In vivo single-voxel proton MR spectroscopy in brain lesions with ring-like enhancement

NMR Biomed. 2001 Oct;14(6):339-49. doi: 10.1002/nbm.711.


It is often difficult to make a correct diagnosis of ring-like enhanced lesions on Gd-enhanced MR brain images. To differentiate these lesions using proton MR spectroscopy (1H-MRS), we retrospectively evaluated the correlation between the 1H-MR spectra and histopathological findings. We evaluated proton MR spectra obtained from the lesions in 45 patients, including metastasis (n = 19), glioblastoma (n = 10), radiation necrosis (n = 7), brain abscess (n = 5), and cerebral infarction (n = 4). The rate of misdiagnosis was found to be lowest at the threshold level of 2.48 for the (choline containing compounds)/(creatine and phosphocreatine) ratio (Cho/Cr) obtained from the whole lesions, which include the enhanced rim and the non-enhanced inner region. That is, the positively predictive values of a Cho/Cr greater than 2.48 for diagnosing metastasis or glioblastoma was 88.9 and 60.0%, respectively, and the positively predictive value of a Cho/Cr less than 2.48 for diagnosing radiation necrosis or cerebral infarction was 71.4 and 100%, respectively. For further differentiating between metastasis and glioblastoma, information about the presence and absence of an N-acetyl-aspartate (NAA) peak and lipid- or lactate-dominant peak was found to be useful. In 73.7% of metastasis cases a lipid-dominant peak was observed in the whole lesion without an NAA peak in the inner region, whereas the same pattern was observed in only 10% of the glioblastoma cases. Correlation with the histopathological findings showed that a high Cho signal is suggestive of neoplasm. Lipid signal in the non-enhanced central region was correlated to necrosis. Lactate signals were often observed in glioblastoma, abscess and sometimes metastasis, presumably reflecting the anaerobic glycolysis by the living cells in the ring-like enhanced rim. Single-voxel proton MR spectroscopy may serve as a potential tool to provide useful information of differentiation of ring-like enhanced lesions that cannot be diagnosed correctly using enhanced MR images alone.

MeSH terms

  • Adult
  • Aged
  • Brain / pathology
  • Brain Abscess / diagnosis
  • Brain Abscess / metabolism
  • Brain Abscess / pathology
  • Brain Diseases / diagnosis*
  • Brain Diseases / metabolism
  • Brain Diseases / pathology
  • Brain Neoplasms / chemistry
  • Brain Neoplasms / diagnosis
  • Brain Neoplasms / pathology
  • Cerebral Infarction / diagnosis
  • Cerebral Infarction / metabolism
  • Cerebral Infarction / pathology
  • Choline / analysis
  • Creatine / analysis
  • Diagnosis, Differential
  • Female
  • Glioblastoma / chemistry
  • Glioblastoma / diagnosis
  • Glioblastoma / pathology
  • Humans
  • Magnetic Resonance Spectroscopy / methods*
  • Male
  • Middle Aged
  • Necrosis
  • Phosphocreatine / analysis
  • Radiation Injuries / diagnosis
  • Radiation Injuries / metabolism
  • Radiation Injuries / pathology
  • Retrospective Studies


  • Phosphocreatine
  • Creatine
  • Choline