Which of the following MRI spectroscopy (MRS) findings at echo time 135ms is MOST characteristic of meningioma?

• A Elevated choline, decreased NAA, elevated lactate
• B Elevated lipid-lactate complex with absent choline
• C Elevated NAA with normal choline
• D Elevated choline with elevated alanine peak at 1.47 ppm and absent NAA ✓

Explanation

Meningioma on MRS characteristically shows an elevated alanine peak at 1.47 ppm (which inverts at TE 135ms), elevated choline due to high cell turnover, and absent or markedly reduced NAA (because meningiomas are not of neuronal origin). The alanine peak is considered specific for meningioma when present. High lactate with absent choline is seen in necrotic tumours. Elevated NAA is a feature of healthy neurones.

Reference: Grainger & Allison's Diagnostic Radiology, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.