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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.
