On MRI spectroscopy of a glioblastoma multiforme, which metabolite pattern is expected compared to normal brain tissue?
- A Reduced choline, elevated NAA, reduced creatine
- B Elevated choline, reduced NAA, elevated lactate and lipid peaks ✓
- C Elevated NAA with normal choline and creatine
- D Elevated myoinositol with reduced choline and NAA
Correct answer: B. Elevated choline, reduced NAA, elevated lactate and lipid peaks
Explanation
In high-grade glioma (GBM), MR spectroscopy shows markedly elevated choline (reflecting increased membrane turnover and cellular proliferation), severely reduced N-acetylaspartate (NAA, indicating neuronal loss), and prominent lactate and lipid peaks (reflecting necrosis and anaerobic glycolysis). The Cho/NAA and Cho/Cr ratios are elevated. Elevated myoinositol with reduced NAA and Cho is the pattern of Alzheimer's disease. Elevated NAA with normal Cho suggests normal tissue or Canavan disease (markedly elevated NAA).
Reference: Grainger & Allison's Diagnostic Radiology, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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