Magnetic Resonance Spectroscopy requires more study – pro

Magnetic resonance spectroscopy measures levels of different metabolites in body tissues and produces an image of resonances that correspond to different molecular arrangements of the “excited” isotopes. Magnetic resonance spectroscopic imaging (MRSI) in addtion incorporates imaging to produce spatially localized spectra from within the sample or patient.

The role of MRS in diagnosis and therapeutic planning has not been established by adequate clinical studies. There have been no credible prospective clinical trials demonstrating improved outcomes in patients evaluated with MRS compared to patients evaluated with conventional imaging modalities. The consensus of experts is that further studies are necessary.

An assessment of MRS prepared by the Tuft’s-New England Medical Center Evidence-Based Practice Center for the Agency for Healthcare Research and Quality (AHRQ) (Jordan et al, 2003) states: “Human studies conducted on the use of MRS for brain tumors demonstrate that this non-invasive method is technically feasible and suggest potential benefits for some of the proposed indications. However, there is a paucity of high quality direct evidence demonstrating the impact on diagnostic thinking and therapeutic decision-making. In addition, the techniques of acquiring the MRS spectra and interpreting the results are not well standardized. In summary, while there are a large number of studies that confirm MRS’ technical feasibility, there are very few published studies to evaluate its diagnostic accuracy and whether it can positively affect diagnostic thinking and therapeutic choice. Those studies that do address these areas often have significant design flaws including inadequate sample size, retrospective design and other limitations that could bias the results.”

A review of MRS for evaluation of suspected brain tumor by the BlueCross BlueShield Association Technology Evaluation Center (2003) concluded that “[t]he evidence is insufficient to permit conclusions concerning the effect of magnetic resonance spectroscopy on health outcomes.”

The Center for Medicare and Medicaid Services (2004) has determined that there is insufficient evidence to deem MRS “reasonable and necessary” for brain tumor diagnosis. Due to “methodological shortcomings” in the 11 studies reviewed on the use of MRS for brain lesion detection and a lack of a controlled comparison of MRS and traditional diagnostic strategies, CMS has announced that it will continue its current national non-coverage determination. Guidelines on bone tumors by ACR’s expert panel on musculoskeletal imaging (Morrison et al, 2005) noted that MRS has potential to differentiate benign from malignant lesions, but recommended more research.

P.C. Sundgren, MR Spectroscopy in Radiation Injury AJNR 2009 30: 1469-1476
W. Hollingwortha, L.S. Medinac, R.E. Lenkinskid, D.K. Shibataa, B. Bernalc, D. Zurakowskie, B. Comstockb and J.G. Jarvika A Systematic Literature Review of Magnetic Resonance Spectroscopy for the Characterization of Brain Tumors American Journal of Neuroradiology 27:1404-1411, August 2006

Moller-Hartmann W, Herminghaus S, Krings T, et al. Clinical application of proton magnetic resonance spectroscopy in the diagnosis of intracranial mass lesions. Neuroradiology 2002;44:371–81

Shah N, Sattar A, Benanti M, Hollander S, Cheuck L. Magnetic resonance spectroscopy as an imaging tool for cancer: A review of the literature. J Am Osteopath Assoc. 2006;106(1):23-27

Majos C, Aguilera C, Alonso J, Julia Sape M, Castener S, Sanchez JJ. Proton MR spectroscopy improves discrimination between tumor and pseudotumoral lesion in solid brain masses. AJNR Am J Neuroradiol 2009; 30: 544-51.

Davison JE, Davies NP, English MW, Philip S, MacPherson LK, Gissen P, Peet AC.
Magnetic resonance spectroscopy in the diagnostic evaluation of brainstem lesions in Alexander disease.J Child Neurol. 2011 Mar;26(3):356-60.

American College of Radiology. Practice Guideline for the Performance and Interpretation Of Magnetic Resonance Spectroscopy of the Central Nervous System. Available at: 2011

Participate in our Forums

To ask questions or participate in a discussion, please visit our Forums. You must LOGIN to participate.

Help Us Help Others

You can become a Site Sponsor. Or you may wish to support our work with a Donation.

Focused Articles For You

Lay Portal