Medical Policy

Subject: Magnetic Resonance Spectroscopy (MRS)
Document #: RAD.00022 Current Effective Date:    06/28/2017
Status: Reviewed Last Review Date:    05/04/2017


This document addresses magnetic resonance spectroscopy (MRS) which is a non-invasive technique that can be used to measure the concentrations of different chemical components within tissues. MRS has been studied most extensively in a variety of brain pathologies and may be performed as an adjunct to magnetic resonance imaging (MRI). While an MRI provides an anatomic image of the brain, MRS provides a functional image related to underlying dynamic physiology.  

Position Statement

Medically Necessary:

Magnetic resonance spectroscopy (MRS) is considered medically necessary when used to:

Investigational and Not Medically Necessary:

Magnetic resonance spectroscopy (MRS) is considered investigational and not medically necessary for all applications not listed above, including, but not limited to:


The non-invasive distinction between benign and malignant disease in the brain is an important diagnostic step that determines the necessity of a brain biopsy.  One common scenario is the distinction between recurrent tumor and radiation necrosis.  If a non-invasive study can accurately identify a benign process, the individual may be spared a brain biopsy, (that is, high negative predictive value).  Conversely, if a study can accurately identify a malignant process, the individual could initiate therapy without a confirmatory biopsy.  It is thought that the diagnostic performance of magnetic resonance imaging (MRI) and positron emission tomography (PET) is inadequate to influence biopsy decisions, and thus, there has been considerable interest in magnetic resonance spectroscopy (MRS), as a non-invasive imaging alternative.  The literature regarding MRS in individuals with suspected brain tumors is dominated by case series of heterogeneous subjects.  These studies suggest that MRS can appropriately influence biopsy decisions.  Additional systematic reviews and meta-analyses have added to the current knowledge base regarding the utility of MRS in the evaluation of brain lesions (Chen, 2016; Chuang, 2016; Wang, 2016).  Despite some limitations noted in the published evidence and the need for larger well-designed robust trials, the currently available evidence is sufficient to demonstrate that MRS is an effective technique for the management of brain lesions.

There is inadequate data regarding other applications of MRS.  Concerning prostate cancer imaging with MRS, the available published evidence includes a meta-analysis conducted in 2008 of the accuracy of prostate cancer studies which use MRS as a diagnostic tool.  Seven studies of MRS as a method to diagnose prostate cancer were included.  The pooled weighted sensitivity was 0.82 (95% confidence interval [CI], 0.73-0.89); specificity, 0.68 (95% CI, 0.58-0.76); and the area under the curve, 83.40.  All of these results were based on a cutoff for identifying "definitive" tumor of 0.85 for the ratio of (choline + creatine) to citrate.  The authors concluded that, as a new method in the diagnosis of prostate cancer, MRS has a better applied value compared to other common modalities but that large scale randomized controlled trials are needed to fully evaluate its clinical value (Wang, 2008).  

In 2010, Jambor assessed the ability of (11)C-acetate PET/CT, MRI, and proton MR spectroscopy ((1)H-MRS) to image localized prostate cancer and detect its aggressiveness, using qualitative and quantitative approaches.  Twenty-one subjects with untreated localized prostate cancer, diagnosed using transrectal ultrasound-guided biopsy, were prospectively enrolled.  Cancer laterality was based on the percentage of cancer and the highest Gleason score determined from biopsies.  In addition to PET/CT, 3-dimensional (1)H-MRS of the entire prostate volume using a quantitative approach was performed.  The imaging and histologic findings of 8 subjects undergoing subsequent prostatectomy were compared on a sextant level.  For each lobe and sextant, standardized uptake values (SUVs) and (choline + creatine + polyamines)-to-citrate (CCP/C) ratios were obtained from (11)C-acetate PET/CT and (1)H-MRS, respectively.  The visual and quantitative findings on PET/CT and MRI data were compared with cancer laterality and aggressiveness based on the Gleason score and with prostate-specific antigen (PSA) velocity and international risk group classification.  The sensitivity, specificity, and accuracy, on a lobar level using visual analysis of (11)C-acetate PET/CT were 80%, 29%, 71%, respectively, and 89%, 29%, 79%, respectively, using contrast-enhanced MRI.  The sensitivity and accuracy of (11)C-acetate PET/CT decreased to 64% and 63% and specificity increased to 62% when sextant analysis was performed.  The agreement between prostate cancer laterality based on biopsy findings and visual interpretation of (11)C-acetate PET/CT and contrast-enhanced MRI was similar at 71%.  The dominant-lesion SUVs or CCP/C values were not associated with histologically determined prostate cancer aggressiveness, nor did PSA velocity correlate with the SUV or CCP/C values from the entire gland.  The authors concluded that (11)C-acetate PET/CT, MRI, and (1)H-MRS enable detection of localized prostate cancer with comparable and limited accuracy but fail to provide information on cancer aggressiveness (Jambor, 2010).  Additional small studies of MRS in prostate cancer evaluation also concluded that larger, well-designed studies are needed to clarify the role of MRS in prostate cancer diagnosis and evaluation of post-treatment recurrence and to demonstrate its impact on clinical outcomes (Panebianco, 2010; Panebianco, 2012; Perdona, 2011; Sciarra, 2010).

In the case of neurological disorders such as Alzheimer's disease, Parkinson's disease, and multiple sclerosis, while MRS has demonstrated changes in neurochemistry, no studies were identified in the scientific literature that positively correlated these changes with clinical findings, established the sensitivity or specificity of MRS in these disorders, or compared the diagnostic or prognostic performance of MRS to that of established imaging techniques and other forms of testing.  The clinical utility of MRS, in terms of its value in clinical decision-making or improvement in health outcomes, as a result of management decisions based on MRS findings, has not been demonstrated, to date, for any conditions beyond brain tumor imaging (Baltzer, 2013; Cen, 2014; Shiino, 2012; Thayyil, 2010; Wang, 2015).


MRS is a non-invasive technique that can be used to measure the concentrations of different chemical components within tissues.  The technique is based on the same physical principles as magnetic resonance imaging (MRI), that is the detection of energy exchange between external magnetic fields and specific nuclei within atoms.  With MRI, this energy exchange, measured as a radiofrequency signal, is then translated into the familiar anatomic image by assigning different gray values, according to the strength of the emitted signal.  The principal difference between MRI and MRS is that in MRI the emitted radiofrequency is based on the spatial position of nuclei, while MRS detects the chemical composition of the scanned tissue.  The information produced by MRS is displayed graphically, as a spectrum with peaks consistent with the various chemicals detected.  MRS may be performed as an adjunct to MRI.  An MRI image is first generated, and then MRS spectra are developed at the site of interest, termed the voxel.  While an MRI provides an anatomic image of the brain, MRS provides a functional image related to underlying dynamic physiology.  MRS can be performed with existing MRI equipment that has been modified with additional software and hardware.  MRS has been studied most extensively in a variety of brain pathologies.


Abscess: A circumscribed collection of infectious material, such as pus, which is frequently associated with swelling and inflammation.

Magnetic resonance spectroscopy (MRS): A non-invasive imaging technique that can be used to measure concentrations of different chemicals in body tissues, aiding in the detection and discrimination of various cystic and tumor masses.


The following codes for treatments and procedures applicable to this document are included below for informational purposes. Inclusion or exclusion of a procedure, diagnosis or device code(s) does not constitute or imply member coverage or provider reimbursement policy. Please refer to the member's contract benefits in effect at the time of service to determine coverage or non-coverage of these services as it applies to an individual member.

When services may be Medically Necessary when criteria are met:

76390 Magnetic resonance spectroscopy
ICD-10 Diagnosis  
C70.0 Malignant neoplasm of cerebral meninges
C71.0-C71.9 Malignant neoplasm of brain
C79.31-C79.32 Secondary malignant neoplasm of brain, cerebral meninges
D32.0 Benign neoplasm of cerebral meninges
D33.0-D33.3 Benign neoplasm of brain, cranial nerves
D42.0 Neoplasm of uncertain behavior of cerebral meninges
D43.0-D43.3 Neoplasm of uncertain behavior of brain, cranial nerves
D49.6 Neoplasm of unspecified behavior of brain
G00.0-G03.9 Meningitis
G04.00-G05.4 Encephalitis, myelitis and encephalomyelitis
G06.0 Intracranial abscess and granuloma
G06.2 Extradural and subdural abscess, unspecified
G07 Intracranial and intraspinal abscess and granuloma in diseases classified elsewhere
G93.6 Cerebral edema
G93.81-G93.89 Other specified disorders of brain
I67.89 Other cerebrovascular disease [radiation necrosis]
T66.XXXS Radiation sickness, unspecified, sequela
Z85.841 Personal history malignant neoplasm of brain

When services are Investigational and Not Medically Necessary:
For the procedure codes listed above when criteria are not met or for all other diagnoses not listed; or when the code describes a procedure indicated in the Position Statement section as investigational and not medically necessary.


Peer Reviewed Publications:

  1. Aaen GS, Holshouser BA, Sheridan C, et al. Magnetic resonance spectroscopy predicts outcomes for children with nonaccidental trauma. Pediatrics. 2010; 125(2):295-303.
  2. Abeloff MD, Armitage JO, Lichter AS, et al. Clinical Oncology. 3rd ed. Edinburgh, UK: Churchill Livingston; 2004.
  3. Achten E, Santens P, Boon P et al. Single-voxel proton MR spectroscopy and positron emission tomography for lateralization of refractory temporal lobe epilepsy. AJNR Am J Neuroradiol. 1998; 19(1):1-8.
  4. Adamson AJ, Rand SD, Prost RW, et al. Focal brain lesions: effect of single-voxel proton MR spectroscopic findings on treatment decisions. Radiology. 1998; 209(1):73-78.
  5. Apisarnthanarax S, Chao KS. Current imaging paradigms in radiation oncology. Radiat Res. 2005; 163(1):1-25.
  6. Arnold DL, Wolinsky JS, Matthews PM, Falini A. The use of magnetic resonance spectroscopy in the evaluation of the natural history of multiple sclerosis. J Neurol Neurosurg Psychiatry. 1998; 64(Suppl 1):S94-101.
  7. Baltzer PA, Dietzel M. Breast lesions: diagnosis by using proton MR spectroscopy at 1.5 and 3.0 T—systematic review and meta-analysis. Radiology. 2013; 267(3):735-746.
  8. Bartella L, Morris EA, Dershaw DD, et al. Proton MR spectroscopy with choline peak as malignancy marker improves positive predictive value for breast cancer diagnosis: preliminary study. Radiology. 2006; 239(3):686-692.
  9. Burn DJ, O'Brien JT. Use of functional imaging in Parkinsonism and dementia. Mov Disord. 2003; 18 Suppl 6:S88-95.
  10. Burtscher IM, Holtas S. Proton magnetic resonance spectroscopy in brain tumors: clinical applications. Neuroradiology. 2001; 43(5):345-352.
  11. Cen D1, Xu L. Differential diagnosis between malignant and benign breast lesions using single-voxel proton MRS: a meta-analysis. J Cancer Res Clin Oncol. 2014; 140(6):993-1001.
  12. Chen WS, Li JJ, Hong L, et al. Diagnostic value of magnetic resonance spectroscopy in radiation encephalopathy induced by radiotherapy for patients with nasopharyngeal carcinoma: a meta-analysis. Biomed Res Int. 2016; 5126074.
  13. Chuang MT, Liu YS, Tsai YS, et al. Differentiating radiation-induced necrosis from recurrent brain tumor using MR perfusion and spectroscopy: a meta-analysis. PLoS One. 2016; 11(1):e0141438.
  14. Croteau D, Scarpace L, Hearshen D, et al. Correlation between magnetic resonance spectroscopy imaging and image-guided biopsies: semiquantitative and qualitative histopathological analyses of patients with untreated glioma. Neurosurgery. 2001; 49(4):823-830.
  15. Davanzo P, Yue K, Thomas MA, et al. Proton magnetic resonance spectroscopy of bipolar disorder versus intermittent explosive disorder in children and adolescence. Am J Psychiatry. 2003; 160(8):1442-1452.
  16. Delikatny EJ, Poptani H. MR techniques for in vivo molecular and cellular imaging. Radiol Clin North Am. 2005; 43(1):205-220.
  17. Fayed N, Morales H, Modrego PJ, Pina MA. Contrast/noise ratio on conventional MRI and choline/creatine ratio on proton MRI spectroscopy accurately discriminates low grade from high grade cerebral gliomas. Acad Radiol. 2006; 13(6):728-737.
  18. Fellows GA, Wright AJ, Sibtain NA, et al. Combined use of neuroradiology and 1H-MR spectroscopy may provide an intervention limiting diagnosis of glioblastoma multiforme. J Magn Reson Imaging. 2010; 32(5):1038-1044.
  19. Filippi M, Rocca MA, Rovaris M. Clinical trials and clinical practices in multiple sclerosis: conventional and emerging magnetic resonance imaging technologies. Curr Neuro Neurosci Rep. 2002; 2(3):267-276.
  20. Fink JR, Carr RB, Matsusue E, et al. Comparison of 3 Tesla proton MR spectroscopy, MR perfusion and MR diffusion for distinguishing glioma recurrence from post-treatment effects. J Magn Reson Imaging. 2012; 35(1):56-63.
  21. Firbank MJ Harrison RM, O'Brien JT. A comprehensive review of proton magnetic resonance spectroscopy studies in dementia and Parkinson's disease. Dement Geriatr Cogn Disord. 2002; 14(2):64-76.
  22. Galanaud D, Chinot O, Nicoli F, et al. Use of proton magnetic resonance spectroscopy of the brain to differentiate gliomatosis cerebri from low-grade glioma. J Neurosurg. 2003; 98(2):269-276. 
  23. Gropman A. Imaging of neurogenetic and neurometabolic disorders of childhood. Curr Neurol Neurosci Rep. 2004; 4(2):139-146.
  24. Harting I, Hartmann M, Jost G, et al. Differentiating primary central nervous system lymphoma from glioma in humans using localized proton magnetic resonance spectroscopy. Neurosci Lett. 2003; 342(3):163-166.
  25. Herholz K, Coope D, Jackson A. Metabolic and molecular imaging in neuro-oncology. Lancet Neurol. 2007; 6(8):711-724.
  26. Herminghaus S, Dierks T, Pilatus U, et al. Determination of histopathological tumor grade in neuroepithelial brain tumors by using spectral pattern analysis of in vivo spectroscopic data. J Neurosurg. 2003; 98(1):74-81.
  27. Hollingworth W, Medina LS, Lenkinski RE, et al. A systematic literature review of magnetic resonance spectroscopy for the characterization of brain tumors. Am J Neuroradiol. 2006; 27(7):1404-1411.
  28. Jambor I, Borra R, Kemppainen J, et al. Functional imaging of localized prostate cancer aggressiveness using 11C-acetate PET/CT and 1H-MR spectroscopy. J Nucl Med. 2010; 51(11):1676-1683.
  29. Johnson BD, Shaw LJ, Buchthal SD, et al. Prognosis in women with myocardial ischemia in the absence of obstructive coronary disease: results from the National Institutes of Health-National Heart, Lung, and Blood Institute-sponsored Women's Ischemia Syndrome Evaluation (WISE). Circulation. 2004; 109(24):2993-2999.
  30. Jung AJ, Westphalen AC. Imaging prostate cancer. Radiol Clin North Am. 2012; 50(6):1043-1059.
  31. Kantarci K, Jack CR Jr. Quantitative magnetic resonance techniques as surrogate markers of Alzheimer's disease. NeuroRx. 2004; 1(2):196-205.
  32. Karl A, Werner A. The use of proton magnetic resonance spectroscopy in PTSD research -- meta-analyses of findings and methodological review. Neurosci Biobehav Rev. 2010; 34(1):7-22.
  33. Kim SH, Chang KH, Song IC, et al. Brain abscess and brain tumor: discrimination with in vivo h-1 MR spectroscopy. Radiology. 1997; 204(1):239-245.
  34. Kimura T, Sako K, Tanaka K, et al. Evaluation of the response of metastatic brain tumors to stereotactic radiosurgery by proton magnetic resonance spectroscopy, 201TICI single photon emission computerized tomography and gadolinium-enhanced magnetic resonance imaging. J Neurosurg. 2004; 100(5):835-841.
  35. Kuzniecky R. Clinical applications of MR spectroscopy in epilepsy. Neuroimaging Clin N Am. 2004; 14(3):507-516.
  36. Lagemaat MW, Zechmann CM, Fütterer JJ, et al. Reproducibility of 3D 1H MR spectroscopic imaging of the prostate at 1.5T. J Magn Reson Imaging. 2012; 35(1):166-173.
  37. Lee CP, Payne GS, Oregioni A, et al. A phase I study of the nitroimidazole hypoxia marker SR4554 using 19F magnetic resonance spectroscopy. Br J Cancer. 2009; 101(11):1860-1868.
  38. Lin A, Bluml S, Mamelak AN. Efficacy Of proton magnetic resonance spectroscopy in clinical decision making for patients with suspected malignant brain tumors. J Neurooncology. 1999; 45(1):69-81.
  39. Lin A, Ross BD, Harris K, Wong W. Efficacy of proton magnetic resonance spectroscopy in neurological diagnosis and neurotherapeutic decision making. NeuroRx. 2005; 2(2):197-214.
  40. Lotumolo A, Caivano R, Rabasco P, et al. Comparison between magnetic resonance spectroscopy and diffusion weighted imaging in the evaluation of gliomas response after treatment. Eur J Radiol. 2015; 84(12):2597-2604.
  41. Lundbom N, Gaily E, Vuori R, et al. Proton spectroscopic imaging shows abnormalities in glial and neuronal cell pools in frontal lobe epilepsy. Epilepsia. 2001; 429(12):1507-1514.
  42. Majos C, Alonso J, Aguilera C, et al. Proton magnetic resonance spectroscopy (1 H MRS) of human brain tumors: assessment of the differences between tumor types and its applicability in brain tumor categorization.  Eur Radiol. 2003; 13(3):582-591.
  43. Majos C, Alonso J, Aguilera C, et al. Utility of proton MR spectroscopy in the diagnosis of radiologically atypical intracranial meningiomas. Neuroradiology. 2003; 45(3):129-136.
  44. Meyerand ME, Pipas JM, Mamourian A, et al. Classification of biopsy-confirmed brain tumors using single-voxel MR spectroscopy. Am J Neuroradiology. 1999; 20(1):117-123.
  45. Mullins PG, Rowland LM, Jung RE, Sibbitt WL Jr. A novel technique to study the brain's response to pain:  proton magnetic resonance spectroscopy.  Neuroimage. 2005; 26(2):642-646.
  46. Narayana PA, Wolinsky JS, Rao SB, et al. Multicentre proton magnetic resonance spectroscopy imaging of primary progressive multiple sclerosis. Mult Scler. 2004; 10 Suppl 1:S73-78.
  47. Norfray JF, Tomita T, Byrd SE, et al. Clinical impact of MR spectroscopy when MR imaging is indeterminate for pediatric brain tumors. AJR Am J Roentgenol. 1999; 173(1):119-125.
  48. O'Neill J, Schuff N, Marks W Jr, et al. Quantitative 1H magnetic resonance spectroscopy and MRI of Parkinson's Disease. Mov Disord. 2002; 17(5):917-927.
  49. Panebianco V, Sciarra A, Ciccariello M, et al. Role of magnetic resonance spectroscopic imaging ([(1)H]MRSI) and dynamic contrast-enhanced MRI (DCE-MRI) in identifying prostate cancer foci in patients with negative biopsy and high levels of prostate-specific antigen (PSA). Radiol Med. 2010; 115(8):1314-1329.
  50. Panebianco V, Sciarra A, Lisi D, et al. Prostate cancer: 1HMRS-DCEMR at 3T versus [(18)F]choline PET/CT in the detection of local prostate cancer recurrence in men with biochemical progression after radical retropubic prostatectomy (RRP). Eur J Radiol. 2012; 81(4):700-708.
  51. Perdona S, Di Lorenzo G, Autorino R, et al. Combined magnetic resonance spectroscopy and dynamic contrast-enhanced imaging for prostate cancer detection. Urol Oncol. 2013; 31(6):761-765.
  52. Pirzkall A, McKnight TR, Graves EE, et al. MR-spectroscopy guided target delineation for high-grade gliomas.  Int J Radiat Oncol Biol Phys. 2001; 50(4):915-928.
  53. Porto L, Kieslich M, Franz K, et al. Proton magnetic resonance spectroscopic imaging in pediatric low-grade gliomas. Brain Tumor Pathol. 2010; 27(2):65-70.
  54. Prat R, Galeano I, Lucas A, et al. Relative value of magnetic resonance spectroscopy, magnetic resonance perfusion, and 2-(18F) fluoro-2-deoxy-D-glucose positron emission tomography for detection of recurrence or grade increase in gliomas. J Clin Neurosci. 2010; 17(1):50-53.
  55. Purohit RS, Shinohara K, Meng MV, Carroll PR. Imaging clinically localized prostate cancer. Urol Clin North Am. 2003; 30(2):279-293.
  56. Rabinov JD, Lee PL, Barker FG, et al. In vivo 3-T MR spectroscopy in the distinction of recurrent glioma versus radiation effects: initial experience. Radiology. 2002; 225(3):871-879.
  57. Rand SD, Prost R, Haughton V, et al. Accuracy of single voxel proton MR spectroscopy in distinguishing neoplastic from non-neoplastic brain lesions. AJNR Am J Neuroradiology. 1997; 18(9):1695-1704. 
  58. Rapoport SI. Hydrogen magnetic resonance spectroscopy in Alzheimer's disease. Lancet Neurol. 2002; 1(2):82.
  59. Schlemmer H.P, Bachert P, Henze M, et al. Differentiation of radiation necrosis from tumor progression using proton magnetic resonance spectroscopy. Neuroradiology. 2002; 44(3):216-222.
  60. Sciarra A, Panebianco V, Ciccariello M, et al. Value of magnetic resonance spectroscopy imaging and dynamic contrast-enhanced imaging for detecting prostate cancer foci in men with prior negative biopsy. Clin Cancer Res. 2010; 16(6):1875-1883.
  61. Shiino A, Watanabe T, Shirakashi Y, et al. The profile of hippocampal metabolites differs between Alzheimer's disease and subcortical ischemic vascular dementia, as measured by proton magnetic resonance spectroscopy. J Cereb Blood Flow Metab. 2012; 32(5):805-815.
  62. Shiroishi MS, Panigrahy A, Moore KR, et al. Combined MRI and MRS improves pre-therapeutic diagnoses of  pediatric brain tumors over MRI alone. Neuroradiology. 2015; 57(9):951-956.
  63. Shukla-Dave A, Gupta RK, Roy R, et al. Prospective evaluation of in vivo proton MR spectroscopy in differentiation of similar appearing intracranial cystic lesions. Magn Reson Imaging. 2001; 19(1):103-110.
  64. Sibtain NA, Howe FA, Saunders DE. The clinical value of proton magnetic resonance spectroscopy in adult brain tumors. Clin Radiol. 2007; 62(2):109-119.
  65. Smith JK, Londono A, Castillo M, Kwock L. Proton magnetic resonance spectroscopy of brain-stem lesions. Neuroradiology. 2002; 44(10):825-829.
  66. Stadbauer A, Gruber S, Nimsky C, et al. Preoperative grading of gliomas using metabolite quantification with high-spatial-resolution proton MR spectroscopic imaging. Radiology. 2006; 238(3):958-969.
  67. Sturrock A, Laule C, Decolongon J, et al. Magnetic resonance spectroscopy biomarkers in premanifest and early Huntington disease. Neurology. 2010; 75(19):1702-1710.
  68. Swindle P, McCredie S, Russell P, et al. Pathologic characterization of human prostate tissue with proton MR spectroscopy. Radiology. 2003; 228(1):144-151.
  69. Tate AR, Underwood J, Acosta DM, et al. Development of a decision support system for diagnosis and grading of brain tumors using in vivo magnetic resonance single voxel spectra. NMR Biomed. 2006; 19(4):411-434.
  70. Taylor JS, Langston JW, Reddick WE, et al. Clinical value of proton magnetic resonance spectroscopy for differentiating recurrent or residual brain tumor from delayed cerebral necrosis. Int J Radiation Oncol Biol Phys. 1996; 36(5):1251-1261.
  71. Thayyil S, Chandrasekaran M, Taylor A, et al. Cerebral magnetic resonance biomarkers in neonatal encephalopathy: a meta-analysis. Pediatrics. 2010; 125(2):e382-e395.
  72. Tong Z, Yamaki T, Harada K, Houkin K. In vivo quantification of the metabolites in normal brain and brain tumors by proton MR spectroscopy using water as an internal standard. Magn Reson Imaging. 2004; 22(7):1017-1024.
  73. Tse GM, Cheung HS, Pang LM, et al. Characterization of lesions of the breast with proton MR spectroscopy:  comparison of carcinomas, benign lesions, and phyllodes tumors. AJR Am J Roentgenol. 2003; 181(5):1267-1272.
  74. Tzika AA, Zarifi MK, Goumnerova L, et al. Neuroimaging in pediatric brain tumors: Gd-DTPA-enhanced hemodynamic and diffusion MR imaging compared with MR spectroscopic imaging. AJNR Am J Neuroradiol. 2002; 23(2):322-333.
  75. Umbehr M, Bachmann LM, Held U, et al. Combined magnetic resonance imaging and magnetic resonance spectroscopy imaging in the diagnosis of prostate cancer: a systematic review and meta-analysis. Eur Urol. 2009; 55(3):575-590.
  76. Vagnozzi R, Signoretti S, Cristofori L, et al. Assessment of metabolic brain damage and recovery following mild traumatic brain injury: a multicenter, proton magnetic resonance spectroscopic study in concussed patients. Brain. 2010; 133(11):3232-3242.
  77. Vaidya SJ, Payne GS, Leach MO, Pinkerton CR. Potential role of magnetic resonance spectroscopy in assessment of tumor response in childhood cancer. Eur J Cancer. 2003; 39(6):728-735.
  78. Vicente J, Fuster-Garcia E, Tortajada S, et al. Accurate classification of childhood brain tumors by in vivo 1H MRS - a multi-center study. Eur J Cancer. 2013; 49(3):658-667.
  79. Walecki J, Tarasow, E, Kubas B, et al. Hydrogen-1 MR spectroscopy of the peritumoral zone in patients with cerebral glioma: assessment of the value of the method. Acad Radiol. 2003; 10(2):145-153.
  80. Wang P, Guo YM, Liu M, et al. A meta-analysis of the accuracy of prostate cancer studies which use magnetic resonance spectroscopy as a diagnostic tool. Korean J Radiol. 2008; 9(5):432-438.
  81. Wang L, Hricak H, Kattan MW, et al. Prediction of organ-confined prostate cancer: incremental value of MR imaging and MR spectroscopic imaging to stage nomograms. Radiology. 2006; 238(2):597-603.
  82. Wang W, Hu Y, Lu P, et al. Evaluation of the diagnostic performance of magnetic resonance spectroscopy in  brain tumors: a systematic review and meta-analysis. PLoS One. 2014; 9(11):e112577.
  83. Wang H, Tan L, Wang HF, et al. Magnetic resonance spectroscopy in Alzheimer's disease: systematic review and meta-analysis. J Alzheimers Dis. 2015; 46(4):1049-1070.
  84. Wang Q, Zhang H, Zhang J, et al. The diagnostic performance of magnetic resonance spectroscopy in  differentiating high-from low-grade gliomas: A systematic review and meta-analysis. Eur Radiol. 2016; 26(8):2670-2684.
  85. Weber MA, Zoubaa S, Schlieter M, et al. Diagnostic performance of spectroscopic and perfusion MRI for distinction of brain tumors. Neurology. 2006; 66(12):1899-1906. Erratum in: Neurology. 2006; 67(5):920.
  86. Weinreb JC, Blume JD, Coakley FV, et al. Prostate cancer: sextant localization at MR imaging and MR spectroscopic imaging before prostatectomy--results of ACRIN prospective multi-institutional clinicopathologic study. Radiology. 2009; 251(1):122-133.
  87. Weybright P, Sundgren PC, Maly P, et al. Differentiation between brain tumor recurrence and radiation injury using MR spectroscopy. AJR Am J Roentgenol. 2005; 185(6):1471-1476.
  88. Wilken B, Dechent P, Herms J, et al. Quantitative proton magnetic resonance spectroscopy of focal brain lesions. Pediatr Neurol. 2000; 23(1):22-31.
  89. Wilson M, Cummins CL, Macpherson L, et al. Magnetic resonance spectroscopy metabolite profiles predict survival in pediatric brain tumors. Eur J Cancer. 2013; 49(2):457-464.
  90. Zapotoczna A, Sasso G, Simpson J, Roach M 3rd. Current role and future perspectives of magnetic resonance spectroscopy in radiation oncology for prostate cancer. Neoplasia. 2007; 9(6):455-463.
  91. Zeng QS, Li CF, Liu H, et al. Distinction between recurrent glioma and radiation injury using magnetic resonance spectroscopy in combination with diffusion-weighted imaging. Int J Radiat Oncol Biol Phys. 2007; 68(1):151-158.
  92. Zeng Q, Liu H, Zhang K, et al. Noninvasive evaluation of cerebral glioma grade by using multivoxel 3D proton MR spectroscopy. Magn Reson Imaging. 2011; 29(1):25-31.
  93. Zhang H, Ma L, Wang Q, et al. Role of magnetic resonance spectroscopy for the differentiation of recurrent  glioma from radiation necrosis: a systematic review and meta-analysis. Eur J Radiol. 2014; 83(12):2181-2189.

Government Agency, Medical Society, and Other Authoritative Publications:

  1. Alberta Health Services. High Field Magnetic Resonance Spectroscopy Imaging for Follow Up of Prostate Cancer Post Brachytherapy Implantation. NCT00126854. Last updated February 24, 2016. Available at: Accessed on March 22, 2017.
  2. American College of Radiology (ACR). Appropriateness Criteria® Practice Guideline for the Performance and Interpretation Of Magnetic Resonance Spectroscopy of the Central Nervous System. Revised 2013. Available at: Accessed on March 22, 2017.
  3. American College of Radiology (ACR). Appropriateness Criteria® : Focal Neurologic Deficit. Updated 2012. Available at: . Accessed on March 22, 2017.
  4. American Urological Association Education and Research, Inc. PSA testing for the pretreatment staging and posttreatment management of prostate cancer: 2013 Revision of 2009 Best Practice Statement. Linthicum, MD: American Urological Association Education and Research, Inc.
  5. Blue Cross Blue Shield Association. Magnetic Resonance Spectroscopy for Evaluation of Suspected Brain  Tumor. TEC Assessment, 2003; 18(1):1-26.
  6. Centers for Medicare and Medicaid Services. National Coverage Determination: Magnetic Resonance Spectroscopy (MRS). NCD #220.2.1. Effective September 10, 2004. Available at: Accessed on March 22, 2017.
  7. Dormont D, Seidenwurm DJ, Davis PC, et al. Expert Panel on Neurologic Imaging. American College of Radiology. ACR Appropriateness Criteria® : Dementia and Movement Disorders. Last reviewed 2015. Available at: . Accessed on March 22, 2017.
  8. Frohman EM, Goodin DS, Calabresi PA, et al.; Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. The utility of MRI in suspected MS: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology. 2003; 61(5):602-611.
  9. Hailey D. Magnetic resonance spectroscopy (MRS) in the management of localized prostate cancer. Ottawa: Canadian Coordinating Office for Health Technology Assessment (CCOHTA) 2003. Available at: Accessed on March 22, 2017.
  10. Jordan H, Bert R, Chew P, et al. Agency for Healthcare Research and Quality (AHRQ). Magnetic Resonance Spectroscopy for Brain Tumors Technology Assessment. Tufts-New England Medical Center. April 24, 2003. No. 290-02-0022. Rockville, MD. Available at: Accessed on March 22, 2017.
  11. Memorial Sloan-Kettering Cancer Center and National Cancer Institute. Monitoring Response to Neoadjuvant Chemotherapy by the Use of Breast Proton MR Spectroscopy. NCT00580086. Last updated December 23, 2009. Available at:  Accessed on March 22, 2017.
  12. Ment LR, Bada HS, Barnes P, et al. Practice parameter: Neuroimaging of the neonate: report of the Quality Standards Subcommittee of the America Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology. 2002; 58(12):1726-1738.
  13. Mowatt G, Scotland G, Boachie C, et al. The diagnostic accuracy and cost-effectiveness of magnetic resonance spectroscopy and enhanced magnetic resonance imaging techniques in aiding the localization of prostate abnormalities for biopsy: a systematic review and economic evaluation. Health Technol Assess. 2013; 17(20):vii-xix, 1-281.
  14. National Cancer Institute (NCI), American College of Radiology Imaging Network. Magnetic Resonance Imaging and Magnetic Resonance Spectroscopic Imaging in Diagnosing the Extent of Disease in Patients With Prostate Cancer.  NLM Identifier: NCT00032058. Last updated on February 18, 2011. Available at: Accessed on March 22, 2017.
  15. NCCN Clinical Practice Guidelines in Oncology. © 2017. National Comprehensive Cancer Network, Inc. For additional information: Accessed on March 22, 2017.
    • Central Nervous System Cancers (V1.2016). Revised July 25, 2016.
    • Prostate Cancer (V2.2017). Revised February 21, 2017.
  16. New York University School of Medicine. Image Guided Therapy in the Treatment of Gliomas.  NLM Identifier:  NCT01263821. Last updated September 8, 2016.  Available at: Accessed on March 22, 2017.
  17. Washington University School of Medicine.  MRI (Including Spectroscopy and Fat-Saturations and Diffusion-Weighted Imaging) in Cervical Cancer.  NCT01060033. Last updated September 5, 2014. Available at: Accessed on March 22, 2017.
Websites for Additional Information
  1. American College of Radiology (ACR). Available at: Accessed on March 22, 2017.

Magnetic Resonance Spectroscopy
NMR Spectroscopy

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Document History




Reviewed 05/04/2017 Medical Policy & Technology Assessment Committee (MPTAC) review. 
Reviewed 05/03/2017 Hematology/Oncology Subcommittee review. Updated the formatting in the Position Statement section. The Rationale and References sections were updated.
Reviewed 05/05/2016 MPTAC review. 
Reviewed 05/04/2016 Hematology/Oncology Subcommittee review. References were updated. Removed ICD-9 codes from Coding section.
Reviewed 05/07/2015 MPTAC review. 
Reviewed 05/06/2015 Hematology/Oncology Subcommittee review. References were updated.
Reviewed 05/15/2014 MPTAC review. 
Reviewed 05/14/2014 Hematology/Oncology Subcommittee review. Coding and References sections were updated.
Reviewed 05/09/2013 MPTAC review. 
Reviewed 05/08/2013 Hematology/Oncology Subcommittee review. Updated the Rationale and Reference sections.
Revised 05/10/2012 MPTAC review. Prostate cancer imaging was added to the list of indications considered investigational and not medically necessary. The Rationale and References were updated.
Reviewed 05/19/2011 MPTAC review. 
Reviewed 05/18/2011 Hematology/Oncology Subcommittee review. Updated Reference section.
Reviewed 05/13/2010 MPTAC review.  Updated Reference section.
Reviewed 05/12/2010 Hematology/Oncology Subcommittee review.
Reviewed 05/21/2009 MPTAC review.  Updated Reference section.
Reviewed 05/20/2009 Hematology/Oncology Subcommittee review.
Reviewed 05/15/2008 MPTAC review.  References were updated.
  02/21/2008 The phrase "investigational/not medically necessary" was clarified to read "investigational and not medically necessary." This change was approved at the November 29, 2007 Medical Policy and Technology Assessment Committee (MPTAC) meeting.
Reviewed 05/17/2007 MPTAC review. Coding and References were updated. 
Reviewed 06/08/2006 MPTAC review. References were updated.
  11/21/2005 Added reference for Centers for Medicare and Medicaid Services (CMS) – National Coverage Determination (NCD).
Revised 07/14/2005 MPTAC review. Revision based on Pre-merger Anthem and Pre-merger WellPoint Harmonization.    
Pre-Merger Organizations

Last Review Date

Document Number


Anthem, Inc.


RAD.00022 Magnetic Resonance Spectroscopy  
WellPoint Health Networks, Inc.


4.01.13 Magnetic Resonance Spectroscopy