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DOI: 10.1148/rg.26si065513
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Advanced MR Imaging Techniques in the Diagnosis of Intraaxial Brain Tumors in Adults1

Riyadh N. Al-Okaili, MD, Jaroslaw Krejza, MD, PhD2, Sumei Wang, MD, John H. Woo, MD and Elias R. Melhem, MD, PhD

1 From the Department of Radiology, University of Pennsylvania School of Medicine, 3400 Spruce St, Dulles 2, Philadelphia, PA 19104. Received May 17, 2006; revision requested June 14 and received July 10; accepted July 13. All authors have no financial relationships to disclose.

Figure 1
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  		Figure 1a.  Right frontal anaplastic oligoastrocytoma (World Health Organization [WHO] grade III) in a 39-year-old man. The diagnosis was proved at biopsy. (a) Axial postcontrast T1-weighted MR image demonstrates a nonenhancing right frontal mass. (b) On an axial relative cerebral blood volume (rCBV) map, there is elevated rTBV compared with contralateral normal brain tissue, especially at the posterior periphery of the lesion. (c) Intermediate-echo MR spectrum shows a decrease in the NAA (at 2.02 ppm) and creatine (Cr) (at 3.0 ppm) peaks and elevation of the choline (Cho) peak (at 3.2 ppm). (d, e) These observations are further illustrated with spectroscopic color maps of the NAA/creatine (d) and choline/creatine (e) ratios.

 

Figure 1
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  		Figure 1b.  Right frontal anaplastic oligoastrocytoma (World Health Organization [WHO] grade III) in a 39-year-old man. The diagnosis was proved at biopsy. (a) Axial postcontrast T1-weighted MR image demonstrates a nonenhancing right frontal mass. (b) On an axial relative cerebral blood volume (rCBV) map, there is elevated rTBV compared with contralateral normal brain tissue, especially at the posterior periphery of the lesion. (c) Intermediate-echo MR spectrum shows a decrease in the NAA (at 2.02 ppm) and creatine (Cr) (at 3.0 ppm) peaks and elevation of the choline (Cho) peak (at 3.2 ppm). (d, e) These observations are further illustrated with spectroscopic color maps of the NAA/creatine (d) and choline/creatine (e) ratios.

 

Figure 1
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  		Figure 1c.  Right frontal anaplastic oligoastrocytoma (World Health Organization [WHO] grade III) in a 39-year-old man. The diagnosis was proved at biopsy. (a) Axial postcontrast T1-weighted MR image demonstrates a nonenhancing right frontal mass. (b) On an axial relative cerebral blood volume (rCBV) map, there is elevated rTBV compared with contralateral normal brain tissue, especially at the posterior periphery of the lesion. (c) Intermediate-echo MR spectrum shows a decrease in the NAA (at 2.02 ppm) and creatine (Cr) (at 3.0 ppm) peaks and elevation of the choline (Cho) peak (at 3.2 ppm). (d, e) These observations are further illustrated with spectroscopic color maps of the NAA/creatine (d) and choline/creatine (e) ratios.

 

Figure 1
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  		Figure 1d.  Right frontal anaplastic oligoastrocytoma (World Health Organization [WHO] grade III) in a 39-year-old man. The diagnosis was proved at biopsy. (a) Axial postcontrast T1-weighted MR image demonstrates a nonenhancing right frontal mass. (b) On an axial relative cerebral blood volume (rCBV) map, there is elevated rTBV compared with contralateral normal brain tissue, especially at the posterior periphery of the lesion. (c) Intermediate-echo MR spectrum shows a decrease in the NAA (at 2.02 ppm) and creatine (Cr) (at 3.0 ppm) peaks and elevation of the choline (Cho) peak (at 3.2 ppm). (d, e) These observations are further illustrated with spectroscopic color maps of the NAA/creatine (d) and choline/creatine (e) ratios.

 

Figure 1
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  		Figure 1e.  Right frontal anaplastic oligoastrocytoma (World Health Organization [WHO] grade III) in a 39-year-old man. The diagnosis was proved at biopsy. (a) Axial postcontrast T1-weighted MR image demonstrates a nonenhancing right frontal mass. (b) On an axial relative cerebral blood volume (rCBV) map, there is elevated rTBV compared with contralateral normal brain tissue, especially at the posterior periphery of the lesion. (c) Intermediate-echo MR spectrum shows a decrease in the NAA (at 2.02 ppm) and creatine (Cr) (at 3.0 ppm) peaks and elevation of the choline (Cho) peak (at 3.2 ppm). (d, e) These observations are further illustrated with spectroscopic color maps of the NAA/creatine (d) and choline/creatine (e) ratios.

 

Figure 2
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  		Figure 2a.  Left parietal glioblastoma multiforme (WHO grade IV) in a 59-year-old woman. (a) Axial postcontrast T1-weighted MR image demonstrates a heterogeneously enhancing, necrotic mass. (b) Axial diffusion-weighted image shows a mixture of facilitated and restricted diffusion (a similar appearance was observed on the axial ADC maps, not shown here). (c) Axial arterial spin-labeled generated cerebral blood flow map shows elevated cerebral blood flow compared with that in contralateral normal brain tissue. (d) Single-voxel short-echo MR proton spectrum of the lesion shows depression of the NAA (at 2.02 ppm) and creatine (Cr) (at 3.0 ppm) peaks, elevation of the lactate (Lac) and/or lipid peak (at 1.33 ppm), and elevation of the choline (Cho) peak (at 3.2 ppm). (e) These observations are further illustrated with intermediate-echo spectroscopic color maps of the NAA/choline ratio.

 

Figure 2
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  		Figure 2b.  Left parietal glioblastoma multiforme (WHO grade IV) in a 59-year-old woman. (a) Axial postcontrast T1-weighted MR image demonstrates a heterogeneously enhancing, necrotic mass. (b) Axial diffusion-weighted image shows a mixture of facilitated and restricted diffusion (a similar appearance was observed on the axial ADC maps, not shown here). (c) Axial arterial spin-labeled generated cerebral blood flow map shows elevated cerebral blood flow compared with that in contralateral normal brain tissue. (d) Single-voxel short-echo MR proton spectrum of the lesion shows depression of the NAA (at 2.02 ppm) and creatine (Cr) (at 3.0 ppm) peaks, elevation of the lactate (Lac) and/or lipid peak (at 1.33 ppm), and elevation of the choline (Cho) peak (at 3.2 ppm). (e) These observations are further illustrated with intermediate-echo spectroscopic color maps of the NAA/choline ratio.

 

Figure 2
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  		Figure 2c.  Left parietal glioblastoma multiforme (WHO grade IV) in a 59-year-old woman. (a) Axial postcontrast T1-weighted MR image demonstrates a heterogeneously enhancing, necrotic mass. (b) Axial diffusion-weighted image shows a mixture of facilitated and restricted diffusion (a similar appearance was observed on the axial ADC maps, not shown here). (c) Axial arterial spin-labeled generated cerebral blood flow map shows elevated cerebral blood flow compared with that in contralateral normal brain tissue. (d) Single-voxel short-echo MR proton spectrum of the lesion shows depression of the NAA (at 2.02 ppm) and creatine (Cr) (at 3.0 ppm) peaks, elevation of the lactate (Lac) and/or lipid peak (at 1.33 ppm), and elevation of the choline (Cho) peak (at 3.2 ppm). (e) These observations are further illustrated with intermediate-echo spectroscopic color maps of the NAA/choline ratio.

 

Figure 2
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  		Figure 2d.  Left parietal glioblastoma multiforme (WHO grade IV) in a 59-year-old woman. (a) Axial postcontrast T1-weighted MR image demonstrates a heterogeneously enhancing, necrotic mass. (b) Axial diffusion-weighted image shows a mixture of facilitated and restricted diffusion (a similar appearance was observed on the axial ADC maps, not shown here). (c) Axial arterial spin-labeled generated cerebral blood flow map shows elevated cerebral blood flow compared with that in contralateral normal brain tissue. (d) Single-voxel short-echo MR proton spectrum of the lesion shows depression of the NAA (at 2.02 ppm) and creatine (Cr) (at 3.0 ppm) peaks, elevation of the lactate (Lac) and/or lipid peak (at 1.33 ppm), and elevation of the choline (Cho) peak (at 3.2 ppm). (e) These observations are further illustrated with intermediate-echo spectroscopic color maps of the NAA/choline ratio.

 

Figure 2
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  		Figure 2e.  Left parietal glioblastoma multiforme (WHO grade IV) in a 59-year-old woman. (a) Axial postcontrast T1-weighted MR image demonstrates a heterogeneously enhancing, necrotic mass. (b) Axial diffusion-weighted image shows a mixture of facilitated and restricted diffusion (a similar appearance was observed on the axial ADC maps, not shown here). (c) Axial arterial spin-labeled generated cerebral blood flow map shows elevated cerebral blood flow compared with that in contralateral normal brain tissue. (d) Single-voxel short-echo MR proton spectrum of the lesion shows depression of the NAA (at 2.02 ppm) and creatine (Cr) (at 3.0 ppm) peaks, elevation of the lactate (Lac) and/or lipid peak (at 1.33 ppm), and elevation of the choline (Cho) peak (at 3.2 ppm). (e) These observations are further illustrated with intermediate-echo spectroscopic color maps of the NAA/choline ratio.

 

Figure 3
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  		Figure 3a.  Bifrontal glioblastoma multiforme (WHO grade IV) in a 79-year-old woman. (a) Axial postcontrast T1-weighted MR image with overlying spectroscopic grid demonstrates a heterogeneously enhancing, necrotic mass. (b, c) Multivoxel short-echo MR proton spectra show depression of the NAA (at 2.02 ppm) and creatine (Cr) (at 3.0 ppm) peaks, elevation of the lactate (Lac) and/or lipid peak (at 1.33 ppm), and elevation of the choline (Cho) peak (at 3.2 ppm) within the enhancing portion of the mass, as seen in voxel 10 (outlined with a white frame in a). There is also evidence of peritumoral infiltration, as voxel 23 (outlined with a black frame in a)— which is beyond the enhancing portion of the lesion—shows the choline/NAA ratio >1.

 

Figure 3
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  		Figure 3b.  Bifrontal glioblastoma multiforme (WHO grade IV) in a 79-year-old woman. (a) Axial postcontrast T1-weighted MR image with overlying spectroscopic grid demonstrates a heterogeneously enhancing, necrotic mass. (b, c) Multivoxel short-echo MR proton spectra show depression of the NAA (at 2.02 ppm) and creatine (Cr) (at 3.0 ppm) peaks, elevation of the lactate (Lac) and/or lipid peak (at 1.33 ppm), and elevation of the choline (Cho) peak (at 3.2 ppm) within the enhancing portion of the mass, as seen in voxel 10 (outlined with a white frame in a). There is also evidence of peritumoral infiltration, as voxel 23 (outlined with a black frame in a)— which is beyond the enhancing portion of the lesion—shows the choline/NAA ratio >1.

 

Figure 3
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  		Figure 3c.  Bifrontal glioblastoma multiforme (WHO grade IV) in a 79-year-old woman. (a) Axial postcontrast T1-weighted MR image with overlying spectroscopic grid demonstrates a heterogeneously enhancing, necrotic mass. (b, c) Multivoxel short-echo MR proton spectra show depression of the NAA (at 2.02 ppm) and creatine (Cr) (at 3.0 ppm) peaks, elevation of the lactate (Lac) and/or lipid peak (at 1.33 ppm), and elevation of the choline (Cho) peak (at 3.2 ppm) within the enhancing portion of the mass, as seen in voxel 10 (outlined with a white frame in a). There is also evidence of peritumoral infiltration, as voxel 23 (outlined with a black frame in a)— which is beyond the enhancing portion of the lesion—shows the choline/NAA ratio >1.

 

Figure 4
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  		Figure 4a.  Right frontal low-grade oligodendroglioma (WHO grade II) in a 35-year-old man. (a) FLAIR image shows a nonenhancing T2 hyperintense mass (similar appearance observed on postcontrast T1-weighted MR images, not shown here). (b) Axial ADC map shows facilitated diffusion. (c) Short-echo MR proton spectrum shows an elevated myoinositol (mI) peak (at 3.55 ppm). Cho = choline, Cr = creatine.

 

Figure 4
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  		Figure 4b.  Right frontal low-grade oligodendroglioma (WHO grade II) in a 35-year-old man. (a) FLAIR image shows a nonenhancing T2 hyperintense mass (similar appearance observed on postcontrast T1-weighted MR images, not shown here). (b) Axial ADC map shows facilitated diffusion. (c) Short-echo MR proton spectrum shows an elevated myoinositol (mI) peak (at 3.55 ppm). Cho = choline, Cr = creatine.

 

Figure 4
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  		Figure 4c.  Right frontal low-grade oligodendroglioma (WHO grade II) in a 35-year-old man. (a) FLAIR image shows a nonenhancing T2 hyperintense mass (similar appearance observed on postcontrast T1-weighted MR images, not shown here). (b) Axial ADC map shows facilitated diffusion. (c) Short-echo MR proton spectrum shows an elevated myoinositol (mI) peak (at 3.55 ppm). Cho = choline, Cr = creatine.

 

Figure 5
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  		Figure 5a.  Left temporal ganglioglioma in a 32-year-old man. (a) Fluid-attenuated inversion-recovery (FLAIR) MR image with overlying spectroscopic grid shows a T2 hyperintense mass. No enhancement was seen on postcontrast T1-weighted MR images (not shown). (b) Short-echo MR proton spectrum shows an elevated myoinositol (mI) peak (at 3.55 ppm). Cho = choline, Cr = creatine. (c) Multivoxel intermediate-echo MR proton spectroscopic color map of the choline/NAA ratio shows choline/NAA elevation.

 

Figure 5
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  		Figure 5b.  Left temporal ganglioglioma in a 32-year-old man. (a) Fluid-attenuated inversion-recovery (FLAIR) MR image with overlying spectroscopic grid shows a T2 hyperintense mass. No enhancement was seen on postcontrast T1-weighted MR images (not shown). (b) Short-echo MR proton spectrum shows an elevated myoinositol (mI) peak (at 3.55 ppm). Cho = choline, Cr = creatine. (c) Multivoxel intermediate-echo MR proton spectroscopic color map of the choline/NAA ratio shows choline/NAA elevation.

 

Figure 5
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  		Figure 5c.  Left temporal ganglioglioma in a 32-year-old man. (a) Fluid-attenuated inversion-recovery (FLAIR) MR image with overlying spectroscopic grid shows a T2 hyperintense mass. No enhancement was seen on postcontrast T1-weighted MR images (not shown). (b) Short-echo MR proton spectrum shows an elevated myoinositol (mI) peak (at 3.55 ppm). Cho = choline, Cr = creatine. (c) Multivoxel intermediate-echo MR proton spectroscopic color map of the choline/NAA ratio shows choline/NAA elevation.

 

Figure 6
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  		Figure 6a.  Bihemispheric gliomatosis cerebri in a 53-year-old woman. (a) FLAIR image shows a T2 hyper-intense nonenhancing mass involving both hemispheres (similar appearance observed on postcontrast T1-weighted MR images, not shown here). (b) On the axial rCBV map, the rTBV is lower than that of normal brain tissue (ratio = 0.83). (c) Short-echo MR proton spectrum shows elevated levels of creatine (Cr) (at 3.0 ppm) and myoinositol (mI) (at 3.55 ppm), a reduced level of NAA (at 2.02 ppm), and a mildly elevated level of choline (Cho) (at 3.2 ppm).

 

Figure 6
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  		Figure 6b.  Bihemispheric gliomatosis cerebri in a 53-year-old woman. (a) FLAIR image shows a T2 hyper-intense nonenhancing mass involving both hemispheres (similar appearance observed on postcontrast T1-weighted MR images, not shown here). (b) On the axial rCBV map, the rTBV is lower than that of normal brain tissue (ratio = 0.83). (c) Short-echo MR proton spectrum shows elevated levels of creatine (Cr) (at 3.0 ppm) and myoinositol (mI) (at 3.55 ppm), a reduced level of NAA (at 2.02 ppm), and a mildly elevated level of choline (Cho) (at 3.2 ppm).

 

Figure 6
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  		Figure 6c.  Bihemispheric gliomatosis cerebri in a 53-year-old woman. (a) FLAIR image shows a T2 hyper-intense nonenhancing mass involving both hemispheres (similar appearance observed on postcontrast T1-weighted MR images, not shown here). (b) On the axial rCBV map, the rTBV is lower than that of normal brain tissue (ratio = 0.83). (c) Short-echo MR proton spectrum shows elevated levels of creatine (Cr) (at 3.0 ppm) and myoinositol (mI) (at 3.55 ppm), a reduced level of NAA (at 2.02 ppm), and a mildly elevated level of choline (Cho) (at 3.2 ppm).

 

Figure 7
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  		Figure 7a.  Metastatic renal cell cancer in a 73-year-old man. (a) Axial postcontrast T1-weighted MR image demonstrates a heterogeneously enhancing small mass in the posterior left frontal lobe with extensive surrounding T2 hyperintensity. (b) Axial diffusion-weighted map shows predominantly facilitated diffusion with a small crescent-shaped area of restricted diffusion that had an ADC value of 1.04 x 10–3 mm2/sec). (c) On an axial rCBV map, the rTBV is elevated (ratio = 6.27).

 

Figure 7
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  		Figure 7b.  Metastatic renal cell cancer in a 73-year-old man. (a) Axial postcontrast T1-weighted MR image demonstrates a heterogeneously enhancing small mass in the posterior left frontal lobe with extensive surrounding T2 hyperintensity. (b) Axial diffusion-weighted map shows predominantly facilitated diffusion with a small crescent-shaped area of restricted diffusion that had an ADC value of 1.04 x 10–3 mm2/sec). (c) On an axial rCBV map, the rTBV is elevated (ratio = 6.27).

 

Figure 7
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  		Figure 7c.  Metastatic renal cell cancer in a 73-year-old man. (a) Axial postcontrast T1-weighted MR image demonstrates a heterogeneously enhancing small mass in the posterior left frontal lobe with extensive surrounding T2 hyperintensity. (b) Axial diffusion-weighted map shows predominantly facilitated diffusion with a small crescent-shaped area of restricted diffusion that had an ADC value of 1.04 x 10–3 mm2/sec). (c) On an axial rCBV map, the rTBV is elevated (ratio = 6.27).

 

Figure 8
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  		Figure 8a.  Primary central nervous system lymphoma in a 50-year-old woman. (a, b) Axial post-contrast T1-weighted MR image (a) demonstrates a homogeneously enhancing mass in the right frontal lobe, which is isointense on the axial fluid-attenuated inversion-recovery MR image (b), with extensive surrounding T2 hyperintensity. (c) Axial ADC map shows restricted diffusion (lowest ADC value obtained was 0.82 x 10–3 mm2/sec).

 

Figure 8
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  		Figure 8b.  Primary central nervous system lymphoma in a 50-year-old woman. (a, b) Axial post-contrast T1-weighted MR image (a) demonstrates a homogeneously enhancing mass in the right frontal lobe, which is isointense on the axial fluid-attenuated inversion-recovery MR image (b), with extensive surrounding T2 hyperintensity. (c) Axial ADC map shows restricted diffusion (lowest ADC value obtained was 0.82 x 10–3 mm2/sec).

 

Figure 8
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  		Figure 8c.  Primary central nervous system lymphoma in a 50-year-old woman. (a, b) Axial post-contrast T1-weighted MR image (a) demonstrates a homogeneously enhancing mass in the right frontal lobe, which is isointense on the axial fluid-attenuated inversion-recovery MR image (b), with extensive surrounding T2 hyperintensity. (c) Axial ADC map shows restricted diffusion (lowest ADC value obtained was 0.82 x 10–3 mm2/sec).

 

Figure 9
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  		Figure 9a.  Periventricular tumefactive demyelinating lesion in a 38-year-old woman. (a) FLAIR image shows a well-defined T2 hyperintense enhancing lesion (similar appearance observed on postcontrast T1-weighted MR images, not shown here). (b) Axial diffusion-weighted image shows restricted diffusion. (c) Axial arterial spin-labeled generated cerebral blood flow map shows no elevation of flow compared with contralateral normal white matter. (d) Single-voxel intermediate-echo MR proton spectrum shows mild depression of the NAA peak (at 2.02 ppm), absence of the lactate peak (at 1.33 ppm), and elevation of the choline (Cho) peak (at 3.2 ppm). Cr = creatine. (e, f) These findings are further illustrated with spectroscopic color maps of NAA and the choline/creatine ratios.

 

Figure 9
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  		Figure 9b.  Periventricular tumefactive demyelinating lesion in a 38-year-old woman. (a) FLAIR image shows a well-defined T2 hyperintense enhancing lesion (similar appearance observed on postcontrast T1-weighted MR images, not shown here). (b) Axial diffusion-weighted image shows restricted diffusion. (c) Axial arterial spin-labeled generated cerebral blood flow map shows no elevation of flow compared with contralateral normal white matter. (d) Single-voxel intermediate-echo MR proton spectrum shows mild depression of the NAA peak (at 2.02 ppm), absence of the lactate peak (at 1.33 ppm), and elevation of the choline (Cho) peak (at 3.2 ppm). Cr = creatine. (e, f) These findings are further illustrated with spectroscopic color maps of NAA and the choline/creatine ratios.

 

Figure 9
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  		Figure 9c.  Periventricular tumefactive demyelinating lesion in a 38-year-old woman. (a) FLAIR image shows a well-defined T2 hyperintense enhancing lesion (similar appearance observed on postcontrast T1-weighted MR images, not shown here). (b) Axial diffusion-weighted image shows restricted diffusion. (c) Axial arterial spin-labeled generated cerebral blood flow map shows no elevation of flow compared with contralateral normal white matter. (d) Single-voxel intermediate-echo MR proton spectrum shows mild depression of the NAA peak (at 2.02 ppm), absence of the lactate peak (at 1.33 ppm), and elevation of the choline (Cho) peak (at 3.2 ppm). Cr = creatine. (e, f) These findings are further illustrated with spectroscopic color maps of NAA and the choline/creatine ratios.

 

Figure 9
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  		Figure 9d.  Periventricular tumefactive demyelinating lesion in a 38-year-old woman. (a) FLAIR image shows a well-defined T2 hyperintense enhancing lesion (similar appearance observed on postcontrast T1-weighted MR images, not shown here). (b) Axial diffusion-weighted image shows restricted diffusion. (c) Axial arterial spin-labeled generated cerebral blood flow map shows no elevation of flow compared with contralateral normal white matter. (d) Single-voxel intermediate-echo MR proton spectrum shows mild depression of the NAA peak (at 2.02 ppm), absence of the lactate peak (at 1.33 ppm), and elevation of the choline (Cho) peak (at 3.2 ppm). Cr = creatine. (e, f) These findings are further illustrated with spectroscopic color maps of NAA and the choline/creatine ratios.

 

Figure 9
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  		Figure 9e.  Periventricular tumefactive demyelinating lesion in a 38-year-old woman. (a) FLAIR image shows a well-defined T2 hyperintense enhancing lesion (similar appearance observed on postcontrast T1-weighted MR images, not shown here). (b) Axial diffusion-weighted image shows restricted diffusion. (c) Axial arterial spin-labeled generated cerebral blood flow map shows no elevation of flow compared with contralateral normal white matter. (d) Single-voxel intermediate-echo MR proton spectrum shows mild depression of the NAA peak (at 2.02 ppm), absence of the lactate peak (at 1.33 ppm), and elevation of the choline (Cho) peak (at 3.2 ppm). Cr = creatine. (e, f) These findings are further illustrated with spectroscopic color maps of NAA and the choline/creatine ratios.

 

Figure 9
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  		Figure 9f.  Periventricular tumefactive demyelinating lesion in a 38-year-old woman. (a) FLAIR image shows a well-defined T2 hyperintense enhancing lesion (similar appearance observed on postcontrast T1-weighted MR images, not shown here). (b) Axial diffusion-weighted image shows restricted diffusion. (c) Axial arterial spin-labeled generated cerebral blood flow map shows no elevation of flow compared with contralateral normal white matter. (d) Single-voxel intermediate-echo MR proton spectrum shows mild depression of the NAA peak (at 2.02 ppm), absence of the lactate peak (at 1.33 ppm), and elevation of the choline (Cho) peak (at 3.2 ppm). Cr = creatine. (e, f) These findings are further illustrated with spectroscopic color maps of NAA and the choline/creatine ratios.

 

Figure 10
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  		Figure 10a.  Left frontal abscess in a 57-year-old man. (a) Axial postcontrast T1-weighted MR image demonstrates a rim-enhancing mass with surrounding edema. (b) Axial diffusion-weighted image shows restricted diffusion with ADC measurements as low as 0.94 x 10–3 mm2/sec, corresponding to the nonenhancing portion of the abscess. (c) Short-echo MR spectrum shows depression of the NAA (at 2.02 ppm), choline (Cho) (at 3.2 ppm), and creatine (Cr) (at 3.0 ppm) peaks, as well as elevation of the amino acid (at 0.9 ppm), lactate (Lac) (at 1.33 ppm), acetate (at 1.9 ppm), and succinate (at 2.4 ppm) peaks. (d) Axial arterial spin-labeled generated cerebral blood flow map shows no elevation of flow compared with contralateral normal white matter.

 

Figure 10
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  		Figure 10b.  Left frontal abscess in a 57-year-old man. (a) Axial postcontrast T1-weighted MR image demonstrates a rim-enhancing mass with surrounding edema. (b) Axial diffusion-weighted image shows restricted diffusion with ADC measurements as low as 0.94 x 10–3 mm2/sec, corresponding to the nonenhancing portion of the abscess. (c) Short-echo MR spectrum shows depression of the NAA (at 2.02 ppm), choline (Cho) (at 3.2 ppm), and creatine (Cr) (at 3.0 ppm) peaks, as well as elevation of the amino acid (at 0.9 ppm), lactate (Lac) (at 1.33 ppm), acetate (at 1.9 ppm), and succinate (at 2.4 ppm) peaks. (d) Axial arterial spin-labeled generated cerebral blood flow map shows no elevation of flow compared with contralateral normal white matter.

 

Figure 10
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  		Figure 10c.  Left frontal abscess in a 57-year-old man. (a) Axial postcontrast T1-weighted MR image demonstrates a rim-enhancing mass with surrounding edema. (b) Axial diffusion-weighted image shows restricted diffusion with ADC measurements as low as 0.94 x 10–3 mm2/sec, corresponding to the nonenhancing portion of the abscess. (c) Short-echo MR spectrum shows depression of the NAA (at 2.02 ppm), choline (Cho) (at 3.2 ppm), and creatine (Cr) (at 3.0 ppm) peaks, as well as elevation of the amino acid (at 0.9 ppm), lactate (Lac) (at 1.33 ppm), acetate (at 1.9 ppm), and succinate (at 2.4 ppm) peaks. (d) Axial arterial spin-labeled generated cerebral blood flow map shows no elevation of flow compared with contralateral normal white matter.

 

Figure 10
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  		Figure 10d.  Left frontal abscess in a 57-year-old man. (a) Axial postcontrast T1-weighted MR image demonstrates a rim-enhancing mass with surrounding edema. (b) Axial diffusion-weighted image shows restricted diffusion with ADC measurements as low as 0.94 x 10–3 mm2/sec, corresponding to the nonenhancing portion of the abscess. (c) Short-echo MR spectrum shows depression of the NAA (at 2.02 ppm), choline (Cho) (at 3.2 ppm), and creatine (Cr) (at 3.0 ppm) peaks, as well as elevation of the amino acid (at 0.9 ppm), lactate (Lac) (at 1.33 ppm), acetate (at 1.9 ppm), and succinate (at 2.4 ppm) peaks. (d) Axial arterial spin-labeled generated cerebral blood flow map shows no elevation of flow compared with contralateral normal white matter.

 

Figure 11
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  		Figure 11.  Algorithm for unknown intracranial mass classification. This practical MR imaging algorithm is composed of a series of nodes or questions that would suggest a diagnosis if the paths are followed to the bottom. Cho = choline, High GN = high-grade neoplasm, Low GN = low-grade neoplasm, TDL = tumefactive demyelinating lesion.

 




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