31Phosphorous and Single Voxel Proton MR Spectroscopy and Diffusion-Weighted Imaging in a Case of Star Fruit Poisoning
Y.L. Chana,
H.K. Ngb,
C.B. Leungc and
D.K.W. Yeungd
a Departments of Diagnostic Radiology and Organ Imaging, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
b Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
c Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
d Clinical Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
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FIG 1. MR images and MR spectroscopy obtained 3 days after admission.
A, Axial view fluid-attenuated inversion recovery T2-weighted MR image (8000/110/1 [TR/TE/NEX]; inversion time, 2400 ms) shows symmetrical hyperintense lesions in both thalami. In the right temporo-occipital lobe junction, gyriform hyperintensity is observed.
B, Axial view T1-weighted MR image (500/15/2) shows a subtle decrease in signal intensity in the thalami and the right superior temporo-occipital junction.
C, Axial view diffusion-weighted image (b = 800 s/mm2; 1600/22/2; diffusion TE, 80 ms) shows the hyperintense lesion in the thalami and right superior temporo-occipital lobe junction in a more conspicuous manner than does the T2-weighted MR image (compare with panel A).
D, Single voxel proton MR spectrum (2000/136) shows a decreased N-acetylaspartate (NAA) peak at 2.02 ppm in the right temporo-occipital lobe lesion. Lactate (Lac) is shown with the inverted doublet centered around 1.33 ppm. Unprocessed and processed spectra are shown, respectively, on the lower and upper parts of the figure.
E, 31Phosphorous MR spectrum shows decreased phosphocreatine (PCr) at 0 ppm, ß-nucleotide triphosphate (ß-NTP) at -16.3 ppm, and elevated inorganic phosphate (Pi) at 4.9 ppm in the right temporo-occipital lobe lesion compared with the contralateral morphologically intact left side. Unprocessed and processed spectra are shown, respectively, on the lower and upper parts of the figure.
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FIG 2. MR images and 31phosphorous MR spectrum obtained 4 weeks after admission and after hemodialysis.
A, Axial view T1-weighted MR image shows hyperintense change at the thalami and right superior temporo-occipital lobe cortex.
B, 31Phosphorous MR spectrum shows phosphocreatine (PCr). ß-nucleoside triphosphates (ß-NTP), relative to inorganic phosphate (Pi) in the right temporo-occipital lobe (same voxel as that shown in Fig 1, panel E), have increased to reach normal levels.
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