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MR Spectroscopy in Gliomatosis Cerebri

Martin BendszusGo,a, Monika Warmuth-Metza, Rüdiger Kleina, Ralf Burgera, Christian Schichora, Jörg C. Tonna and Laszlo Solymosia

a From the Departments of Neuroradiology (M.B., M.W-M., L.S.), Neuropathology (R.K.), and Neurosurgery (R.B., C.S., J.C.T.), University of Würzburg, Germany.



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  		FIG 1. Case 4: 38-year-old woman with bifrontal hyperintensity and tumor spread via corpus callosum.

A, Axial T2-weighted spin-echo localizer image (1900/80).

B, Corresponding spectrum (CSI, PRESS, 1500/135, voxel size = 7.5 x 7.5 x 15 mm) shows a moderate increase in Cho/Cr and Cho/NAA and a decrease in NAA/Cr.



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  		FIG 2. Case 5: 12-year-old boy with seizure.

A, Axial T1-weighted localizer image (fast low-angle shot, 80/10) shows extensive hypointense infiltration of the right hemisphere with little mass effect.

B, Corresponding spectrum (CSI, PRESS, 1500/135, voxel size = 7.5 x 7.5 x 15 mm) shows a marked increase in Cho/Cr and Cho/NAA and a pronounced decrease in NAA/Cr. Moreover, there is a lactate doublet at 1.35 ppm.



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  		FIG 3. Case 8: 55-year-old man with diffuse involvement of both hemispheres.

A, Axial T2-weighted spin-echo localizer image (1900/80).

B, Corresponding spectrum. Stereotactic biopsy sample was taken from the denoted voxel, with a maximum Cho/NAA ratio of the lesion of 8.9 as well as a lactate doublet at 1.35 ppm. Histopathologic examination revealed a grade IV tumor. In other areas of the tumor there were lipid signals at 0.8 to 1.3 ppm (CSI, PRESS, 1500/135, voxel size = 7.5 x 7.5 x 15 mm).

FIG 4. Case 1: 10-year-old boy with seizure. Axial spin-echo T2-weighted image (1900/80) shows extensive hyperintensity of the left occipital, parietal, and temporal lobes, with infiltration of the thalamus and the insula. Both gray and white matter are affected, and there is little mass effect



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  		FIG 5. Metabolite ratios for Cho/Cr, NAA/Cr, and Cho/NAA. The difference between the histopathologic tumor grades is most pronounced in the Cho/NAA ratio. In the group of low-grade lesions, the maximum Cho/NAA level is 1.3, whereas in anaplastic tumors, the Cho/NAA ratio is at least 2.5 with a maximum value of 8.9 in a grade IV lesion





Copyright © 2009 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X