Single-voxel proton MR spectroscopy of nonneoplastic brain lesions suggestive of a neoplasm. AJNR Am J Neuroradiol 1998 Oct;19(9):1695-703
Date
11/05/1998Pubmed ID
9802493Pubmed Central ID
PMC8337475Scopus ID
2-s2.0-0343526542 (requires institutional sign-in at Scopus site) 68 CitationsAbstract
BACKGROUND AND PURPOSE: MR spectroscopy is used to characterize biochemical components of normal and abnormal brain tissue. We sought to evaluate common histologic findings in a diverse group of nonneoplastic diseases in patients with in vivo MR spectroscopic profiles suggestive of a CNS neoplasm.
METHODS: During a 2-year period, 241 patients with suspected neoplastic CNS lesions detected on MR images were studied with MR spectroscopy. Of these, five patients with a nonneoplastic diagnosis were identified retrospectively; a sixth patient without tissue diagnosis was added. MR spectroscopic findings consistent with a neoplasm included elevated choline and decreased N-acetylaspartate and creatine, with or without detectable mobile lipid and lactate peaks.
RESULTS: The histologic specimens in all five patients for whom tissue diagnoses were available showed significant WBC infiltrates, with both interstitial and perivascular accumulations of lymphocytes, macrophages, histiocytes, and (in one case) plasma cells. Reactive astrogliosis was also prominent in most tissue samples. This cellular immune response was an integral component of the underlying disorder in these patients, including fulminant demyelination in two patients, human herpesvirus 6 encephalitis in one patient, organizing hematoma from a small arteriovenous malformation in one patient, and inflammatory pseudotumor in one patient. Although no histologic data were available in the sixth patient, neoplasm was considered unlikely on the basis of ongoing clinical and neuroradiologic improvement without specific therapy.
CONCLUSION: Nonneoplastic disease processes in the CNS may elicit a reactive proliferation of cellular elements of the immune system and of glial tissue that is associated with MR spectroscopic profiles indistinguishable from CNS neoplasms with current in vivo MR spectroscopic techniques. Such false-positive findings substantiate the need for histologic examination of tissue as the standard of reference for the diagnosis of intracranial mass lesions.
Author List
Krouwer HG, Kim TA, Rand SD, Prost RW, Haughton VM, Ho KC, Jaradeh SS, Meyer GA, Blindauer KA, Cusick JF, Morris GL, Walsh PRAuthors
Karen A. Blindauer MD Chief, Professor in the Neurology department at Medical College of WisconsinJoseph F. Cusick MD Adjunct Professor in the Neurosurgery department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
AdolescentAdult
Brain
Brain Diseases
Brain Neoplasms
Diagnosis, Differential
False Positive Reactions
Humans
Magnetic Resonance Spectroscopy
Male
Middle Aged
Retrospective Studies
