Role of Proton Magnetic Resonance Spectroscopy in Evaluation of Intracranial Space Occupying Lesion

Introduction: Magnetic resonance spectroscopy (MRS) is a potential tool for differential diagnosis between brain abscesses and noninfectious lesion such as a primary brain tumor, lymphoma, brain metastasis, and tuberculoma. Aims and Objectives: To evaluate the role of MRS in imaging of intracranial space occupying lesion and differentiate between benign and malignant conditions and correlate between imaging findings with histopathological findings. Materials and Methods: The study was performed on whole body system 1-5 tesla GE Signa HDx magnetic resonance imaging (MRI) at MP MRI scan Centre Medical College, Jabalpur, using a dedicated head coil. Multiplannar, T1 and T2 weighted diffusion, gradient images using spin echo sequences point resolved spectroscopy chemical shift selective. Result: A total of 70 patients included in our study of the space occupying lesion in the brain, 33 patients had nonneoplastic lesions. Remaining 37 patients had neoplastic lesions. 0-40 years comprising 75% of patients having nonneoplastic pathologies. Only remaining 8 patients (25%) were above the age of 40 years; the majority of patients in our study were males (67%). Only 33% patients were females. Benign pathologies were more common in females 13/23 (56% of females). In males, neoplastic pathologies were more common seen in 27 out of 47 patients (58% of males). Glioma and tuberculoma were most commonly seen in our study in 27 patients comprising 38.5% each, respectively. Mean N-acetylaspartate/creatine (Cr) levels in nonneoplastic and neoplastic category were 1.18 and 1.02, respectively, being higher in the nonneoplastic group. Mean choline/Cr levels were higher in the neoplastic group: 1.9 as compared to 1.07 seen in nonneoplastic group. Conclusion: MRS is able to distinguish between neoplastic and nonneoplastic intracranial space occupying lesions on the basis of metabolites level. Tuberculoma and pyogenic abscess can be differentiated with the spectroscopic patterns.