A systematic literature review of magnetic resonance spectroscopy for the characterization of brain tumors

William Hollingworth, L. S. Medina, R. E. Lenkinski, D. K. Shibata, B. Bernal, D. Zurakowski, B. Comstock, J. G. Jarvik

Research output: Contribution to journalReview articlepeer-review

177 Scopus citations


BACKGROUND AND PURPOSE: Proton MR spectroscopy (1H-MR spectroscopy) is a potentially useful adjunct to anatomic MR imaging in the characterization of brain tumors. We performed an updated systematic review of the evidence. METHODS: We employed a standardized search strategy to find studies published during 2002-2004. We reviewed studies measuring diagnostic accuracy and diagnostic, therapeutic, or health impact of 1H-MR spectroscopy. We abstracted information on study design, 1H-MR spectroscopy technique, and methodologic quality. We categorized studies into 5 subgroups: (1) metastasis versus high-grade tumor; (2) high-versus low-grade tumor; (3) recurrent tumor versus radiation necrosis; (4) tumor extent; and (5) tumor versus non-neoplastic lesion. RESULTS: We identified 26 studies evaluating diagnostic performance, diagnostic impact, or therapeutic impact. No articles evaluated patient health or cost-effectiveness. Methodologic quality was mixed; most used histopathology as the reference standard but did not specify blinded interpretation of histopathology. One large study demonstrated a statistically significant increase in diagnostic accuracy for indeterminate brain lesions from 55%, based on MR imaging, to 71% after analysis of 1H-MR spectroscopy. Several studies have found that 1H-MR spectroscopy is highly accurate for distinguishing high- and low-grade gliomas, though the incremental benefit of 1H-MR spectroscopy in this setting is less clear. Interpretation for the other clinical subgroups is limited by the small number of studies. CONCLUSION: The current evidence on the accuracy of 1H-MR spectroscopy in the characterization of brain tumors is promising. However, additional high-quality studies are needed to convince policy makers. We present guidelines to help focus future research in this area.

Original languageEnglish (US)
Pages (from-to)1404-1411
Number of pages8
JournalAmerican Journal of Neuroradiology
Issue number7
StatePublished - Aug 1 2006

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Clinical Neurology


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