Female, 73 years old, with recent biopsy diagnosis of GBM in the left temporal lobe. Evaluate additional lesions in the right temporal lobe, right parietal lobe and left periventricular region for the possibility of nonenhancing tumor. Short TE single voxel spectroscopy was performed over T2 hyperintense lesions in the left periatrial region, the right parietal lobe, and the right mesial temporal lobe/hippocampus. The spectrum obtained from the left periatrial lesion demonstrates elevation of choline more than twofold relative to contralateral normal white matter, and significant reduction of NAA. The spectrum obtained from the right hippocampus also demonstrates elevation of choline and reduction of NAA. The spectrum obtained from a small right parietal lesion shows a nonspecific pattern of reduced NAA and normal to reduced choline.
Lesions in the left periatrial region and the right mesial temporal lobe demonstrate MR spectra with features typical of tumor. A small lesion in the right parietal region shows a nonspecific spectral pattern is of uncertain significance.