Abdelaziz Osama, Eshra Mohamed, Belal Ahmed, Elshafei Mohamed
Department of Neurosurgery, Alexandria University, Alexandria, Egypt.
Department of Diagnostic Radiology, Alexandria University, Alexandria, Egypt.
J Neurol Surg A Cent Eur Neurosurg. 2016 Jul;77(4):283-90. doi: 10.1055/s-0035-1571162. Epub 2016 Mar 2.
Background Magnetic resonance spectroscopy (MRS) is usually added to conventional magnetic resonance imaging (MRI) to refine the diagnosis of different brain lesions. Stereotactic brain biopsy is a well-established method to obtain tissues for histopathologic examination. The purpose of the study is to compare the diagnostic yields of MRS and stereotactic biopsy in the characterization of brain lesions. Material and Methods A prospective study conducted on 27 consecutive patients presenting with multifocal, diffuse, as well as deeply seated intra-axial brain lesions. All patients had both brain MRI and MRS prior to stereotactic biopsy. Histopathologic examinations of the obtained tissue specimens, using appropriate stains including immunostains, were performed. Results MRS diagnosed neoplastic brain lesions in 15 cases (56%) and nonneoplastic brain lesions in 12 (44%). Correlation between the preoperative diagnosis by MRS and the histopathologic diagnosis following stereotactic biopsy of either a neoplastic or nonneoplastic lesion revealed matching in 25 of 27 cases (sensitivity 88%; specificity 100%). Within the group of cases (n = 15) diagnosed preoperatively by MRS as neoplastic, 12 patients were diagnosed with brain gliomas of different grades. The MRS grading of gliomas exactly matched the histopathologic grading following stereotactic biopsy in 10 of the 12 cases (sensitivity 89%; specificity 67%). Conclusions MRS is a useful addition to the management armamentarium, providing molecular information that assists in the characterization of various brain lesions. Multivoxel MRS may increase the diagnostic yield of stereotactic biopsy by guidance to target the higher choline and lower N-acetylaspartate areas, expected to have greater tumor activity.
背景 磁共振波谱（MRS）通常会被添加到传统的磁共振成像（MRI）中，以完善对不同脑病变的诊断。立体定向脑活检是一种成熟的获取组织进行组织病理学检查的方法。本研究的目的是比较MRS和立体定向活检在脑病变特征诊断中的诊断率。材料与方法 对27例连续出现多灶性、弥漫性以及深部轴内脑病变的患者进行了一项前瞻性研究。所有患者在立体定向活检前均进行了脑部MRI和MRS检查。对获取的组织标本进行了组织病理学检查，使用了包括免疫染色在内的适当染色方法。结果 MRS诊断出15例（56%）脑肿瘤性病变和12例（44%）非肿瘤性脑病变。MRS术前诊断与立体定向活检后肿瘤性或非肿瘤性病变的组织病理学诊断之间的相关性显示，27例中有25例匹配（敏感性88%；特异性100%）。在术前被MRS诊断为肿瘤性病变的病例组（n = 15）中，12例患者被诊断为不同级别的脑胶质瘤。在12例病例中的10例中，胶质瘤的MRS分级与立体定向活检后的组织病理学分级完全匹配（敏感性89%；特异性67%）。结论 MRS是管理手段中的一项有用补充，可提供有助于各种脑病变特征化的分子信息。多体素MRS可通过引导靶向胆碱含量较高和N - 乙酰天门冬氨酸含量较低的区域（预计具有更高的肿瘤活性）来提高立体定向活检的诊断率。
