International Journal of Research & Review (www.ijrrjournal.com) 470 Vol.5; Issue: 10; October 2018 International Journal of Research and Review www.ijrrjournal.com E-ISSN: 2349-9788; P-ISSN: 2454-2237 Original Research Article Grading of Intracranial Neoplasms with MR Perfusion and MR Spectroscopy Niharika Gupta 1 , Samar Chatterjee 2 , Rajesh Uddandam 3 , Udaybhanu Kovilapu 2 , Narendra Kumar Jain 2 , Dr J Sai Kiran 3 1 Dept of Radiodiagnosis, Command Hospital (WC), Panchkula - 134107 2 Dept of Radiodiagnosis, Armed Forces Medical College, Pune - 411040 3 Dept of Internal Medicine, Interfaith Medical Center, Brooklyn, New York Corresponding Author: Samar Chatterjee ABSTRACT Purpose: To compare findings of conventional magnetic resonance (MR) imaging, MR perfusion and MR spectroscopy in grading of the primary intra-cranial neoplasms. Materials and Methods: This prospective observational, comparative study was conducted in a tertiary care hospital. 37 consecutive patients with freshly detected primary intracranial intra-axial neoplasms were included in the study. T1 axial, T2 axial, FLAIR axial, diffusion-weighted images, Coronal T2 weighted, T1-weighted, dynamic susceptibility contrast (DSC) MR perfusion, MR spectroscopy and post contrast T1-weighted 3D images were obtained. Grading of the intracranial neoplasms was done on the basis of MR imaging. Histology specimen was obtained by surgical resection or stereotactic biopsy and graded as high-grade glioma (HGG) and low-grade glioma (LGG). Results: On histopathological examination, 24 cases were proven to be HGG and 13 to be LGG. The mean Cho/NAA ratio for HGG was 7.3 and for LGG it was 1.7. The mean rCBV for HGG was 2.95 and for LGG was 0.92. Out of 37 intra-axial tumors, 24 histologically proven HGG were all correctly diagnosed with spectroscopy imaging, however 2 LGG were over diagnosed to be HGG. The sensitivity, specificity, PPV, and NPV for determination of a high-grade glioma with MR Spectroscopy and MR Perfusion imaging were 100%, 84.6%, 92.3%, and 100%, respectively. AUC measured 0.92. Conclusion: Advanced neuroimaging using DSC MR perfusion and MR Spectroscopy allows accurate grading of tumor, which enables surgical planning, guiding accurate stereotactic biopsy from the most malignant part of the tumor and planning further treatment. Keywords: Gliomas, Magnetic resonance imaging, Spectroscopy, Perfusion INTRODUCTION Gliomas are very heterogeneous group of central nervous system (CNS) tumors and are classified by World Health Organization (WHO) in terms of histologic grades. [1] Biopsy sampling of the brain tumors is associated with inherent limitations due to sampling error and technique. This highlights the critical role of imaging to find the part of the tumor with the highest grade, as the therapeutic approaches, response to therapy, and prognosis depend on accurate grading. Imaging also aids in presurgical planning of the brain tumors, as it helps to preserve eloquent regions of the brain and fiber tracts with reduced post-surgical morbidity. [2, 3] Neuroimaging is a powerful primary diagnostic noninvasive tool to determine and prognosticate the management of