Detecting Tumor-Associated Intracranial Hemorrhage Using Proton Magnetic Resonance Spectroscopy

Intracranial hemorrhage associated with primary or metastatic brain tumors is a critical condition that requires urgent intervention, often through open surgery. Nevertheless, surgical interventions may not always be feasible due to two main reasons: (1) extensive hemorrhage can obscure the underlying tumor mass, limiting radiological assessment; and (2) intracranial hemorrhage may occasionally present as the first symptom of a brain tumor without prior knowledge of its existence. The current review of case studies suggests that advanced radiological imaging techniques can improve diagnostic power for tumoral hemorrhage. Adding proton magnetic resonance spectroscopy (1H-MRS), which profiles biochemical composition of mass lesions could be valuable: it provides unique information about tumor states distinct from hemorrhagic lesions bypassing the structural obliteration caused by the hemorrhage. Recent advances in 1H-MRS techniques may enhance the modality's reliability in clinical practice. This perspective proposes that 1H-MRS can be utilized in clinical settings to enhance diagnostic power in identifying tumors underlying intracranial hemorrhage.