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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.
