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PT  - JOURNAL ARTICLE
AU  - Hollingworth, W.
AU  - Medina, L.S.
AU  - Lenkinski, R.E.
AU  - Shibata, D.K.
AU  - Bernal, B.
AU  - Zurakowski, D.
AU  - Comstock, B.
AU  - Jarvik, J.G.
TI  - A Systematic Literature Review of Magnetic Resonance Spectroscopy for the Characterization of Brain Tumors
DP  - 2006 Aug 01
TA  - American Journal of Neuroradiology
PG  - 1404--1411
VI  - 27
IP  - 7
4099  - http://www.ajnr.org/content/27/7/1404.short
4100  - http://www.ajnr.org/content/27/7/1404.full
SO  - Am. J. Neuroradiol.2006 Aug 01; 27
AB  - 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.