Abstract
Noninvasive localized proton magnetic resonance spectroscopy (MRS) was used for differential diagnosis of a focal brain lesion in a 2.5-year-old girl. The clinical signs were a mild head tilt and neck pain. Magnetic resonance imaging (MRI) revealed a lesion in the right hemisphere of the cerebellum, but its nature remained obscure. In this lesion quantitative determinations of cerebral metabolites by fully relaxed, short-echo-time proton MRS revealed markedly lowered N-acetylaspartate (NAA) and pronounced elevations of choline-containing compounds (Cho) and myo-inositol (Ins), whereas metabolite concentrations in cortical gray matter and white matter were within normal ranges. The metabolite pattern of the lesion indicated loss of vital neuroaxonal tissue (low NAA) and enhanced glial proliferation (high Cho and Ins), which, together with the MRI morphology, suggested a brain tumor. The diagnosis was established by neurosurgical exploration and total extirpation of the tumor. Histology confirmed an astrocytoma (WHO II). After 2 weeks' recovery the child was discharged with no neurological signs.
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References
Brand AD, Richter-Landsberg C, Leibfritz D (1993) Multinuclear NMR studies on the energy metabolism of glial and neuronal cells. Dev Neurosci 15:289–298
Bruhn H, Frahm J, Gyngell ML, Merboldt KD, Hänicke W, Sauter R, Hamburger C (1989) Noninvasive differentiation of tumors with use of localized H-1 MR spectroscopy in vivo: initial experience in patients with cerebral tumors. Radiology 172:541–548
Bruhn H, Michaelis T, Merboldt KD, Hänicke W, Gyngell ML, Hamburger C, Frahm J (1992) On the interpretation of proton NMR spectra from brain tumors in vivo and in vitro. NMR Biomed 5:253–258
Cohen ME, Duffner PK (1994) Brain tumors in children. Principles of diagnosis and treatment. Raven Press, New York
Frahm J, Michaelis T, Merbold KD, Bruhn H, Gyngell ML, Hänicke W (1990) Improvements in localized proton NMR spectroscopy of human brain. Water suppression, short echo times, and 1 ml resolution. J Magn Reson 90:464–473
Frahm J, Bruhn H, Hänicke W, Merbold KD, Mursch K, Markakis E (1991) Localized proton NMR spectroscopy of brain tumors using short-echo time STEAM sequences. J Comput Assist Tomogr 15:915–922
Hüppi PS, Posse S, Lazeyras F, Burri R, Bossi E (1991) Magnetic resonance in preterm and term newborns: 1H-spectroscopy in developing human brain. Pediatr Res 30:574–578
Kinoshita Y, Kajiwara H, Yokota A, Koga Y (1994) Proton magnetic resonance spectroscopy of brain tumors: an in vitro study. Neurosurgery 35:606–614
Kreis R, Ernst T, Ross BD (1993) Development of the human brain: in vivo quantification of metabolite and water content with proton magnetic resonance spectroscopy. Magn Reson Med 30:424–437
Michaelis T, Merboldt KD, Bruhn H, Hänicke W, Frahm J (1993) Absolute concentrations of metabolites in the adult human brain in vivo. Quantification of localized proton MR spectra. Magn Reson Med 30:672–679
Peden CJ, Cowan FM, Bryant DJ, Sargentoni J, Cox IJ (1991) Proton MR spectroscopy of the brain in infants. J Comput Assist Tomogr 14:886–894
Provencher SW (1993) Estimation of metabolite concentration from localized in vivo proton NMR spectra. Magn Reson Med 30:672–679
Sutton LN, Wehrli SL, Gennarelli L, Wang Z, Zimmerman R, Bonner K, Rorke LB (1994) High-resolution 1H-magnetic resonance spectroscopy of pediatric posterior fossa tumors in vitro. J Neurosurg 81:443–448
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Wilken, B., Helms, G., Christen, H.J. et al. Localized proton magnetic resonance spectroscopy of a cerebellar tumor in a two-year-old child. Child's Nerv Syst 12, 626–629 (1996). https://doi.org/10.1007/BF00261659
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DOI: https://doi.org/10.1007/BF00261659