Diagnostic impact of proton MR-spectroscopy versus image-guided stereotactic biopsy.
BACKGROUND
The aim of this study was to compare the diagnostic accuracy of (1)H MR-spectroscopy versus image-guided stereotactic biopsy.


METHODS
A cohort of 83 consecutive patients with a broad spectrum of brain lesions were examined. Prior to stereotactic biopsy, the patients were subjected to (1)H MR-spectroscopy examination. Diagnostic accuracy of (1)H MR-spectroscopy and image guided stereotactic biopsy was determined for the largest diagnostic subgroups. Each diagnostic procedure was tested for concordance in every subgroup.


RESULTS
The subgroups of patients comprised: low grade glioma, high grade glioma (grades III and IV), lymphoma and metastasis. For the sensitivity of (1)H MR-spectroscopy ranged from 87.7 in high grade glioma to 92.3% in metastasis and for specificity from 93.3% for high grade glioma to 100% in low grade glioma. The highest positive predictive value of 100% was reached in the subgroup of low grade glioma. The highest negative predictive value was reached in lymphoma and metastasis, 100%. The kappa values were highly significant for all comparisons (p<0.001). The co-efficient ranged from 0.68 to 0.84. It was lowest in assessing high grade glioma and highest in lymphoma.


CONCLUSIONS
Compared with each other (1)H MR-spectroscopy and image-guided stereotactic biopsy showed a moderate to good, statistically highly significant concordance. In patients in whom operation is at an increased risk e.g., due to severe medical illness, (1)H MR-spectroscopy as a noninvasive procedure may be sufficient to assess the diagnosis.
Setzer
M
M
Department of Neurosurgery, Institute of Neuroradiology, (Edinger Institute), Johann Wolfgang Goethe-University, Frankfurt am Main, Germany. Matthias.Setzer@kgu.de
Herminghaus
S
S
Marquardt
G
G
Tews
D S
DS
Pilatus
U
U
Seifert
V
V
Zanella
F
F
Lanfermann
H
H
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000473:pathology* / Q000601:surgery; D001932:Brain Neoplasms / Q000473:pathology* / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003937:Diagnosis, Differential; D003951:Diagnostic Errors / Q000517:prevention & control; D005260:Female; D006801:Humans; D009682:Magnetic Resonance Spectroscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D013238:Stereotaxic Techniques / Q000295:instrumentation*; D025321:Surgery, Computer-Assisted / Q000379:methods*