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MR spectroscopy evaluation of brain stem and temporal lobe

Case Study
Abbas, Yasser, M.D., Ph.D. Cairo, Misr Radiology Center Egypt
Ibrahim, Ahmed, MD Cairo, Misr Radiology Center Egypt

MRS evaluation of brain stem and temporal lobe

Patient history:

A 20-year-old male presented at Misr Radiology Center with brain stem symptoms and low grade fever. The MR examination was done to help differentiate tumor from inflammation.

MR spectroscopy examination:

Conventional MRI at 1.5T was performed using various pre- and post-contrast sequences, including axial FLAIR sequences, followed by two single-voxel spectroscopic sequences at TE 31 and 144, respectively, centered on brain stem area.

MR images/spectra and interpretation:



The axial FLAIR image shows high signal intensity involving the whole brain stem region and to a lesser extent the left temporal region. The lesion involves both the brain stem and left temporal lobe, a pattern suggestive of encephalitis.


The MRS spectra corroborate, showing a clear elevation of the myo-inositol peak at 3.5 ppm, an astrocytic marker. This is best demonstrated on the short TE sequence 31 ms, due to the particular decay time of myo-inositol. Moreover, there are mild to moderate elevations of the lipids and lactates and also a suggestion of a slight elevation of the glutamine glutamate group. In addition, choline is not seen to be substantially elevated. Malignant tumors in particular demontrate elevations in choline as this represents accentuated cell membrane turnover. There is an obvious reduction of NAA, which is the normal neuronal marker, however this occurs both with inflammatory and neoplastic processes, reflecting the reduced neurons in the affected regions of the brain. Therefore, quantitatively, there is remarkable elevation of the myo-inositol-to-creatine ratio.

Working diagnosis:

Encephalitis. MRS data point toward an inflammatory versus neoplastic process.

Impact of MRS:

When conventional MRI scans fail to characterize a lesion with certainty, MRS can facilitate diagnosis by demonstrating distinct metabolic signatures of disparate pathologies, thereby informing treatment options.


More information in the Clinical View article:

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Mar 27, 2006

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