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Use of serial proton magnetic resonance spectroscopy to differentiate low grade glioma from tumefactive plaque in a patient with multiple sclerosis

Departments of ¹ Neuroradiology and ² Neuropathology, Newcastle General Hospital, Westgate Road, Newcastle upon Tyne NE4 6BE, UK

View larger version (128K): [in a new window]   Figure 1. T2 weighted image at the level of the bodies of the lateral ventricles showing hyperintense periventricular white matter lesions characteristic of multiple sclerosis.

View larger version (127K): [in a new window]   Figure 2. T2 weighted image through the cerebral cortex showing the high signal right frontal mass lesion.

View larger version (104K): [in a new window]   Figure 3. Metabolite map for choline at the level of the lesion, showing the positions of the regions of interest over the lesion (1) and normal brain (2).

View larger version (16K): [in a new window]   Figure 4. 1H MRS spectra of a normal cortex voxel (top), and from a voxel within the frontal lesion (bottom).

View larger version (157K): [in a new window]   Figure 5. High power (magnification x 200) view of uniform tumour cells with round nuclei showing artefactual perinuclear clearing; "fried egg" appearance. Haematoxylin and eosin stain.

View larger version (159K): [in a new window]   Figure 6. High power (magnification x 200) view showing reactive astrocytosis, loss of myelin and mild infiltration by tumour cells. Haematoxylin and eosin stain.