Apparent diffusion coefficient and Magnetic resonance spectroscopy in grading of malignant brain neoplasms

Aim: This work aims to study the role of combined apparent diffusion coefficient (ADC) and Magnetic resonance spectroscopy (MRS) in grading malignant brain neoplasms. Methods: A prospective study included 40 patients who were evaluated by standard contrast enhanced MRI, diffusion weighted imaging and multivoxel spectroscopy. Results: Statistically significant difference was found between tumoral ADC values in low grade versus high grade tumors and metastasis and also between the peritumoral ADC values in metastasis versus low and high grade tumors. Statistically significant difference is noticed between tumoral Cho/Cr ratio values in low grade versus high grade tumors and metastasis, and also peritumoral Cho/Cr ratio values in low grade and metastasis versus high grade tumors. Statistically significant difference between tumoral Cho/NAA ratio in low grade versus high grade tumors and metastasis and lastly between peritumoral Cho/NAA ratio in low grade and metastasis versus high grade tumors was found. Lipid and lactate peaks were found frequently in high grade tumors and metastasis. Conclusion: The combination of calculated ADC values and MR spectroscopy is useful in grading of malignant brain tumors and were more useful together than each on its own