# Utility of Magnetic Resonance Spectroscopy and Perfusion Imaging in Differentiating Brain Tumors From Mimics in a Tertiary Hospital in the Philippines

## TL;DR

This study shows how MRS and MRP help distinguish brain tumors from similar-looking non-cancerous lesions using non-invasive imaging techniques in a Philippine hospital.

## Contribution

The study demonstrates the clinical utility of MRS and MRP in differentiating brain tumors from mimics in a real-world hospital setting.

## Key findings

- 60% of patients had neoplastic lesions, while 21.6% had radiation necrosis.
- MR results correlated with biopsies in 7 out of 9 cases.
- MRS and MRP provided non-invasive insights into lesion biochemistry and helped avoid unnecessary biopsies.

## Abstract

Background: A wide range of non-neoplastic brain lesions can mimic tumors on magnetic resonance imaging (MRI), creating diagnostic challenges. Although MRI is the gold standard for evaluating brain lesions, differentiating between neoplastic and non-neoplastic lesions, as well as high- and low-grade tumors, can be difficult, sometimes leading to unnecessary biopsies. Magnetic resonance spectroscopy (MRS) helps by analyzing biochemical and metabolic processes, especially when conventional MRI falls short. Perfusion MRI (MRP), sensitive to microvasculature, is used to classify tumors, detect strokes, and evaluate other conditions. Both methods are non-invasive alternatives to radiation-based imaging techniques.

Methods: A retrospective, cross-sectional study of patients with intracranial lesions who underwent MRS and perfusion imaging in a tertiary hospital in the Philippines were analyzed.

Results: The study included 37 patients (28 male, 9 female) aged 19-78, with MRS and MRP data collected. Seizures were the most common symptom (24%), followed by weakness, headache, dizziness, and visual changes. Notably, 24% were asymptomatic. Among all patients examined by MRI with MRS and MRP for intracranial mass lesions, 60% were neoplasm, 21.6% were radiation necrosis, 5.4% were demyelinating lesions, 2.7% were infection, and 2.7% were vascular lesions. Biopsies were performed on nine patients, with seven correlating to MR results. Thirty-five point one percent of patients showed no clinical change, while 18.9% fully recovered. Imaging revealed lesion reduction in 35.1% of patients, no change in 29.7%, and lesion growth in 18.9%.

Conclusion: MRS and MRP complement conventional MRI in distinguishing neoplastic from non-neoplastic lesions, differentiation of types of malignancies, and differentiating tumor recurrence from radiation necrosis, offering a non-invasive way of catechizing the biochemical make-up of intracranial lesions.