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AJNR - American Journal of Neuroradiology

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American Journal of Neuroradiology 24:946-951, May 2003
© 2003 American Society of Neuroradiology

Case Report
BRAIN

Proton MR Spectroscopy of Gliomatosis Cerebri: Case Report of Elevated Myoinositol with Normal Choline Levels

Efrat Saraf-Lavi^a, Brian C. Bowen^a, Pradip M. Pattany^a, Evelyn M.L. Sklar^a, James B. Murdoch^c and Carol K. Petito^b

^a Department of Radiology, University of Miami School of Medicine, Miami, FL
^b Department of Pathology, University of Miami School of Medicine, Miami, FL
^c Philips Medical Systems, Cleveland OH

Address reprint requests to Brian C. Bowen, MD, PhD, Department of Radiology, University of Miami School of Medicine, 1115 NW 14th Street, Miami, FL 33135

Summary: A 69-year-old woman presented with clinical and imaging findings suspicious for gliomatosis cerebri, later confirmed by biopsy (moderately cellular, infiltrating glioma). Single voxel proton MR spectroscopy (TE 20 and TE 135) and spectroscopic imaging (TE 135) performed at admission showed normal choline, decreased N-acetyl, and elevated myo-inositol levels relative to creatine. The primary conclusion is that in suspected cases of gliomatosis cerebri, myo-inositol/creatine and myo-inositol/N-acetyl should be determined because they may provide evidence of tumor, even though choline/creatine is normal. A corollary to this conclusion is that choline/creatine may be misleading if used to demarcate infiltrating glioma from edema.