DIAGNOSTIC ACCURACY OF MAGNETIC RESONANCE SPECTROGRAPHY VERSUS MAGNETIC RESONANCE IMAGING WITH AND WITHOUT CONTRAST TO DIFFERENTIATE LOW AND HIGH GRADE GLIOMA TAKING HISTOPATHOLOGY AS GOLD STANDARD

DR RABIA BABAR , DR NAEEM AHMAD KHAN, DR RAFIA IRUM

Background: The most widespread primary malignant tumors of the central nervous system are gliomas. Proper treatment planning and prognosis of gliomas requires proper preoperative grading. MRI is a highly applicable method in the assessment of tumors of the brain, but magnetic resonance spectroscopy (MRS) offers more metabolic data that might enhance the accuracy of diagnosis.

Objective: To identify the diagnostic value of magnetic resonance spectroscopy and magnetic resonance imaging in the differentiation of low- and high-grade glioma using histopathology as the gold standard.

Methodology: This validation cross-sectional study was carried out in the Department of Radiology, Services Hospital Lahore from July 2025 to October 2025. Non-probability consecutive sampling was used to include 150 patients aged 1665 years with clinical suspicion of glioma. MRI and MRS were performed on all patients and biopsy done to ascertain the histopathology outcome. MRI grading was done through the values of apparent diffusion coefficient (ADC) and MRS grading through the ratios of the metabolites such as Cho/Cr, Cho/NAA and the presence of lipid/lactate peaks. Diagnostic parameters such as sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy were computed using histopathology that was used as the gold standard.

Results: The average age of 150 patients was 42.3 / 11.6 years, and the males were the majority. High-grade and low-grade glioma were established by histopathology in 69 (46%) and 81 (54) patients respectively. The sensitivity, specificity, PPV, NPV and diagnostic accuracy of MRI was 88.4, 84.0, 82.7, 89.3, and 86.0 respectively. MRS had a sensitivity of 92.8, specificity of 91.3, PPV of 89.8, NPV of 93.8 and a diagnostic accuracy of 92.0. Conclusion: Magnetic resonance spectroscopy also proved to be more accurate in helping in the diagnosis of low- and high-grade gliomas than traditional MRI. The use of MRS in daily neuroimaging practices could be useful in improving preoperative tumor grading.