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Unusual MR Spectroscopic Imaging Pattern of an Astrocytoma: Lack of Elevated Choline and High myo-Inositol and Glycine Levels

Ana Londoñoa, Mauricio Castilloa, Diane Armaoa, Lester Kwocka and Kinuko Suzukia

a From the University of North Carolina School of Medicine, Chapel Hill, NC



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  		FIG 1. Axial view fluid-attenuated inversion recovery image shows increased signal intensity involving cortex and white matter in the right insular and frontal regions.



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  		FIG 2. A, Localizer T2-weighted MR image shows position of voxel within the area of high signal intensity in the right insula.

B, Proton MR spectroscopic image (TE 30) obtained from the image shown in A shows low NAA, elevated Cr and m-Ins/Gly (MyoG), and normal appearing Cho.

C, Localizer T2-weighted MR image, obtained 15 mm below the level at which the image shown in A was obtained, shows position of the voxel within area of increased signal intensity in the right insula.

D, Proton MR spectroscopic image (TE 30) obtained from the image shown in C shows mildly decreased NAA, normal Cho to Cr relationship, and elevated m-Ins/Gly. The spectra shown are similar and are representative of the pattern seen throughout the lesion.



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  		FIG 3. Proton MR spectroscopic image (TE 135) obtained from a voxel within the area of T2 signal intensity abnormality. This long TE study confirms that the low levels of Cho and NAA revealed by short TE MR spectroscopy are not due to relaxation effects because they continue to be low. The Cr peak is high.





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