Multivoxel magnetic resonance spectroscopy in gliomatosis cerebri

Gliomatosis cerebri is a rare entity with non-specific clinical and conventional magnetic resonance imaging (MRI) findings; accurate diagnosis is a differential diagnostic challenge. MR spectroscopy has recently been introduced as a useful diagnostic tool for detection of this entity. We present a gliomatosis cerebri case in which we made the radiological diagnosis using the MR spectroscopy findings; the diagnosis was confirmed by subsequent biopsy and histopathologic evaluation. Multivoxel spectroscopy (CSI, PRESS, 1500/135) shows a marked increase in Cho/NAA (6.6), normal to mild increase in Cho/Cr (1.2), and marked decrease in NAA/Cr (0.2) compared with the normally appearing contralateral side (Cho/NAA: 0.8, Cho/Cr: 0.9, NAA/Cr: 1.2).