title: Characterisation of musculoskeletal tumours by multivoxel proton MR spectroscopy.
abstract: OBJECTIVE
  The purpose of this study is to evaluate the role of multi-voxel proton MR spectroscopy in differentiating benign and malignant musculoskeletal tumours in a more objective way and to correlate the MRS data parameters with histopathology.
  
  
  METHODS
  A hospital-based prospective study was carried out comprising 42 patients who underwent MRI examinations from 1 July 2013 to 30 June 2014. After routine sequences, single-slice multi-voxel proton MR spectroscopy was included at TE-135 using the PRESS sequence. The voxel with the maximum choline/Cr ratio was used for analysis of data in 32 patients. The strength of association between the MR spectroscopy findings and the nature of tumour and histopathological grading were assessed.
  
  
  RESULTS
  Of the 42 patients, the MR spectra were not of diagnostic quality in 10. In the remaining 32 patients, 12 (37.5%) had benign and 20 (62.5%) malignant tumours. The mean choline/Cr ratio was 6.97 ± 5.95 (SD) for benign tumours and 25.39 ± 17.72 (SD) for malignant tumours. In our study statistical significance was noted between the choline/Cr ratio and the histological nature of musculoskeletal tumours (p = 0.002) assessed by unpaired t-test. The choline/Cr ratio and histological grading were also found to be significant (p = 0.001) when assessed by one-way ANOVA test.
  
  
  CONCLUSIONS
  Multi-voxel MR spectroscopy showed a higher choline/Cr ratio in malignant musculoskeletal tumours than in benign ones (p = 0.002). The choline/Cr ratio and histological grading of musculoskeletal tumours also showed statistical significance (p = 0.001).
authors.affiliation: Department of Radio-diagnosis, Assam Medical College, Dibrugarh, Assam, India.
authors.forename: Ruchi S
authors.initials: RS
authors.lastname: Patni
authors.affiliation: Department of Radio-diagnosis, Assam Medical College, Dibrugarh, Assam, India. drdeb_rad@yahoo.co.in.|M-Lane, RCC-4, Assam Medical College Campus, Dibrugarh, Assam, 786002, India. drdeb_rad@yahoo.co.in.
authors.forename: Deb K
authors.initials: DK
authors.lastname: Boruah
authors.affiliation: Consultant Radiologist, Airedale General Hospital, West Yorkshire, UK.
authors.forename: Shantiranjan
authors.initials: S
authors.lastname: Sanyal
authors.affiliation: Department of Pathology, NEIGHRMS, Shillong, Meghalaya, India.
authors.forename: Bidyut B
authors.initials: BB
authors.lastname: Gogoi
authors.affiliation: Department of Anesthesiology, Geetanjali Medical College, Udaipur, Rajasthan, India.
authors.forename: Maninder
authors.initials: M
authors.lastname: Patni
authors.affiliation: Department of Pathology, Assam Medical College, Dibrugarh, Assam, India.
authors.forename: Rosy
authors.initials: R
authors.lastname: Khandelia
authors.affiliation: Department of Radio-diagnosis, Assam Medical College, Dibrugarh, Assam, India.
authors.forename: Nripen
authors.initials: N
authors.lastname: Gogoi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001859:Bone Neoplasms / Q000000981:diagnostic imaging*; D002648:Child; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019042:Muscle Neoplasms / Q000000981:diagnostic imaging*; D009141:Musculoskeletal System / Q000000981:diagnostic imaging*; D011446:Prospective Studies; D066244:Proton Magnetic Resonance Spectroscopy / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D055815:Young Adult
keywords: Choline/creatine ratio; Histopathology (HPE); Magnetic resonance imaging (MRI); Proton magnetic resonance spectroscopy (1H-MRS)