Case Reports

  • Stefan Blüml
  • Ashok Panigrahy


This section consists of a selection of individual cases we deem to be interesting and educational examples for the use of MR spectroscopy in a clinical or research environment. Some of the case studies are complex including follow-up with several MRS studies whereas often only a single study was available for review. There are a few caveats for the reader. First, findings in individual patients may be incidental and thus should not be generalized. When selecting the cases we did not always look for the most typical studies but for the more striking cases. Second, whenever available, final diagnoses/outcomes are provided. Still, in a substantial number of cases that information, as of today, is not available. We nevertheless decided to include such cases. Under the head Interpretation/Discussion, the findings as filed in the medical records of a patient at the time of the study are summarized. This may also include interpretations that turned out to be incorrect—illustrating pitfalls and opportunities. In addition, essentially for all spectra, absolute concentrations of metabolites were available and used for the original interpretation of MRS. We have omitted information about absolute concentrations whenever we deemed absolute quantitation not essential to arrive at a final interpretation. MRS remains a technically challenging modality. For that reason we also included cases where MRS studies were incomplete or failed for technical or other reasons. The “natural” strategy for the interpretation of MRS, in our opinion, is to consider clinical information and to look at the MRI first, followed by reviewing spectra. We have generally followed this strategy when presenting the cases. Essentially all spectra were acquired and processed using the same methodology, which simplifies the interpretation of the studies. All cases were selected from a database of more than 3,000 pediatric cases studied at Children’s Hospital Los Angeles between 2001 and 2011.


Pilocytic Astrocytoma Posterior Reversible Encephalopathy Syndrome Diffuse Intrinsic Pontine Glioma Clinical Background Elevated Lactate 
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  1. 1.
    Moreno-Torres A, Martinez-Perez I, Baquero M, Campistol J, Capdevila A, Arus C, et al. Tau detection by proton magnetic resonance spectroscopy in medulloblastoma: contribution to noninvasive differential diagnosis with cerebellar astrocytomas. Neurosurgery. 2004;55:824–9.PubMedCrossRefGoogle Scholar
  2. 2.
    Kovanlikaya A, Panigrahy A, Krieger MD, Gonzalez-Gomez I, Ghugre N, McComb JG, et al. Untreated pediatric primitive neuroectodermal tumor in vivo: quantitation of Tau with MR spectroscopy. Radiology. 2005;236(3):1020–5.PubMedCrossRefGoogle Scholar
  3. 3.
    Delikatny EJ, Chawla S, Leung DJ, Poptani H. MR-visible lipids and the tumor microenvironment. NMR Biomed. 2011;24(6):592–611.PubMedGoogle Scholar
  4. 4.
    Seymour ZA, Panigrahy A, Finlay JL, Nelson Jr MD, Bluml S. Citrate in pediatric CNS tumors? AJNR Am J Neuroradiol. 2008;29(5):1006–11.PubMedCrossRefGoogle Scholar
  5. 5.
    Blüml S, Panigrahy A, Laskov M, Dhall G, Krieger MD, Nelson MD, et al. Elevated citrate in pediatric astrocytomas with malignant progression. Neuro Oncol. 2011;13:1107–17.PubMedCrossRefGoogle Scholar
  6. 6.
    Cady EB, Lorek A, Penrice J, Reynolds EO, Iles RA, Burns SP, et al. Detection of propan-1,2-diol in neonatal brain by in vivo proton magnetic resonance spectroscopy. Magn Reson Med. 1994;32(6):764–7.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2013

Authors and Affiliations

  • Stefan Blüml
    • 1
  • Ashok Panigrahy
    • 2
    • 3
  1. 1.Department of RadiologyChildren’s Hospital Los Angeles, Keck School of Medicine, University of Southern CaliforniaLos AngelesUSA
  2. 2.Department of Pediatric RadiologyChildren’s Hospital of Pittsburgh of UPMCPittsburghUSA
  3. 3.Department of RadiologyUniversity of Pittsburgh School of MedicinePittsburghUSA

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