was found between different tumor types and signal ratios. MR spectroscopy improved diagnostic accuracy by differentiating infiltrative from circumscribed tumors; however, diagnostic accuracy was not improved in terms of differentiating the types of infiltrative or circumscribed lesions.
  
  
  CONCLUSIONS
  MR spectroscopy can improve diagnostic accuracy by differentiating circumscribed brain lesions from histologically infiltrating processes, which may be difficult or impossible solely on the basis of clinical or neuroradiologic findings.
authors.affiliation: Department of Radiology, University Hospital, Lund, Sweden.
authors.forename: I M
authors.initials: IM
authors.lastname: Burtscher
authors.forename: G
authors.initials: G
authors.lastname: Skagerberg
authors.forename: B
authors.initials: B
authors.lastname: Geijer
authors.forename: E
authors.initials: E
authors.lastname: Englund
authors.forename: F
authors.initials: F
authors.lastname: Ståhlberg
authors.forename: S
authors.initials: S
authors.lastname: Holtås
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D001932:Brain Neoplasms / Q000175:diagnosis*; D005260:Female; D006801:Humans; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013238:Stereotaxic Techniques