FIG 4. Case 18: A typical case in which the spectroscopic voxel is heterogeneous on MR images before and after contrast agent administration.

A, T1-weighted MR image shows the spectroscopic voxel (square) filled with heterogeneous tumor, including intratumoral hemorrhage appearing as a hyperintense area.

B, Contrast-enhanced T1-weighted MR image shows heterogeneous enhancement within the voxel.

C, Proton spectrum obtained from the region indicated in A shows a Cho value of 5.21.

D, Photomicrograph of the resected tumor indicates glioblastoma multiforme (grade 4) (hematoxylin-eosin, original magnification x100).

E, Photomicrograph of Ki-67 staining of the same tumor specimen shows a Ki-67 labeling index of 50.20% (original magnification x100).