Magnetic Resonance Spectroscopy By A. Ghazavi, M.D.

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Presentation transcript:

Magnetic Resonance Spectroscopy By A. Ghazavi, M.D.

MR spectroscopy consensus group: MR spectroscopy adds diagnostic and prognostic benefits to MR imaging and adds in treatment planning and monitoring of brain cancer.

MRI: Signal versus time (anatomic changes) ----------------------------------------------------- MRS: signal versus frequency (biochemical and metabolic changes)

Long TE

Short TE

Clinical applications of MRS Evaluation of normal brain development and regional brain differences: Newborn up to 3 months: increased MI and Cho decreased NAA No lac Pre-term newborn up to 40 days: High lac

Clinical applications of MRS 2. Brain tumors: Glioma: High Cho, Low NAA and Cr differentiation between tumor and peri-tumoral edema grading of tumor

Differentiation of neoplastic from pseudotumoral lesions

Metastasis Near normal peri-tumoral MRS Lactate level

Schwannoma: absence of Cr and increased lipid Meningioma: high Cho and Ala

2. Epilepsy Temporal lobe epilepsy: Mesial temporal sclerosis If MRI negative To evaluate the other apparent normal hippocampal head To predict outcome of surgery Low NAA/Cr and NAA/Cho High Lac in post-ictal phase for 6 hours

3. Alzheimer’s disease: Increased MI/Cr and decreased NAA/Cr in temporoparietal lobes and hippocampi Pick’s disease: the same but in only frontal lobe Other causes of increased MI/Cr: DM, CRF, Hypernatremia and chronic hypoxic encephalopathy

4. Metabolic disorders and leukoencephalopathy: Phenylketonuria: increased phenylalanine Canavan’s disease: increased NAA

5. Cerebral abscess v.s. necrotic tumor: Low Cho, Cr and NAA New resonance of aminoacids Lac may increase

6. Acquired immunodeficiency syndrome: Infants of HIV-infected mothers: decrease in NAA after 10 days NAA Cr Cho MI Lac Lipid Toxoplasmosis Lymphoma Cryptococosis PML

7. Multiple sclerosis: Mobile lipid signal