Use of serial proton magnetic resonance spectroscopy to differentiate low grade glioma from tumefactive plaque in a patient with multiple sclerosis

Abstract

We report on the use of serial proton MR spectroscopy ((1)H MRS) to differentiate between glioma and tumefactive plaque in a known multiple sclerosis (MS) patient who developed a symptomatic cerebral space occupying lesion. Gliomas and acute MS plaques may have indistinguishable chemical resonance spectra, whereas that of chronic plaque is distinct. In our case (1)H MRS demonstrated elevated concentrations of choline, lactate and lipid, with reduced N-acetyl aspartate, a pattern consistent with either low grade glioma or acute demyelinating plaque. A repeat study 4 months later showed no change, this was felt to be incompatible with the natural history of an acute plaque and low grade glioma was diagnosed. Surgical removal of the lesion revealed an oligodendroglioma, confirming the imaging findings.

Proton Magnetic Resonance Spectroscopy of the Central Nervous System

“…The recovery of NAA can be attributed to resolution of edema, diameter increment of the previously shrinked axons, as a result of the re-myelination and reversible metabolic changes in neurons [64,65]. There are reports of elevated Cho resonance in chronic MS plaque, probably reflecting the associated gliotic process [66]. Cr seems to be a variable metabolite both in chronic and acute, but is also described to be slowly increasing over time, indicative of gliotic reaction or attempts of incomplete re-myelination of the chronic diseased tissue phases [14].…”

Recent Advances in Magnetic Resonance Neurospectroscopy

“…89 Increases in Cho due to inflammation have also been reported. 90,91 These two observations may cause some overlap in interpreting results in lesions, such as tumefactive MS, [92][93][94][95] that may have both inflammation and demyelination present.…”

18F-fluoroethyl-L-tyrosine positron emission tomography for the differential diagnosis of tumefactive multiple sclerosis versus glioma: A case report

“…However, biopsy may be reluctantly undertaken due to its inherent small but non-negligible risks (6). As recently suggested, factors advocating the diagnosis of tumefactive MS and supporting deferral of biopsy include the additional presence of oligoclonal cerebrospinal fluid (CSF) banding, and/or white matter lesions suggestive of MS, and/or a sustained response to corticosteroids.…”