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Introduction We attempted to find the sensitivity and specificity of various pediatric brain masses in the Pakistani population while keeping histopathology or clinical diagnosis as the gold standard. Methods This was a retrospective study that was conducted from January 2007 to January 2016. We reviewed the records of 204 patients that presented to the radiology department of Aga Khan University Hospital (AKUH). Out of the 204, 135 pediatric patients in the 0-18 age group with focal brain lesions who underwent magnetic resonance spectroscopy (MRS) and a biopsy or clinical diagnosis were included. If histopathology was available, it was taken as the gold standard test; otherwise, clinical diagnosis was considered the gold standard. Results We had a total of 135 patients, of which 71 (52.6%) were male and 64 (47.4%) were female. The mean age represented was 7.2 ± 4.5 years with a range of 1-18 years. We found radiology (magnetic resonance imaging (MRI) and MRS) to have a 91.7% sensitivity and a 94.3% specificity for tumors. For leukodystrophy, there was a 64.3% sensitivity and a 97.3% specificity. On the other hand, infection and mitochondrial disorders had sensitivities of 35.7% and 21.7%, respectively, and specificities of 98.9% and 97.1%, respectively. The category labeled "others" had a sensitivity of 27.4% and a specificity of 86.0%. Conclusion A combination of MRI and MRS was highly sensitive and specific for tumors. For infections, leukodystrophy, mitochondrial disorders, and the category of "others," it was highly specific but poorly sensitive.



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