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<meta name="DC.Title" content="Utility of Proton MR Spectroscopy for Differentiating Typical and Atypical Primary Central Nervous System Lymphomas from Tumefactive Demyelinating Lesions" />
<meta name="DC.Identifier" content="10.3174/ajnr.A3677" />
<meta name="DC.Date" content="2014-02-01" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
<meta name="DC.Rights" content="© 2014 by American Journal of Neuroradiology" />
<meta name="DC.AccessRights" content="restricted" />
<meta name="DC.Description" content="BACKGROUND AND PURPOSE: It may be challenging to differentiate primary CNS lymphomas, especially primary CNS lymphomas with atypical MR features, from tumefactive demyelinating lesions by the use of conventional MR. This study aimed to investigate the usefulness of 1H-MR spectroscopy for making this discrimination.

MATERIALS AND METHODS: Forty-four patients with primary CNS lymphomas and 21 with tumefactive demyelinating lesions were enrolled. Single-voxel (TE = 144 ms) 1H-MR spectroscopy scans with the use of the point-resolved spectroscopy sequence were retrospectively analyzed. The Cho/Cr and Cho/NAA area ratios were calculated. The lipid and/or lactate peak was visually categorized into 5 grades on the basis of comparison with the height of the Cr peak. The 1H-MR spectroscopy findings were compared in all of the primary CNS lymphomas and the tumefactive demyelinating lesions and in the subgroup of atypical primary CNS lymphomas and tumefactive demyelinating lesions. The thresholds and added value of 1H-MR spectroscopy to conventional MR were calculated by use of receiver operating characteristic curves.

RESULTS: Discrepancies between all of the primary CNS lymphomas and tumefactive demyelinating lesions were found in the Cho/Cr ratio ( P = .000), Cho/NAA ratio ( P = .000), and the lipid and/or lactate peak grade ( P = .000). Lymphoma rather than tumefactive demyelinating lesions was suggested when the Cho/Cr ratio was &gt;2.58, the Cho/NAA ratio was &gt;1.73, and a high lipid and/or lactate peak grade (grade &gt;3) was seen. Higher Cho/Cr ratios, Cho/NAA ratios, and lipid and/or lactate peak grades were found in atypical primary CNS lymphomas when compared with those of tumefactive demyelinating lesions. The area under the receiver operating characteristic curve of conventional MR was improved from 0.827 to 0.870 when Cho/NAA ratio was added in the uncertain cases.

CONCLUSIONS: 1H-MR spectroscopy may be useful for differentiating primary CNS lymphomas from tumefactive demyelinating lesions. Cho/NAA ratio could provide added value to conventional MR imaging.

PCNSL
:   primary central nervous system lymphoma
TDL
:   tumefactive demyelinating lesion
lip-lac
:   lipid and/or lactate peak
ROC
:   receiver operating characteristic
AUC
:   area under the receiver operating characteristic curve" />
<meta name="DC.Contributor" content="S.-S. Lu" />
<meta name="DC.Contributor" content="S.J. Kim" />
<meta name="DC.Contributor" content="H.S. Kim" />
<meta name="DC.Contributor" content="C.G. Choi" />
<meta name="DC.Contributor" content="Y.-M. Lim" />
<meta name="DC.Contributor" content="E.J. Kim" />
<meta name="DC.Contributor" content="D.Y. Kim" />
<meta name="DC.Contributor" content="S.H. Cho" />
<meta name="article:published_time" content="2014-02-01" />
<meta name="article:section" content="Brain" />
<meta name="citation_title" content="Utility of Proton MR Spectroscopy for Differentiating Typical and Atypical Primary Central Nervous System Lymphomas from Tumefactive Demyelinating Lesions" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;It may be challenging to differentiate primary CNS lymphomas, especially primary CNS lymphomas with atypical MR features, from tumefactive demyelinating lesions by the use of conventional MR. This study aimed to investigate the usefulness of &lt;sup&gt;1&lt;/sup&gt;H-MR spectroscopy for making this discrimination.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;Forty-four patients with primary CNS lymphomas and 21 with tumefactive demyelinating lesions were enrolled. Single-voxel (TE = 144 ms) &lt;sup&gt;1&lt;/sup&gt;H-MR spectroscopy scans with the use of the point-resolved spectroscopy sequence were retrospectively analyzed. The Cho/Cr and Cho/NAA area ratios were calculated. The lipid and/or lactate peak was visually categorized into 5 grades on the basis of comparison with the height of the Cr peak. The &lt;sup&gt;1&lt;/sup&gt;H-MR spectroscopy findings were compared in all of the primary CNS lymphomas and the tumefactive demyelinating lesions and in the subgroup of atypical primary CNS lymphomas and tumefactive demyelinating lesions. The thresholds and added value of &lt;sup&gt;1&lt;/sup&gt;H-MR spectroscopy to conventional MR were calculated by use of receiver operating characteristic curves.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;Discrepancies between all of the primary CNS lymphomas and tumefactive demyelinating lesions were found in the Cho/Cr ratio (&lt;i&gt;P&lt;/i&gt; = .000), Cho/NAA ratio (&lt;i&gt;P&lt;/i&gt; = .000), and the lipid and/or lactate peak grade (&lt;i&gt;P&lt;/i&gt; = .000). Lymphoma rather than tumefactive demyelinating lesions was suggested when the Cho/Cr ratio was &amp;gt;2.58, the Cho/NAA ratio was &amp;gt;1.73, and a high lipid and/or lactate peak grade (grade &amp;gt;3) was seen. Higher Cho/Cr ratios, Cho/NAA ratios, and lipid and/or lactate peak grades were found in atypical primary CNS lymphomas when compared with those of tumefactive demyelinating lesions. The area under the receiver operating characteristic curve of conventional MR was improved from 0.827 to 0.870 when Cho/NAA ratio was added in the uncertain cases.&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;&lt;sup&gt;1&lt;/sup&gt;H-MR spectroscopy may be useful for differentiating primary CNS lymphomas from tumefactive demyelinating lesions. Cho/NAA ratio could provide added value to conventional MR imaging.&lt;/p&gt;" />
<meta name="citation_journal_title" content="American Journal of Neuroradiology" />
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<meta name="citation_firstpage" content="270" />
<meta name="citation_lastpage" content="277" />
<meta name="citation_author" content="S.-S. Lu" />
<meta name="citation_author_institution" content="aFrom the Department of Radiology and Research Institute of Radiology (S.-S.L. S.J.K., H.S.K., C.G.C., D.Y.K., S.H.C.)" />
<meta name="citation_author_institution" content="cDepartment of Radiology (S.-S.L.), The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China" />
<meta name="citation_author" content="S.J. Kim" />
<meta name="citation_author_institution" content="aFrom the Department of Radiology and Research Institute of Radiology (S.-S.L. S.J.K., H.S.K., C.G.C., D.Y.K., S.H.C.)" />
<meta name="citation_author" content="H.S. Kim" />
<meta name="citation_author_institution" content="aFrom the Department of Radiology and Research Institute of Radiology (S.-S.L. S.J.K., H.S.K., C.G.C., D.Y.K., S.H.C.)" />
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<meta name="citation_author_institution" content="aFrom the Department of Radiology and Research Institute of Radiology (S.-S.L. S.J.K., H.S.K., C.G.C., D.Y.K., S.H.C.)" />
<meta name="citation_author" content="Y.-M. Lim" />
<meta name="citation_author_institution" content="bDepartment of Neurology (Y.-M.L.), University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea" />
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<meta name="twitter:title" content="Utility of Proton MR Spectroscopy for Differentiating Typical and Atypical Primary Central Nervous System Lymphomas from Tumefactive Demyelinating Lesions" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: It may be challenging to differentiate primary CNS lymphomas, especially primary CNS lymphomas with atypical MR features, from tumefactive demyelinating lesions by the use of conventional MR. This study aimed to investigate the usefulness of 1H-MR spectroscopy for making this discrimination.

MATERIALS AND METHODS: Forty-four patients with primary CNS lymphomas and 21 with tumefactive demyelinating lesions were enrolled. Single-voxel (TE = 144 ms) 1H-MR spectroscopy scans with the use of the point-resolved spectroscopy sequence were retrospectively analyzed. The Cho/Cr and Cho/NAA area ratios were calculated. The lipid and/or lactate peak was visually categorized into 5 grades on the basis of comparison with the height of the Cr peak. The 1H-MR spectroscopy findings were compared in all of the primary CNS lymphomas and the tumefactive demyelinating lesions and in the subgroup of atypical primary CNS lymphomas and tumefactive demyelinating lesions. The thresholds and added value of 1H-MR spectroscopy to conventional MR were calculated by use of receiver operating characteristic curves.

RESULTS: Discrepancies between all of the primary CNS lymphomas and tumefactive demyelinating lesions were found in the Cho/Cr ratio ( P = .000), Cho/NAA ratio ( P = .000), and the lipid and/or lactate peak grade ( P = .000). Lymphoma rather than tumefactive demyelinating lesions was suggested when the Cho/Cr ratio was &gt;2.58, the Cho/NAA ratio was &gt;1.73, and a high lipid and/or lactate peak grade (grade &gt;3) was seen. Higher Cho/Cr ratios, Cho/NAA ratios, and lipid and/or lactate peak grades were found in atypical primary CNS lymphomas when compared with those of tumefactive demyelinating lesions. The area under the receiver operating characteristic curve of conventional MR was improved from 0.827 to 0.870 when Cho/NAA ratio was added in the uncertain cases.

CONCLUSIONS: 1H-MR spectroscopy may be useful for differentiating primary CNS lymphomas from tumefactive demyelinating lesions. Cho/NAA ratio could provide added value to conventional MR imaging.

PCNSL
:   primary central nervous system lymphoma
TDL
:   tumefactive demyelinating lesion
lip-lac
:   lipid and/or lactate peak
ROC
:   receiver operating characteristic
AUC
:   area under the receiver operating characteristic curve" />
<meta name="og-title" property="og:title" content="Utility of Proton MR Spectroscopy for Differentiating Typical and Atypical Primary Central Nervous System Lymphomas from Tumefactive Demyelinating Lesions" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/35/2/270" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: It may be challenging to differentiate primary CNS lymphomas, especially primary CNS lymphomas with atypical MR features, from tumefactive demyelinating lesions by the use of conventional MR. This study aimed to investigate the usefulness of 1H-MR spectroscopy for making this discrimination.

MATERIALS AND METHODS: Forty-four patients with primary CNS lymphomas and 21 with tumefactive demyelinating lesions were enrolled. Single-voxel (TE = 144 ms) 1H-MR spectroscopy scans with the use of the point-resolved spectroscopy sequence were retrospectively analyzed. The Cho/Cr and Cho/NAA area ratios were calculated. The lipid and/or lactate peak was visually categorized into 5 grades on the basis of comparison with the height of the Cr peak. The 1H-MR spectroscopy findings were compared in all of the primary CNS lymphomas and the tumefactive demyelinating lesions and in the subgroup of atypical primary CNS lymphomas and tumefactive demyelinating lesions. The thresholds and added value of 1H-MR spectroscopy to conventional MR were calculated by use of receiver operating characteristic curves.

RESULTS: Discrepancies between all of the primary CNS lymphomas and tumefactive demyelinating lesions were found in the Cho/Cr ratio ( P = .000), Cho/NAA ratio ( P = .000), and the lipid and/or lactate peak grade ( P = .000). Lymphoma rather than tumefactive demyelinating lesions was suggested when the Cho/Cr ratio was &gt;2.58, the Cho/NAA ratio was &gt;1.73, and a high lipid and/or lactate peak grade (grade &gt;3) was seen. Higher Cho/Cr ratios, Cho/NAA ratios, and lipid and/or lactate peak grades were found in atypical primary CNS lymphomas when compared with those of tumefactive demyelinating lesions. The area under the receiver operating characteristic curve of conventional MR was improved from 0.827 to 0.870 when Cho/NAA ratio was added in the uncertain cases.

CONCLUSIONS: 1H-MR spectroscopy may be useful for differentiating primary CNS lymphomas from tumefactive demyelinating lesions. Cho/NAA ratio could provide added value to conventional MR imaging.

PCNSL
:   primary central nervous system lymphoma
TDL
:   tumefactive demyelinating lesion
lip-lac
:   lipid and/or lactate peak
ROC
:   receiver operating characteristic
AUC
:   area under the receiver operating characteristic curve" />
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    <title>Utility of Proton MR Spectroscopy for Differentiating Typical and Atypical Primary Central Nervous System Lymphomas from Tumefactive Demyelinating Lesions | American Journal of Neuroradiology</title>  
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    <div class="highwire-article-citation highwire-citation-type-highwire-article node12817--5" data-node-nid="12817" id="top-node-12817--61496059983" data-pisa="ajnr;35/2/270" data-pisa-master="ajnr;ajnr.A3677" data-apath="/ajnr/35/2/270.atom" data-hw-author-tooltip-instance="highwire_author_tooltip"><div class="highwire-cite highwire-cite-highwire-article highwire-citation-jcore-article-title-complete clearfix has-author-tooltip highwire-citation-highwire-article-top-a">
  
  
      <div class="highwire-cite-overline"><span  class="highwire-cite-metadata-article-type highwire-cite-metadata">Research Article</span><span class="separator-pipe"></span><span  class="highwire-cite-metadata-art-cat highwire-cite-metadata"><span class="wrapper">Brain</span></span></div>
  
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      <h1 class="highwire-cite-title" id="page-title">Utility of Proton MR Spectroscopy for Differentiating Typical and Atypical Primary Central Nervous System Lymphomas from Tumefactive Demyelinating Lesions</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">S.-S. Lu</span>, <span class="highwire-citation-author" data-delta="1">S.J. Kim</span>, <span class="highwire-citation-author" data-delta="2">H.S. Kim</span>, <span class="highwire-citation-author" data-delta="3">C.G. Choi</span>, <span class="highwire-citation-author" data-delta="4">Y.-M. Lim</span>, <span class="highwire-citation-author" data-delta="5">E.J. Kim</span>, <span class="highwire-citation-author" data-delta="6">D.Y. Kim</span> and <span class="highwire-citation-author" data-delta="7">S.H. Cho</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">February 2014,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">35 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(2) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">270-277; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A3677 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-12817--61496059983" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">S.-S. Lu </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Radiology and Research Institute of Radiology (S.-S.L. S.J.K., H.S.K., C.G.C., D.Y.K., S.H.C.)</div><div class='author-affiliation'><span class='nlm-sup'>c</span>Department of Radiology (S.-S.L.), The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=S.-S.%2BLu%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Lu%20S&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AS.-S.%2BLu%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">S.J. Kim </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Radiology and Research Institute of Radiology (S.-S.L. S.J.K., H.S.K., C.G.C., D.Y.K., S.H.C.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=S.J.%2BKim%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Kim%20S&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AS.J.%2BKim%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">H.S. Kim </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Radiology and Research Institute of Radiology (S.-S.L. S.J.K., H.S.K., C.G.C., D.Y.K., S.H.C.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=H.S.%2BKim%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Kim%20H&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AH.S.%2BKim%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">C.G. Choi </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Radiology and Research Institute of Radiology (S.-S.L. S.J.K., H.S.K., C.G.C., D.Y.K., S.H.C.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=C.G.%2BChoi%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Choi%20C&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AC.G.%2BChoi%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-4"><div class="author-tooltip-name">Y.-M. Lim </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Department of Neurology (Y.-M.L.), University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Y.-M.%2BLim%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Lim%20Y&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AY.-M.%2BLim%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-5"><div class="author-tooltip-name">E.J. Kim </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>d</span>Philips Healthcare (E.J.K.), Seoul, Korea.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=E.J.%2BKim%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Kim%20E&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AE.J.%2BKim%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-6"><div class="author-tooltip-name">D.Y. Kim </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Radiology and Research Institute of Radiology (S.-S.L. S.J.K., H.S.K., C.G.C., D.Y.K., S.H.C.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=D.Y.%2BKim%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Kim%20D&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AD.Y.%2BKim%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-7"><div class="author-tooltip-name">S.H. Cho </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Radiology and Research Institute of Radiology (S.-S.L. S.J.K., H.S.K., C.G.C., D.Y.K., S.H.C.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=S.H.%2BCho%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Cho%20S&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AS.H.%2BCho%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div></div></div>  </div>

  
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    <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" data-highwire-cite-ref-tooltip-instance="highwire_reflinks_tooltip" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div class="article abstract-view "><span class="highwire-journal-article-marker-start"></span><div class="section abstract" id="abstract-2"><h2>Abstract</h2>
<div id="sec-1" class="subsection">

<p id="p-2"><strong>BACKGROUND AND PURPOSE:</strong> It may be challenging to differentiate primary CNS lymphomas, especially primary CNS lymphomas with atypical MR features, from tumefactive demyelinating lesions by the use of conventional MR. This study aimed to investigate the usefulness of <sup>1</sup>H-MR spectroscopy for making this discrimination.</p>
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<p id="p-3"><strong>MATERIALS AND METHODS:</strong> Forty-four patients with primary CNS lymphomas and 21 with tumefactive demyelinating lesions were enrolled. Single-voxel (TE = 144 ms) <sup>1</sup>H-MR spectroscopy scans with the use of the point-resolved spectroscopy sequence were retrospectively analyzed. The Cho/Cr and Cho/NAA area ratios were calculated. The lipid and/or lactate peak was visually categorized into 5 grades on the basis of comparison with the height of the Cr peak. The <sup>1</sup>H-MR spectroscopy findings were compared in all of the primary CNS lymphomas and the tumefactive demyelinating lesions and in the subgroup of atypical primary CNS lymphomas and tumefactive demyelinating lesions. The thresholds and added value of <sup>1</sup>H-MR spectroscopy to conventional MR were calculated by use of receiver operating characteristic curves.</p>
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<p id="p-4"><strong>RESULTS:</strong> Discrepancies between all of the primary CNS lymphomas and tumefactive demyelinating lesions were found in the Cho/Cr ratio (<em>P</em> = .000), Cho/NAA ratio (<em>P</em> = .000), and the lipid and/or lactate peak grade (<em>P</em> = .000). Lymphoma rather than tumefactive demyelinating lesions was suggested when the Cho/Cr ratio was &gt;2.58, the Cho/NAA ratio was &gt;1.73, and a high lipid and/or lactate peak grade (grade &gt;3) was seen. Higher Cho/Cr ratios, Cho/NAA ratios, and lipid and/or lactate peak grades were found in atypical primary CNS lymphomas when compared with those of tumefactive demyelinating lesions. The area under the receiver operating characteristic curve of conventional MR was improved from 0.827 to 0.870 when Cho/NAA ratio was added in the uncertain cases.</p>
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<p id="p-5"><strong>CONCLUSIONS:</strong> <sup>1</sup>H-MR spectroscopy may be useful for differentiating primary CNS lymphomas from tumefactive demyelinating lesions. Cho/NAA ratio could provide added value to conventional MR imaging.</p>
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</div><div class="section glossary" id="glossary-1">
<h2>ABBREVIATIONS:</h2>
<dl id="def-list-1"><dt id="def-item-1">PCNSL<span class="def-item-dt-sep"></span></dt><dd>primary central nervous system lymphoma<span class="def-item-dd-sep"></span></dd><dt id="def-item-2">TDL<span class="def-item-dt-sep"></span></dt><dd>tumefactive demyelinating lesion<span class="def-item-dd-sep"></span></dd><dt id="def-item-3">lip-lac<span class="def-item-dt-sep"></span></dt><dd>lipid and/or lactate peak<span class="def-item-dd-sep"></span></dd><dt id="def-item-4">ROC<span class="def-item-dt-sep"></span></dt><dd>receiver operating characteristic<span class="def-item-dd-sep"></span></dd><dt id="def-item-5">AUC<span class="def-item-dt-sep"></span></dt><dd>area under the receiver operating characteristic curve</dd></dl>
</div><ul class="copyright-statement"><li class="fn" id="copyright-statement-1">© 2014 by American Journal of Neuroradiology</li></ul><span class="highwire-journal-article-marker-end"></span></div><span class="related-urls"></span></div><a href="http://ajnr-stage2.stage.highwire.org/content/35/2/270.full" class="hw-link hw-link-article-full-text" data-icon-position="" data-hide-link-title="0">View Full Text</a></div>  </div>

  
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        	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-volume highwire-cite-metadata">Vol. 35</span>, <span  class="highwire-cite-metadata-issue highwire-cite-metadata">Issue 2 </span><div  class="highwire-cite-metadata-pubdate highwire-cite-metadata">1 Feb 2014 </div></div>
      
      
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    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Feb 2014, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">35 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(2) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">270-277; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A3677 </span></div>
  
  
  
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      <div class="highwire-cite-title">Utility of Proton MR Spectroscopy for Differentiating Typical and Atypical Primary Central Nervous System Lymphomas from Tumefactive Demyelinating Lesions</div>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">S.-S.</span> <span class="nlm-surname">Lu</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">S.J.</span> <span class="nlm-surname">Kim</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">H.S.</span> <span class="nlm-surname">Kim</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">C.G.</span> <span class="nlm-surname">Choi</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">Y.-M.</span> <span class="nlm-surname">Lim</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">E.J.</span> <span class="nlm-surname">Kim</span></span>, <span class="highwire-citation-author" data-delta="6"><span class="nlm-given-names">D.Y.</span> <span class="nlm-surname">Kim</span></span>, <span class="highwire-citation-author" data-delta="7"><span class="nlm-given-names">S.H.</span> <span class="nlm-surname">Cho</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Feb 2014, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">35 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(2) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">270-277; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A3677 </span></div>
  
  
  
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