Keywords:
Neuroradiology brain, Oncology, CNS, MR-Spectroscopy, MR-Diffusion/Perfusion, Statistics, Biopsy, Diagnostic procedure, Neoplasia, Metastases, Pathology
Authors:
N. Nersesyan, J. L. León Guijarro, B. Celda Muñoz, A. Bosca, J. J. Delgado Moraleda; Valencia/ES
DOI:
10.1594/ecr2018/C-2080
Results
From the 134 patients with tumoral lesions in MRI,
123 were confirmed by the histologic examination as represented in Figure 1.
The use of Biomarkers
The biomarker of tumor infiltration was found to be statistically relevant allowing for the differentiation between high and low-grade tumors:
- Low-grade tumors: PPV 70%,
NPV 99%,
Sn 93% and Sp 94.4%
- High-grade tumors: PPV 94.2%,
NPV 86.1%,
Sn 94.3% and Sp 86.1%
- Metastasis: PPV 95%,
NPV 98.1%,
Sn 90% and Sp 99%
An example of a low-grade glial tumor can be found in Figure 2,
where Col/NAA ratio <2.2,
rCBF < 1.76 and absence of peritumoral infiltration were identified.
In the example of a high-grade glial tumor found in Figure 32,
Col/NAA ratio > 2.2,
rCBF > 1.76 and presence of peritumoral infiltration were identified.
Protocol Application
The application of multimodal MRI protocol increased the diagnostic precision,
allowing the differentiation between high and low-grade tumors.
In all cases and for different variables,
p<0.05 was obtained those warranting the use of the flowchart provided as a diagnostic tool with clinical applications.
The use of Spectrometry
The use of multivoxel spectrometry was necessary for the characterization,
extension,
and definition of the tumoral infiltration due to the inhomogeneity of the high-grade glial tumors.
A better delimitation of the affected area allows for better surgical technique and improves the diagnostic performance in the biopsies.