Abstract
Objectives
Assessing a posterior fossa tumour in an adult can be challenging. Metastasis, haemangioblastoma, ependymal tumours, and medulloblastoma are the most common diagnostic possibilities. Our aim was to evaluate the contribution of magnetic resonance spectroscopy (MRS) in the diagnosis of these entities.
Methods
We retrospectively evaluated 56 consecutive patients with a posterior fossa tumour and histological diagnosis of ependymal tumour, medulloblastoma, haemangioblastoma, and metastasis in which good-quality spectra at short (TE 30 ms) or/and intermediate (TE, 136 ms) TE were available. Spectra were compared using the Mann-Whitney U non-parametric test in order to select the spectral datapoints and the intensity ratios that showed significant differences between groups of lesions. Performance of these datapoints and their ratios were assessed with ROC curves.
Results
The most characteristic signatures on spectroscopy were high choline (Cho) in medulloblastoma (p < 0.001), high myoinositol (mIns) in ependymal tumours (p < 0.05), and high lipids (LIP) in haemangioblastoma (p < 0.01) and metastasis (p < 0.01). Selected ratios between normalised intensity signals of resonances provided accuracy values between 79 and 95% for pairwise comparisons. Intensity ratio NI3.21ppm/3.55ppm provided satisfactory discrimination between medulloblastoma and ependymal tumours (accuracy, 92%), ratio NI2.11ppm/1.10ppm discriminated ependymal tumours from haemangioblastoma (accuracy, 94%), ratio NI3.21ppm/1.13ppm discriminated haemangioblastoma from medulloblastoma (accuracy, 95%), and ratio NI1.28ppm/2.02pmm discriminated haemangioblastoma from metastasis (accuracy, 83%).
Conclusions
MRS may improve the non-invasive diagnosis of posterior fossa tumours in adults.
Key Points
• High choline suggests a medulloblastoma in a posterior fossa tumour.
• High myoinositol suggests an ependymal lesion in a posterior fossa tumour.
• High lipids suggest a metastasis or a haemangioblastoma in a posterior fossa tumour.
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Abbreviations
- Cho:
-
Choline
- Glx:
-
Glutamine-glutamate
- LIP:
-
Lipids
- MRS:
-
Magnetic resonance spectroscopy
- mIns:
-
Myoinositol
- NI:
-
Normalised to unit length datapoint intensities
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Funding
This work was partially funded by the Ministerio de Economía y Competitividad (MINECO) grant MOLIMAGLIO (SAF2014-52332-R). It was also funded by Centro de Investigación Biomédica en Red – Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN, [http://www.ciber-bbn.es/en]), an initiative of the Instituto de Salud Carlos III (Spain) co-funded by EU Fondo Europeo de Desarrollo Regional (FEDER).
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The scientific guarantor of this publication is Carlos Majós MD, PhD.
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The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.
Statistics and biometry
One of the authors has significant statistical expertise.
Informed consent
Written informed consent was obtained from all subjects (patients) in this study.
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Institutional Review Board approval was obtained.
Study subjects or cohorts overlap
Some study subjects or cohorts have been previously reported in:
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Methodology
• retrospective
• diagnostic or prognostic study/observational
• performed at one institution
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Mora, P., Pons, A., Cos, M. et al. Magnetic resonance spectroscopy in posterior fossa tumours: the tumour spectroscopic signature may improve discrimination in adults among haemangioblastoma, ependymal tumours, medulloblastoma, and metastasis. Eur Radiol 29, 2792–2801 (2019). https://doi.org/10.1007/s00330-018-5879-z
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DOI: https://doi.org/10.1007/s00330-018-5879-z