NetForum uses cookies to ensure that we give you the best experience on our website. If you continue to use the site, we'll assume that you are happy to receive these cookies on the NetForum website. Read about our cookies.
NetForum Community
Learn. Share. Optimize.
Log in | Sign up now | Submit content | Contact

Attention valued NetForum members:

Due to evolving technology needs and global privacy regulations, we have made the hard decision to suspend the NetForum User Community platform on Friday, November 29, 2019.

After this date, the current NetForum can no longer be reached. Please click here for more information about this decision, what happens next and how to stay in touch with us about the future of the community.

Go to similar content

MRS of right-sided cerebellar space-occupying lesion

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

Patient history:

A 25-year-old male presented at Misr Radiology Center with known right-sided cerebellar space-occupying lesion and ataxia. Lesion was suspicious of malignant neoplasm.

MR examination:

Conventional MRI at 1.5T was performed using variable pre-and post-contrast sequences, including axial FLAIR and sagittal T2-weighted sequences, followed by single-voxel MRS sequences at TE 144, after specifically placing single voxel on tissue portion of lesion.

MR images/spectra and interpretation:

Axial FLAIR Sagittal T2-weighted
Axial FLAIR
Sagittal T2-weighted

 

The axial FLAIR image shows right cerebellar space-occupying lesion of intermediate signal surrounded by minimal vasogenic white matter edema and consequent positive mass effect.

 

The mass exhibits predominantly low signal on T2-weighted sagittal and FLAIR images, reflecting its high cellularity. A small central portion of the lesion shows signs of breaking down.

 

It is somewhat difficult to decide whether the mass is located extra-axially or intra-axially, as it apparently has a wide dural base, yet also some features that suggest intra-axial location.

 

Regarding MRS findings, the striking feature is the remarkable increase in the choline metabolic peak, denoting very high cell membrane turnover with marked reductions of the other normal metabolic peaks, specifically N-acetyl aspartate and creatine. The lactate/lipid metabolic peaks are apparently minimally increased.

 

 

MRS single-voxel TE 144
MRS single-voxel TE 144

 

Remarkable increase in the choline metabolic peak, denoting high cell membrane turnover (associated significant decrease in NAA and Cr peaks) points to a malignant neoplastic lesion. Note in particular that the choline to N-acetyl aspartate ratio is highly elevated. The lactate/lipid metabolic peaks are minimally increased.

 

The striking feature is the remarkable increase in the choline metabolic peak, denoting very high cell membrane turnover with marked reductions of the other normal metabolic peaks, specifically N-acetyl aspartate and creatine. The lactate/lipid metabolic peaks are apparently minimally increased.

Working diagnosis:

The highly elevated choline metabolic peak and concomitantly marked NAA and creatine levels are suggestive of a malignant neoplastic lesion, such as a primary neuroectodermal tumor (PNET), most likely a medulloblastoma.

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.

 

Private clinic spearheads practical MR spectroscoscopy



This content has been made possible by NetForum Community.
Share this on: Share your link in twitter Share your link in facebook Share your link on LinkedIn Print Rate this article: Log in to vote

 
Rating:
Votes:
0
Views:
2482
Added:
Mar 27, 2006

Rate this:
Log in to vote
 

Case Study
Intera 1.5T
Release 10, Release 11, Release 8, Release 9
Explorer / Nova Dual, gradients, Master / Nova, Omni / Stellar, Power / Pulsar
Neuro, Spectroscopy
 

Clinical News
Best Practices
Case Studies
Publications and Abstracts
White Papers
Web seminars and Presentations
ExamCards
Protocols
Application Tips and FAQ
Training
Try an Application
Business News
Case Studies
White Papers
Web Seminars and Presentations
Utilization Services
Contributing Professionals
Contributing Institutions
Become a Contributor