Aim: The purpose of this article is to analyze different advanced MRI parameters and characterize the efficacy of each one of them in the differentiation of these two pathologies.
Background: The differentiation by means of magnetic
resonance between high-grade gliomas and intracranial solitary single
metastasis is of the utmost importance since they condition both surgical and
complementary treatment. For decades, different methods have been devised to
try to differentiate both, given that the final result of surgery and
complementary treatment differs substantially between the two. What's more,
knowing the possible diagnosis in advance would improve the prognosis of both
pathologies.
Methods: Retrospective study that analyzes the parameters of
advanced magnetic resonance imaging: spectroscopy, diffusion and perfusion,
specifically focused on the differences in the coefficients of the metabolites
Cho/Cr, Cho/ NAA and NAA/Cr in peritumoral edema between high-grade gliomas and
metastases. The data have been statistically analyzed using ROC (receiver
operating characteristic) curves, and cutoff values were obtained.
Results: A total of 79 patients with histologically analyzed
tumors were analyzed: 49 high-grade gliomas (40 multiform glioblastomas and 9
anaplastic astrocytomas) and 30 metastases. A statistically significant mean
difference was obtained in the three metabolite ratios. The area under the
curve for the Cho/NAA ratio was 0.958 (CI: 0.903–1), for Cho/Cr 0.922 (CI:
0.859–0.985) and for NAA/Cr 0.163 (CI: 0.068–0.258; p < 0.001). The cutoff
values were 1.115 for Cho/NAA (sensitivity 93.87%, specificity 93.33%, global
precision 93.67%); 1.18 for the Cho/Cr ratio (sensitivity 89.79%, specificity
93.33% and precision 91.13%) and 1.155 for the NAA/Cr ratio (sensitivity
67.34%, specificity 93.33%, global precision 44.30%).
Conclusion: The
results of the study support the premise that spectroscopy at the level of
peritumoral edema is able to differentiate between high-grade gliomas and
metastases by showing tumor infiltration in peritumoral edema. This difference
allows not only tumor diagnosis but also the possibility of performing
high-grade glioma surgery guided by spectroscopy to find tumor infiltration in
apparently healthy tissue.
Author(s) Details:
Arévalo-Sáenz, Alejandra A.,
San Carlos University Hospital, Madrid, Spain.
Pujante Ferrández, Borja,
San Carlos University Hospital, Madrid, Spain.
Rascón-Ramírez, Fernando J.,
San Carlos University Hospital, Madrid, Spain.
Please see the link here: https://stm.bookpi.org/ANUMS-V10/article/view/13922
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