Fig. 2
From: Magnetic resonance spectroscopy in pediatric brain tumors: how to make a more confident diagnosis
A 16-year-old male patient presented with ataxic gait. a, b Axial T1WI pre- and post-contrast shows a hypointense SOL in the left cerebellar hemisphere acquiring minimal enhancement after contrast administration. c On axial T2WI, it shows heterogenous hyper intense signal. d 2D PRESS 144 ms echo spectrum shows remarkable elevation of choline peak with marked reduction of NAA and near absence of creatine. The Cho/Cr ratio = 14.8, the Cho/NAA ratio = 13.4, the Cho/NAA+Cr ratio = 7, NAA/Cho ratio = 0.07, and NAA/Cr ratio = 1.1. MRS diagnosis in favor of primary high-grade malignant lesion; likely medulloblastoma. Histopathologically proved: medulloblastoma