imporatnce of MR Spectroscopy to radiologically diagnosis and thesis results

1. Dr Devendra Khatana (3rd Yr Resident)
Dr Sangeeta Saxena (Prof. & HOD)
Dr Dharamraj Meena
Dr Harshvardhan
Dept. Of Radiodiagnosis
Govt.Medical College Kota

2. 1. INTRODUCTION
2. AIMS- OBJECTIVES
3. MATERIALS & METHODS
4. OBSERVATION & RESULTS
5. CASE DISCUSSION
6. CONCLUSION
7. REFERENCES

3.  D/D for peripheral or ring enhancing
Brain lesions :
1. Metastasis
2. Abscess
3. Glioblastoma multiforme(GBM)
4. Tuberculoma
5. Neurocysticercosis(NCC)
6. Subacute infarct / haemorrhage / contusion
7. Demyelination (incomplete ring)
8. Tumefactive demyelinating lesion (incomplete ring)
9. Postoperative change
10. Lymphoma - in HIV pt

4. CECT
MR-T1W,T2W,DW
MR SPECTROSCOPY

5. Magnetic resonance spectroscopy (MRS) provides
information about the possible extent and nature of changes on
a routine MRI scan by analyzing the presence and/or ratio of
tissue metabolites such as NAA, creatine, choline, and lactate
etc.

6. 1.
• To differentiate neoplastic from non neoplastic
brain lesions using conventional and advanced MR
imaging techniques.
2.
• To study the characteristic imaging findings of
various Ring enhancing lesions on MRI.
3.
• To establish a D/D of the various Ring enhancing
lesions on conventional MRI
4.
• To study the role of MR spectroscopy in the
evaluation of various ring enhancing lesions

7. SOURCE OF DATA:
Patients from Goverment Medical College And
Associated Group of Hospitals,Kota.
METHOD OF COLLECTION OF DATA:
 All patients CT Diagnosed cerebral ring
enhancing lesions in a period of 1 years was
subjected for the study.
 50 Patients of CT ring enhancing lesions
evaluated for MRI & MRS.
EQUIPMENT
1.5 TESLA PHILIPS ACHIEVA MRI MACHINE

9. • All patients with ring enhancing lesions of
brain detected on contrast MR studies
• All patients with incidentally diagnosed
ring enhancing lesion by CT.
• All age groups irrespective of sex

10. • Patient having H/O claustrophobia.
• Patient having metallic implants insertion,
cardiac pacemakers and metallic foreign
body in situ

12. 22
6 5
11
5
1
0
5
10
15
20
25
MALE
FEMALE
TOTAL

13. 62%
38%
SEX WISE DISTRIBUTION
MALE
FEMALE

14. 0 10 20 30 40 50
SEIZURE
HEADACHE
VOMITING
WEAKNESS
FEVER
ATAXIA
42
11
9
3
4
3
NO. OF CASES WITH C/F

15. 0
5
10
15
20
25
SINGLE TWO -FOUR MULTIPLE(>4)
17
25
12
NO.OF LESIONS

16. 0
5
10
15
20
25
30
35
< 2CM 2-4 CM > 4 CM
34
11
5
NO. OF CASES

17. DW IN RING ENHANCING LESIONS
21
22
23
24
25
26
27
DIFFUSION
RESTRICTION
NO
RESTRICTION
27
23

18. 17
14
17
2
SIDE OF PATHOLOGY
RIGHT
LEFT
B/L
MIDLINE

19. 5 5
14
5
3
6
12
0
2
4
6
8
10
12
14
16
0-10 Nov-
20
21-30 31-40 41-50 51-60 >60
NO. OF CASES

20. VARIOUS METABOLITE PEAK IN VARIOUS
RING ENHANCING LESIONS
0
5
10
15
20
25
30 28
27
25
17
3
NO.OF LESIONS

39. CONCLUSION
1. MRI is the most sensitive modality in the
characterization of intracranial ring enhancing lesions
2. Irregular type of ring enhancement is the most common
feature noted in most of the lesions .
3. Most common lesion seen is Tuberculoma (44%) followed
by primary brain Tumours (22%),NCC(12%) Abscess (10%),
Metastasis ( 10%), and Tumefactive demyelination (2%).
4. 21-30 years is the most common age group involve 28%
5. Male are more prevalance sex 62%

40. CONCLUSION….
6. Seizures is the most common presenting complaint (84%).
7. Multiple lesion was noted in 66 % of patients whereas the
rest 34% presented with single lesions.
8. Choline peak seen in most of lesions(56%) followed by
lipid peak
9. Pattern of signal intensity on T2 and FLAIR, DWI and
MRS help to differentiate between benign and malignant
lesions.
10. MRS helps in characterization of various ring enhancing
lesions. However no lesion can be diagnosed based on the
findings of MRS as the sole criteria.

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 Daoud E, Mezghani S, Fourati H, Ketata H, Guermazi Y, Ayadi
K, Dabbeche C, Mnif J, Ben Mahfoudh K, Mnif Z MR imaging
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42. THANK YOU…….
THANK YOU