FIG 6. Images obtained at the second follow-up evaluation (1 month later) in the patient in Figure 5 include conventional axial T1-weighted Gd-enhanced (T1W Gd) and hemodynamic (rCBV) MR images and multivoxel MR spectroscopic data. The increased size of the mass and mass effect implied tumor progression (Fig 5). Note that regions with high Cho levels that did not enhance in Figure 5 (spectra 6 and 7) are now enhancing. Neuropathologic analysis of stereotactic biopsy samples obtained from these regions confirmed the presence of tumor. Spectra 1–4 illustrate that hypointense regions of tumor corresponding mostly to normal tissue (spectrum 1) and central necrosis (spectrum 2). The high rCBV level corresponds to the ring of enhancement and regions of high Cho levels that are detected beyond the contrast-enhancing region (spectra 3 and 4). The complementary value of multivoxel MR spectroscopic imaging and hemodynamic MR imaging is illustrated.