Hydrogen Proton Magnetic Resonance Spectroscopy (MRS) in Differential Diagnosis of Intracranial Tumors: A Systematic Review.

Meningioma, glioma, and metastases are the most common intracranial tumors in clinical practice. In order to improve the prognosis of patients, timely diagnosis and early treatment are crucial. Hydrogen proton magnetic resonance spectroscopy (1H-MRS) imaging can noninvasively display the biochemical information of tissues in vivo and has been applied to identify and diagnose intracranial tumors. We want to comprehensively evaluate 1H-MRS identify and diagnose intracranial tumors by meta-analysis. Some databases such as PubMed and Cochrane Library were used to systematically search articles that were about identifying and diagnosing intracranial tumors with 1H-MRS. Then, weighted mean difference (WMD) was used as an effect size to conduct meta-analysis. There are altogether nine articles, including 533 patients. Results of meta-analysis: The Cho/Cr and Cho/NAA ratios in the LGG group were significantly lower than those in the HGG group (WMD = -0.69, 95% CI (-0.92, -0.45), P < 0.001, WMD = -0.76, 95% CI (-1.03, -0.48), P < 0.001). The Cho/Cr ratio of tumor and peritumor in the HGG group was significantly different from that in the metastasis group (0.68, 95% CI (-1.27, 2.62), P < 0.001, WMD = 0.94, 95% CI (0.41, 1.47), P < 0.001). There was no significant difference in the tumor and peritumor NAA/Cr ratio between the HGG group and metastasis group (WMD = -0.64, 95% CI (-1.63, 0.34), P=0.31, WMD = -0.22, 95% CI (-0.59, 0.15), P=0.24). 1H-MRS can provide metabolic information of different intracranial tumors and can effectively diagnose and differentiate glioma and metastasis. 1H-MRS can also provide a reliable basis for the classification of glioma, and has certain clinical application value.