The Adelaide MR Web Site
MR Spectroscopy Case Study
Recurrent Astrocytoma
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Prepared by Greg Brown    Royal Adelaide Hospital North Terrace Adelaide South Australia 5000
March 5th 2001		 Back to MRS Page

Images and Spectra obtained on a Siemens VISION 1.5T using Numairs VB33E software.  Images and Spectra converted to JPEG files using eFilm.

Presentation Imaging MRS Technique MRS Results Histopathology Discussion

Presentation
 (PJ) M48  Anaplastic astrocytoma resected 2.5 years ealier, with radiotherapy folllow up.  Regular MRI  suggets recurrent tumour, ? radiotherapy chanegs, ? residual tumour.  Now presents with dysphasia and right homonomous heminopia.

Imaging
 
MRI
20/5/98		 Pre-surgical examination.  3cm Ovoid lesion in the left temporal lobe surrounded by a rim of oedema.  Contrast enhanced views demonstrate a nectrotic centre.
MRI
17/7/00		 Increased mass effect compared to the pre-op MRI.  Post contrast scans show recurrent tumour extending into putamen and thalamus.

MRS Technique
Difficult shim and water suppression. SVS SE135 8cc voxel and STEAM 20

MRS Results

SE135
STEAM 20
MRS performed 10 minutes post contrast.  Substantial increase in Choline and reduced NAA. I am uncertain about the peaks at 1.5 ppm.The doublet is not at 1.3ppm and has more than 7Hz spread. A STEAM20 was attempted, but water referencing was poor, proper phasing unachievable.  Increased Choline can still be appreciated.  Clearly the changes in the surgical field are tomour.

Histopathology
Resected tissue 16/8/00
Recurrent infiltrating ganglioma with no evidence of anaplasia.
No tumour necrosis identified

Discussion