The role of magnetic resonance spectroscopy in differentiation of neoplastic from non-neoplastic pediatric intracerebral brain lesions

Background Pediatric brain tumors are considered a significant health problem and present several imaging challenges. The role of imaging is no longer limited to merely providing anatomical details. In this research, we explained the role of magnetic resonance spectroscopy (MRS) in the differentiation of neoplastic from non-neoplastic intracerebral brain lesions in pediatric patients. The aim was to assess the role of MRS in pediatric brain tumors by discrimination between tumors and tumor-like lesions, differentiation between primary and secondary neoplasms, differentiation between high-grade and low-grade tumors, and determination of tumor extension. Patients and methods A total of 30 pediatric patients with cerebral lesions were examined by MRS. Choline (Cho), creatine (cr), N-acetylaspartate (NAA), and lipid-lactate peaks were evaluated. Of the 30 patients, 26 underwent stereotactic biopsy. Histopathological results were compared with the MRS results. Results Diagnostic accuracy of spectroscopic data for prediction of neoplastic lesions in the current study was assessed. Regarding Cho/NAA, a cutoff point greater than 2 had 88% sensitivity and 75% specificity for prediction of neoplastic lesions, with areas under the curve (AUC) of 0.91 (P = 0.01). Regarding Cho/Cr, a cutoff point greater than 1.86 had 85% sensitivity and 75% specificity for prediction of neoplastic lesions, with AUC of 0.85 (P = 0.02). Regarding Cho/NAA+Cr, a cutoff point greater than 0.8 had 88% sensitivity and 100% specificity for prediction of neoplastic lesions, with AUC of 0.91 (P = 0.009). Conclusion MRS can potentially overcome the limitations of sampling errors with histopathologic grading of the tumor for determining the most optimal therapy regimen and regularity and aggressiveness of postoperative follow-up and treatment.