Improving diagnostic yield in brain biopsy: Coupling spectroscopic targeting with real-time needle placement

Walter A. Hall, Alastair Martin, Haiying Liu, Chip Truwit

Research output: Contribution to journalArticlepeer-review

83 Scopus citations


The purpose of this study was to determine the utility of intraoperative magnetic resonance spectroscopy (MRS) for targeting during brain biopsy using a skull-mounted trajectory guide. From January 1999 to January 2000, 17 patients had intraoperative MRS-guided brain biopsy using a trajectory guide. Ten had turbo spectroscopic imaging (TSI), and seven had both SVS (single-voxel spectroscopy) and TSI. Prospective stereotaxy was used to align the device in a short-bore 1.5-T MR scanner. Areas of elevated choline relative to creatine on SVS and TSI were targeted during the biopsy. Intraoperative imaging confirmed appropriate positioning of the biopsy needle at the time of tissue sampling in all cases. All 17 biopsies (100%) yielded diagnostic tissue. Six patients (34%) had glioblastomas multiforme, three (18%) had anaplastic astrocytomas, three (18%) had anaplastic oligodendrogliomas, two (12%) had radiation necrosis, and one each (6%) had germinoma, ganglioglioma, and astrocytoma. Postoperative imaging confirmed the absence of clinically and radiographically relevant hemorrhage. The findings on SVS correlated with the pathology in all seven cases (100%). In 13 of 17 patients (76%) who had TSI, the spectra correlated well with the permanent pathologic examination. The SVS and TSI spectra were similar in six of seven (86%) cases. Intraoperative MRS-guided brain biopsy using a trajectory guide is a simple, safe, and accurate technique for accessing areas of the brain of diagnostic interest.

Original languageEnglish (US)
Pages (from-to)12-15
Number of pages4
JournalJournal of Magnetic Resonance Imaging
Issue number1
StatePublished - 2001


  • Biopsy
  • Brain neoplasm
  • Image-guided surgery
  • Interventional magnetic resonance imaging
  • Magnetic resonance imaging
  • Stereotactic biopsy

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