{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T11:15:25Z","timestamp":1788434125858,"version":"build-2803163510"},"reference-count":26,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T00:00:00Z","timestamp":1787875200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"University of Medicine and Pharmacy of Craiova, Romania"},{"id":[{"id":"https:\/\/ror.org\/031d5vw30","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Purpose: To evaluate whether proton MR spectroscopy (1H-MRS) improves the differentiation of tumoral from non-tumoral intracranial lesions beyond conventional MRI, and to quantify its effect on diagnostic confidence, in a consecutive real-world bicentric cohort of diagnostically ambiguous lesions. Methods: This retrospective, bicentric observational study screened 122 consecutive patients who underwent brain MRI with 1H-MRS at two imaging centers, of whom 99 were eligible for final analysis after excluding 23 patients due to insufficient follow-up (&lt;12 months) or incomplete reference standard. The reference standard was histopathological confirmation in 43 cases (43.4%) and structured clinico-radiological follow-up of at least 12 months in 56 cases (56.6%). The reporting radiologist\u2019s binary diagnostic impression and confidence score were recorded before and after 1H-MRS. Conventional MRI alone was compared to MRI plus 1H-MRS using the exact McNemar test; Cho\/NAA discrimination was assessed by ROC analysis with bootstrap confidence intervals, and confidence change by the Wilcoxon signed-rank test. Secondary analyses comprised an intention-to-diagnose analysis of all 99 examinations, counting non-diagnostic spectra as test failures, and an evaluable-case sensitivity analysis restricted to histopathologically confirmed patients with interpretable spectra. Results: Of 99 examinations, 89 (89.9%) yielded interpretable spectra. In the primary analysis, qualitative MRS interpretation demonstrated sensitivity of 76.0% (95% CI: 61.8\u201386.9), specificity of 94.9% (95% CI: 82.7\u201399.4), and accuracy of 84.3% (CI: 75.0\u201391.1), compared with 54.0%, 89.7% and 69.7% (59.0\u201379.0) for conventional MRI alone (exact McNemar p = 0.024). ROC analysis of the Cho\/NAA ratio (n = 89) yielded an AUC of 0.858 (0.774\u20130.931); the exploratory, cohort-specific Youden-optimal cut-off was 1.41 (sensitivity 78.0%, specificity 87.2%). In the intention-to-diagnose analysis including all 99 examinations, accuracy was 78.8% (69.4\u201386.4). Diagnostic confidence increased significantly after 1H-MRS (median 1 to 2; Wilcoxon p &lt; 0.001; effect size r = 0.81), with moderate or major added value in 71 of 99 examinations (71.7%). Conclusions: In a diagnostically heterogeneous real-world cohort, 1H-MRS significantly improved the accuracy achievable with conventional MRI alone and substantially increased reported diagnostic confidence, with high specificity but only moderate sensitivity. A zone-based Cho\/NAA interpretative framework better reflects biological overlap than rigid binary thresholds. As this study assessed diagnostic accuracy and reported confidence rather than therapeutic decisions or patient outcomes, 1H-MRS should be regarded as an adjunctive decision-support modality rather than a standalone classifier in routine neuro-oncologic workflows.<\/jats:p>","DOI":"10.3390\/diagnostics16172772","type":"journal-article","created":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T18:33:52Z","timestamp":1787942032000},"page":"2772","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["1H-MR Spectroscopy as a Decision-Support Tool in the Differential Diagnosis of Intracranial Lesions: A Real-World Bicentric Retrospective Cohort"],"prefix":"10.3390","volume":"16","author":[{"given":"Laura Maria","family":"Georgescu","sequence":"first","affiliation":[{"name":"Doctoral School, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"},{"name":"Department of Radiology, University of Medicine and Pharmacy Carol Davila, 050474 Bucharest, Romania"},{"name":"Department of Radiology, Emergency University Hospital Bucharest, 050098 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandru","family":"\u0218erb\u0103noiu","sequence":"additional","affiliation":[{"name":"Department of Radiology, University of Medicine and Pharmacy Carol Davila, 050474 Bucharest, Romania"},{"name":"Department of Radiology, Emergency University Hospital Bucharest, 050098 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrian","family":"Costache","sequence":"additional","affiliation":[{"name":"Department of Radiology, University of Medicine and Pharmacy Carol Davila, 050474 Bucharest, Romania"},{"name":"Pathology Department, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-3099-4637","authenticated-orcid":false,"given":"Ioana-Andreea","family":"C\u00eerlig","sequence":"additional","affiliation":[{"name":"Doctoral School, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"},{"name":"Department of Radiology and Medical Imaging, Emergency Clinical County Hospital of Craiova, 200642 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"data-curation","vocabulary":"credit"}]},{"given":"Cristina-Mihaela","family":"Ciofiac","sequence":"additional","affiliation":[{"name":"Department of Radiology and Medical Imaging, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-1642-3587","authenticated-orcid":false,"given":"Nica Raluca","family":"Elena","sequence":"additional","affiliation":[{"name":"Department of Radiology and Medical Imaging, Emergency Clinical County Hospital of Craiova, 200642 Craiova, Romania"},{"name":"Department of Radiology and Medical Imaging, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucian-Mihai","family":"Florescu","sequence":"additional","affiliation":[{"name":"Department of Radiology and Medical Imaging, Emergency Clinical County Hospital of Craiova, 200642 Craiova, Romania"},{"name":"Department of Radiology and Medical Imaging, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"data-curation","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-0079-1449","authenticated-orcid":false,"given":"Radu Tudor","family":"Ion","sequence":"additional","affiliation":[{"name":"Department of Radiology, University of Medicine and Pharmacy Carol Davila, 050474 Bucharest, Romania"},{"name":"Department of Radiology, Emergency University Hospital Bucharest, 050098 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-0954-1266","authenticated-orcid":false,"given":"Ioana-Andreea","family":"Gheonea","sequence":"additional","affiliation":[{"name":"Department of Radiology and Medical Imaging, Emergency Clinical County Hospital of Craiova, 200642 Craiova, Romania"},{"name":"Department of Radiology and Medical Imaging, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"supervision","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1093\/neuros\/nyx103","article-title":"Current Clinical Brain Tumor Imaging","volume":"81","author":"Mabray","year":"2017","journal-title":"Neurosurgery"},{"key":"ref_2","first-page":"465","article-title":"Neuroimaging in neuro-oncology","volume":"6","author":"Cha","year":"2009","journal-title":"Neurother. 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