Role of magnetic resonance spectroscopy, diffusion-weighted imaging, and apparent diffusion coefficient in distinguishing intracranial space-occupying lesions.

Parth  Bhayana; Neekita Meher; Santosh Kumar  Padhy; Pravakar  Bahinipati

doi:10.51168/sjhrafrica.v7i2.2648

Authors

Parth Bhayana Senior Resident, Department of Radiodiagnosis, Institute of Medical Sciences and SUM Hospital, Siksha O Anusandhan Deemed to be University, Bhubaneswar, Odisha, India.
Neekita Meher Assistant Professor, Department of Radiodiagnosis, Institute of Medical Sciences and SUM Hospital, Siksha O Anusandhan Deemed to be University, Bhubaneswar, Odisha, India.
Santosh Kumar Padhy Associate Professor, Department of Radiodiagnosis, Institute of Medical Sciences and SUM Hospital, Siksha O Anusandhan Deemed to be University, Bhubaneswar, Odisha, India.
Pravakar Bahinipati Professor, Department of Radiodiagnosis, Institute of Medical Sciences and SUM Hospital, Siksha O Anusandhan Deemed to be University, Bhubaneswar, Odisha, India.

DOI:

https://doi.org/10.51168/sjhrafrica.v7i2.2648

Keywords:

Magnetic Resonance Spectroscopy, Diffusion-Weighted Imaging, Apparent Diffusion Coefficient, Intracranial Space-Occupying Lesions, Glioblastoma

Abstract

Introduction

Objectives: To evaluate the role of magnetic resonance spectroscopy (MRS), diffusion-weighted imaging (DWI), and apparent diffusion coefficient (ADC) mapping in distinguishing infective from neoplastic intracranial space-occupying lesions (ICSOLs).

Methods

This prospective observational study was conducted at a tertiary care teaching hospital over two years. Eighty patients presenting with seizures, headache, neurological deficits, or an intracranial space-occupying lesion detected on computed tomography underwent multiparametric MRI, including conventional MRI, DWI, ADC mapping, and MRS. Imaging findings were correlated with histopathological diagnoses. Statistical analyses were performed using appropriate parametric and non-parametric tests, with a p-value <0.05 considered statistically significant.

Results

The mean age of the participants was 49.0 ± 16.8 years, with an equal gender distribution (50% males and 50% females). Peri-lesional ADC values were significantly higher than intra-lesional ADC values across all lesion groups, particularly in high-grade tumours (1.57 ± 0.14 vs. 0.87 ± 0.23 × 10⁻³ mm²/s; p < 0.001). Diffusion restriction patterns showed significant associations with tumour grade and lesion etiology. Spectroscopic analysis demonstrated significantly lower absolute choline levels in high-grade malignancies than in benign lesions (p = 0.013), while benign extra-axial lesions exhibited the highest Cho/NAA ratio (8.47 ± 2.25).

Conclusion

Multiparametric MRI substantially improves the characterization of ICSOLs by integrating anatomical, diffusion, and metabolic information. Combined interpretation of conventional MRI, DWI, ADC mapping, and MRS enhances diagnostic confidence and facilitates accurate preoperative lesion characterization and grading.

Recommendation

Multiparametric MRI should be incorporated into the routine preoperative evaluation of patients with suspected ICSOLs whenever available. Larger multicenter studies are recommended to validate these findings and establish standardized imaging protocols for differentiating infective and neoplastic lesions.

References

Rathod V, Bhole A, Chauhan M, Ramteke H, Wani B. Study of clinico-radiological and clinico-pathological correlation of intracranial space-occupying lesions at a rural center. Int J Neurosurg. 2009;7. https://doi.org/10.5580/ba1

Hema NA, Ravindra RS, Karnappa AS. Morphological Patterns of Intracranial Lesions in a Tertiary Care Hospital in North Karnataka: A Clinicopathological and Immunohistochemical Study. J Clin Diagn Res. 2016;10(8):EC01-5. https://doi.org/10.7860/JCDR/2016/19101.8237 PMid:27656442 PMCid:PMC5028572

Hutter A, Schwetye KE, Bierhals AJ, McKinstry RC. Brain neoplasms: epidemiology, diagnosis, and prospects for cost-effective imaging. Neuroimaging Clin N Am. 2003;13(2):237-50, x-xi. https://doi.org/10.1016/S1052-5149(03)00016-9 PMid:13677804

Nabors LB, Ammirati M, Bierman PJ, Brem H, Butowski N, Chamberlain MC, et al. Central nervous system cancers. J Natl Compr Canc Netw. 2013;11(9):1114-51. https://doi.org/10.6004/jnccn.2013.0132 PMid:24029126 PMCid:PMC4124889

Somaa F, Baliyan A, Bokari F. Classification of Intracranial Space-Occupying Lesions (ICSOL) based on histopathology: A Narrative Review. JCHR. 2023;13(4): 655-670

Manias KA, Peet A. What is MR spectroscopy? Arch Dis Child Educ Pract Ed. 2018;103(4):213-216. https://doi.org/10.1136/archdischild-2017-312839 PMid:28844055

Tognarelli JM, Dawood M, Shariff MI, Grover VP, Crossey MM, Cox IJ, et al. Magnetic Resonance Spectroscopy: Principles and Techniques: Lessons for Clinicians. J Clin Exp Hepatol. 2015;5(4):320-8. https://doi.org/10.1016/j.jceh.2015.10.006 PMid:26900274 PMCid:PMC4723643

Baliyan V, Das CJ, Sharma R, Gupta AK. Diffusion weighted imaging: Technique and applications. World J Radiol. 2016;8(9):785-798. https://doi.org/10.4329/wjr.v8.i9.785 PMid:27721941 PMCid:PMC5039674

Gupta K, Jain N, Saggar K. Role of Diffusion Weighted Imaging and MR Spectroscopy in Characterization of Intracranial Neoplasms. Int J Anat Radiol Surg. 2018;7:RO55-61. DOI: 10.7860/IJARS/2018/35836:2419

S. SP, Kattoju S. Role of magnetic resonance spectroscopy and diffusion weighted imaging in characterizing intra-axial brain tumours. Int J Res Med Sci. 2023;11:3722-8. https://doi.org/10.18203/2320-6012.ijrms20233026

Lee EJ, terBrugge K, Mikulis D, Choi DS, Bae JM, Lee SK, Moon SY. Diagnostic value of peritumoral minimum apparent diffusion coefficient for differentiation of glioblastoma multiforme from solitary metastatic lesions. AJR Am J Roentgenol. 2011 Jan;196(1):71-6. https://doi.org/10.2214/AJR.10.4752 PMid:21178049

Howe FA, Barton SJ, Cudlip SA, Stubbs M, Saunders DE, Murphy M, et al. Metabolic profiles of human brain tumors using quantitative in vivo 1H magnetic resonance spectroscopy. Magn Reson Med. 2003;49(2):223-32. https://doi.org/10.1002/mrm.10367 PMid:12541241

Ahmed HAK, Mokhtar H. The diagnostic value of MR spectroscopy versus DWI-MRI in therapeutic planning of suspicious multi-centric cerebral lesions. Egypt J Radiol Nucl Med. 2020;51:67. https://doi.org/10.1186/s43055-020-00154-w

Arévalo-Sáenz A, Rodríguez-Boto Amago G, Pedrosa Sánchez M. High-grade glioma and solitary metastasis: differentiation by spectroscopy and advanced magnetic resonance techniques. Egypt J Neurosurg. 2022;37:34. https://doi.org/10.1186/s41984-022-00172-y