Diagnostic Performance of MR Spectroscopy in differentiating Brain Lesions

Abstract

Magnetic resonance spectroscopy (MRS) has emerged as an important advanced magnetic resonance imaging technique that provides non-invasive metabolic information beyond the anatomical details obtained from conventional MRI. By evaluating the biochemical composition of brain tissue through metabolites such as N-acetylaspartate (NAA), choline (Cho), creatine (Cr), lactate, lipids, and myo-inositol, MRS enhances tissue characterization and improves the differentiation of various intracranial lesions. Characteristic metabolite profiles and metabolite ratios, including Cho/NAA and Cho/Cr, have demonstrated significant value in distinguishing neoplastic from non-neoplastic lesions, grading gliomas, differentiating primary brain tumors from metastases, and identifying tumor recurrence following therapy. The integration of MRS with advanced MRI techniques, including diffusion-weighted imaging (DWI) and perfusion-weighted imaging (PWI), further improves diagnostic accuracy and clinical confidence by combining structural, physiological, and metabolic information. Despite its promising clinical applications, factors such as technical variability, spectral overlap, prolonged acquisition time, and the lack of standardized acquisition protocols continue to limit its widespread implementation. Recent advances in high-field MRI, artificial intelligence, radiomics, and quantitative metabolic analysis are expected to further enhance the diagnostic performance and clinical utility of MRS. This review summarizes the fundamental principles, metabolite characteristics, diagnostic performance, clinical applications, advantages, limitations, and future perspectives of MR spectroscopy in differentiating brain lesions, highlighting its growing role as a valuable adjunct to conventional neuroimaging.