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

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

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

4. Long TE

5. Short TE

6. 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

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

11. Differentiation of neoplastic from pseudotumoral lesions

13. Metastasis Near normal peri-tumoral MRS Lactate level

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

15. 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

16. 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

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

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

19. 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

20. 7. Multiple sclerosis: Mobile lipid signal