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    Can magnetic resonance spectroscopy adequately differentiate neoplastic from non-neoplastic and low-grade from high-grade lesions in brain masses?
    (2010) Karata?, Ozan; Karata?, Gülden Yenice; Uysal, Ender; Can, S.Meltem; Ertürk, Mehmet; Başak, Muzaffer
    Objective: The aim of this study was to evaluate the usefulness of Magnetic Resonance Spectroscopy in the differential diagnosis of brain lesions. Materials and Methods: Forty-six patients with cerebral lesions were examined by Magnetic Resonance Spectroscopy. Choline, creatine, N-acetyl aspartate and lipid-lactate peaks were evaluated. Forty of the 46 patients underwent stereotactic biopsy or surgery. Histopathological results were compared with the Magnetic Resonance Spectroscopy results. Results: The Choline / N- acetyl aspartate ratio had the highest sensitivity (87.2%) in neoplastic versus nonneoplastic differentiation and the specificities of the Choline / Creatine, Choline / N-acetyl aspartate and Choline+Creatine / N-acetyl aspartate ratios were found to be 100%. Choline / Creatine ratios showed the highest sensitivity (95.7%) in low-grade versus high-grade differentiation and specificities of Choline / Nacetyl aspartate, Choline+Creatine / N- acetyl aspartate ratios and lipid-lactate levels were found to be 100%. Consequently, a value of Choline / Creatine > 2.2 and an accompanying lipid-lactate peak differentiated neoplasms as low-grade versus high-grade with a sensitivity of 100% (82.2-100%) and a specificity of 100% (71.7-100%). Conclusion: The presence of elevated Choline and decreased N-acetyl aspartate levels are effective in the differetiation of neoplastic versus non-neoplastic lesions with high sensitivity and specificity. A proposed ratio of Choline / Creatine > 2.2 and an accompanying lipid-lactate peak provide valuable information in differentiating low-grade from high-grade lesions.