Original Research Article
Year: 2018 | Month: October | Volume: 5 | Issue: 10 | Pages: 470-480
rading of Intracranial Neoplasms with MR Perfusion and MR Spectroscopy
Niharika Gupta1, Samar Chatterjee2, Rajesh Uddandam3, Udaybhanu Kovilapu2, Narendra Kumar Jain2, Dr J Sai Kiran3
1Dept of Radiodiagnosis, Command Hospital (WC), Panchkula – 134107
2Dept of Radiodiagnosis, Armed Forces Medical College, Pune – 411040
3Dept of Internal Medicine, Interfaith Medical Center, Brooklyn, New York
Corresponding Author: Samar Chatterjee
ABSTRACT
Purpose: To compare findings of conventional magnetic resonance (MR) imaging, MR perfusion and MR spectroscopy in grading of the primary intra-cranial neoplasms.
Materials and Methods: This prospective observational, comparative study was conducted in a tertiary care hospital. 37 consecutive patients with freshly detected primary intracranial intra-axial neoplasms were included in the study. T1 axial, T2 axial, FLAIR axial, diffusion-weighted images, Coronal T2 weighted, T1-weighted, dynamic susceptibility contrast (DSC) MR perfusion, MR spectroscopy and post contrast T1-weighted 3D images were obtained. Grading of the intracranial neoplasms was done on the basis of MR imaging. Histology specimen was obtained by surgical resection or stereotactic biopsy and graded as high-grade glioma (HGG) and low-grade glioma (LGG).
Results: On histopathological examination, 24 cases were proven to be HGG and 13 to be LGG. The mean Cho/NAA ratio for HGG was 7.3 and for LGG it was 1.7. The mean rCBV for HGG was 2.95 and for LGG was 0.92. Out of 37 intra-axial tumors, 24 histologically proven HGG were all correctly diagnosed with spectroscopy imaging, however 2 LGG were over diagnosed to be HGG. The sensitivity, specificity, PPV, and NPV for determination of a high-grade glioma with MR Spectroscopy and MR Perfusion imaging were 100%, 84.6%, 92.3%, and 100%, respectively. AUC measured 0.92.
Conclusion: Advanced neuroimaging using DSC MR perfusion and MR Spectroscopy allows accurate grading of tumor, which enables surgical planning, guiding accurate stereotactic biopsy from the most malignant part of the tumor and planning further treatment.
Key words: Gliomas, Magnetic resonance imaging, Spectroscopy, Perfusion
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