title: Combined MRI and MRS improves pre-therapeutic diagnoses of pediatric brain tumors over MRI alone.
abstract: BACKGROUND
  The specific goal of this study was to determine whether the inclusion of MRS had a measureable and positive impact on the accuracy of pre-surgical MR examinations of untreated pediatric brain tumors over that of MRI alone in clinical practice.
  
  
  METHODS
  Final imaging reports of 120 pediatric patients with newly detected brain tumors who underwent combined MRI/MRS examinations were retrospectively reviewed. Final pathology was available in all cases. Group A comprised 60 subjects studied between June 2001 and January 2005, when MRS was considered exploratory and radiologists utilized only conventional MRI to arrive at a diagnosis. For group B, comprising 60 subjects studied between January 2005 and March 2008, the radiologists utilized information from both MRI and MRS. Furthermore, radiologists revisited group A (blind review, time lapse >4 years) to determine whether the additional information from MRS would have altered their interpretation.
  
  
  RESULTS
  Sixty-three percent of patients in group A were diagnosed correctly, whereas in 10% the report was partially correct with the final tumor type mentioned (but not mentioned as most likely tumor), while in 27% of cases the reports were wrong. For group B, the diagnoses were correct in 87%, partially correct in 5%, and incorrect in 8% of the cases, which is a significant improvement (p < 0.005). Re-review of combined MRI and MRS of group A resulted 87% correct, 7% partially correct, and 7% incorrect diagnoses, which is a significant improvement over the original diagnoses (p < 0.05).
  
  
  CONCLUSIONS
  Adding MRS to conventional MRI significantly improved diagnostic accuracy in preoperative pediatric patients with untreated brain tumors.
authors.affiliation: Department of Radiology, Children's Hospital Los Angeles/Keck School of Medicine of USC, MS 81, 4650 Sunset Boulevard, Los Angeles, CA, 90027, USA.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Shiroishi
authors.affiliation: Department of Radiology, Children's Hospital Los Angeles/Keck School of Medicine of USC, MS 81, 4650 Sunset Boulevard, Los Angeles, CA, 90027, USA.|Department of Pediatric Radiology, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Ashok
authors.initials: A
authors.lastname: Panigrahy
authors.affiliation: Department of Radiology, Primary Children's Medical Center, Salt Lake City, UT, USA.
authors.forename: Kevin R
authors.initials: KR
authors.lastname: Moore
authors.affiliation: Department of Radiology, Children's Hospital Los Angeles/Keck School of Medicine of USC, MS 81, 4650 Sunset Boulevard, Los Angeles, CA, 90027, USA.
authors.forename: Marvin D
authors.initials: MD
authors.lastname: Nelson
authors.affiliation: Department of Pathology, Children's Hospital Los Angeles/Keck School of Medicine of USC, Los Angeles, CA, USA.
authors.forename: Floyd H
authors.initials: FH
authors.lastname: Gilles
authors.affiliation: Department of Pathology, All Children's Hospital, St. Petersburg, FL, USA.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Gonzalez-Gomez
authors.affiliation: Department of Radiology, Children's Hospital Los Angeles/Keck School of Medicine of USC, MS 81, 4650 Sunset Boulevard, Los Angeles, CA, 90027, USA. sbluml@chla.usc.edu.|Rudi Schulte Research Institute, Santa Barbara, CA, USA. sbluml@chla.usc.edu.
authors.forename: Stefan
authors.initials: S
authors.lastname: Blüml
mesh_terms: D001932:Brain Neoplasms / Q000175:diagnosis*; D002648:Child; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D009682:Magnetic Resonance Spectroscopy / Q000379:methods*; D008297:Male; D064847:Multimodal Imaging
keywords: Diagnoses; MR imaging; MR spectroscopy; Pediatric brain tumors