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FIG 3.
37-year-old-man with a history of oligodendroglioma who had previously had a resection and received radiation therapy. He presented with three separate enhancing lesions and extensive surrounding edema.
A, Spectra were extracted that corresponded to the most posterior lesion (bottom spectrum), the middle lesion (middle spectrum), and the relatively normal contralateral hemisphere (top spectrum).
B–D, The reconstructed Cho (B) and lipid (C) maps are shown with anatomic contours extracted from an inversion-recovery image (D). Both lesions showed elevated Cho with reduced Cr and NAA. The most posterior lesion is likely more necrotic, as evidenced by lipid both on its spectra and in the corresponding region of the lipid image.
E–H, Immediately after preoperative imaging, a burrhole was created and trajectory alignment was accomplished. A contrast agent was administered, and T1-weighted imaging was performed during the alignment and biopsy processes. The central region of enhancement was selected for biopsy and an appropriately aligned trajectory guide was visible in oblique sagittal (E) and coronal (F) planes. These image planes were then monitored during the insertion of the biopsy needle to assure it reached the intended target (G and H)
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