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Evaluation of the added value of (1)H-magnetic resonance spectroscopy for the diagnosis of pediatric brain lesions in clinical practice

BACKGROUND: Magnetic resonance spectroscopy (MRS) aids noninvasive diagnosis of pediatric brain tumors, but use in clinical practice is not well documented. We aimed to review clinical use of MRS, establish added value in noninvasive diagnosis, and investigate potential impact on patient care. METHO...

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Autores principales: Manias, Karen, Gill, Simrandip K, Zarinabad, Niloufar, Davies, Paul, English, Martin, Ford, Daniel, MacPherson, Lesley, Nicklaus-Wollenteit, Ina, Oates, Adam, Solanki, Guirish, Adamski, Jenny, Wilson, Martin, Peet, Andrew C
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5909808/
https://www.ncbi.nlm.nih.gov/pubmed/29692921
http://dx.doi.org/10.1093/nop/npx005
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author Manias, Karen
Gill, Simrandip K
Zarinabad, Niloufar
Davies, Paul
English, Martin
Ford, Daniel
MacPherson, Lesley
Nicklaus-Wollenteit, Ina
Oates, Adam
Solanki, Guirish
Adamski, Jenny
Wilson, Martin
Peet, Andrew C
author_facet Manias, Karen
Gill, Simrandip K
Zarinabad, Niloufar
Davies, Paul
English, Martin
Ford, Daniel
MacPherson, Lesley
Nicklaus-Wollenteit, Ina
Oates, Adam
Solanki, Guirish
Adamski, Jenny
Wilson, Martin
Peet, Andrew C
author_sort Manias, Karen
collection PubMed
description BACKGROUND: Magnetic resonance spectroscopy (MRS) aids noninvasive diagnosis of pediatric brain tumors, but use in clinical practice is not well documented. We aimed to review clinical use of MRS, establish added value in noninvasive diagnosis, and investigate potential impact on patient care. METHODS: Sixty-nine children with lesions imaged using MRS and reviewed by the tumor board from 2014 to 2016 met inclusion criteria. Contemporaneous MRI diagnosis, spectroscopy analysis, histopathology, and clinical information were reviewed. Final diagnosis was agreed on by the tumor board at study end. RESULTS: Five cases were excluded for lack of documented MRI diagnosis. The principal MRI diagnosis by pediatric radiologists was correct in 59%, increasing to 73% with addition of MRS. Of the 73%, 19.1% (95% CI, 9.1%-33.3%) were incorrectly diagnosed with MRI alone. MRS led to a significant improvement in correct diagnosis over all tumor types (P = .012). Of diagnoses correctly made with MRI, confidence increased by 37% when adding MRS, with no patients incorrectly re-diagnosed. Indolent lesions were diagnosed noninvasively in 85% of cases, with MRS a major contributor to 91% of these diagnoses. Of all patients, 39% were managed without histopathological diagnosis. MRS contributed to diagnosis in 68% of this group, modifying it in 12%. MRS influenced management in 33% of cases, mainly through avoiding and guiding biopsy and aiding tumor characterization. CONCLUSION: MRS can improve accuracy and confidence in noninvasive diagnosis of pediatric brain lesions in clinical practice. There is potential to improve outcomes through avoiding biopsy of indolent lesions, aiding tumor characterization, and facilitating earlier family discussions and treatment planning.
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spelling pubmed-59098082018-04-24 Evaluation of the added value of (1)H-magnetic resonance spectroscopy for the diagnosis of pediatric brain lesions in clinical practice Manias, Karen Gill, Simrandip K Zarinabad, Niloufar Davies, Paul English, Martin Ford, Daniel MacPherson, Lesley Nicklaus-Wollenteit, Ina Oates, Adam Solanki, Guirish Adamski, Jenny Wilson, Martin Peet, Andrew C Neurooncol Pract Original Articles BACKGROUND: Magnetic resonance spectroscopy (MRS) aids noninvasive diagnosis of pediatric brain tumors, but use in clinical practice is not well documented. We aimed to review clinical use of MRS, establish added value in noninvasive diagnosis, and investigate potential impact on patient care. METHODS: Sixty-nine children with lesions imaged using MRS and reviewed by the tumor board from 2014 to 2016 met inclusion criteria. Contemporaneous MRI diagnosis, spectroscopy analysis, histopathology, and clinical information were reviewed. Final diagnosis was agreed on by the tumor board at study end. RESULTS: Five cases were excluded for lack of documented MRI diagnosis. The principal MRI diagnosis by pediatric radiologists was correct in 59%, increasing to 73% with addition of MRS. Of the 73%, 19.1% (95% CI, 9.1%-33.3%) were incorrectly diagnosed with MRI alone. MRS led to a significant improvement in correct diagnosis over all tumor types (P = .012). Of diagnoses correctly made with MRI, confidence increased by 37% when adding MRS, with no patients incorrectly re-diagnosed. Indolent lesions were diagnosed noninvasively in 85% of cases, with MRS a major contributor to 91% of these diagnoses. Of all patients, 39% were managed without histopathological diagnosis. MRS contributed to diagnosis in 68% of this group, modifying it in 12%. MRS influenced management in 33% of cases, mainly through avoiding and guiding biopsy and aiding tumor characterization. CONCLUSION: MRS can improve accuracy and confidence in noninvasive diagnosis of pediatric brain lesions in clinical practice. There is potential to improve outcomes through avoiding biopsy of indolent lesions, aiding tumor characterization, and facilitating earlier family discussions and treatment planning. Oxford University Press 2018-03 2017-05-13 /pmc/articles/PMC5909808/ /pubmed/29692921 http://dx.doi.org/10.1093/nop/npx005 Text en © The Author(s) 2017. Published by Oxford University Press on behalf of the Society for Neuro-Oncology and the European Association of Neuro-Oncology. http://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Original Articles
Manias, Karen
Gill, Simrandip K
Zarinabad, Niloufar
Davies, Paul
English, Martin
Ford, Daniel
MacPherson, Lesley
Nicklaus-Wollenteit, Ina
Oates, Adam
Solanki, Guirish
Adamski, Jenny
Wilson, Martin
Peet, Andrew C
Evaluation of the added value of (1)H-magnetic resonance spectroscopy for the diagnosis of pediatric brain lesions in clinical practice
title Evaluation of the added value of (1)H-magnetic resonance spectroscopy for the diagnosis of pediatric brain lesions in clinical practice
title_full Evaluation of the added value of (1)H-magnetic resonance spectroscopy for the diagnosis of pediatric brain lesions in clinical practice
title_fullStr Evaluation of the added value of (1)H-magnetic resonance spectroscopy for the diagnosis of pediatric brain lesions in clinical practice
title_full_unstemmed Evaluation of the added value of (1)H-magnetic resonance spectroscopy for the diagnosis of pediatric brain lesions in clinical practice
title_short Evaluation of the added value of (1)H-magnetic resonance spectroscopy for the diagnosis of pediatric brain lesions in clinical practice
title_sort evaluation of the added value of (1)h-magnetic resonance spectroscopy for the diagnosis of pediatric brain lesions in clinical practice
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5909808/
https://www.ncbi.nlm.nih.gov/pubmed/29692921
http://dx.doi.org/10.1093/nop/npx005
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