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brain MRI spectroscopy Cho NAA Cr ratios interpretation elevated
Here is a detailed breakdown of what is in these two report pages:
Report Summary: Brain MRI Spectroscopy (MRS)
Patient: Anita Kumari
Date of Birth: 11/05/1974 (52 years old, Female)
Hospital: Fortis Hospital Mohali
Date of Study: 09/06/2026
Study ID: 17194 | MR E11 | OP 20414457
Scan Time: 13:03:34
Page 1 - MR Spectroscopy (MRS) Waveforms + Metabolite Maps
This page contains proton MR spectroscopy (¹H-MRS) data. Multiple voxels (sampling boxes) were placed across different brain regions and the metabolite peaks were measured.
Key metabolites shown in the spectral graphs:
| Metabolite | Chemical Shift | What it Represents |
|---|---|---|
| Cho (Choline) | ~3.2 ppm | Cell membrane turnover; elevated in tumors/inflammation |
| Cr (Creatine) | ~3.0 ppm | Energy metabolism; relatively stable reference |
| NAA (N-Acetylaspartate) | ~2.0 ppm | Neuronal integrity; reduced when neurons are damaged |
What the spectra show (reading the individual voxel plots):
The 6 spectral plots from different brain regions show varying Cho, Cr, and NAA peak heights. The key ratios visible are:
- Cho/NAA ratios appear elevated in several voxels (Cho peaks appear taller relative to NAA in multiple plots). The report labels show Cho values around 1.6-3.9 and NAA values around 1.3-4.8 depending on the voxel.
- In some voxels, Cho is noticeably higher than NAA, which is clinically significant.
Bottom section - Metabolite Maps (color-coded grids):
Two overlaid brain maps are shown:
- Cho/NAA map (left) - A color-coded grid showing the ratio of Choline to NAA across the brain slice. Warmer colors (red/orange) indicate higher Cho/NAA ratios (abnormal areas). The grid shows several voxels with values highlighted in warm colors, particularly in the right hemisphere area (labeled "RHA").
- Cr/NAA map (right) - Shows the Creatine to NAA ratio across the same region.
The color scale on the left of each map ranges from cool (blue = low/normal) to warm (red = high/abnormal). Several regions show elevated Cho/NAA ratios, suggesting possible neoplastic, inflammatory, or demyelinating pathology in those areas.
Technical parameters:
- TR 1700 / TE 135 ms
- NA 3 / TA 3:36
- Voxel size: 10 x 10 x 15 mm
- Version: H1U HQL pwc_12
Page 2 - Perfusion/Diffusion Color Maps
This page shows 24 axial brain slices displayed as color-coded parametric maps (likely cerebral blood flow / perfusion or ADC diffusion maps), arranged from inferior (top rows, showing cerebellum/brainstem level) to superior (bottom rows, showing cortex level).
- The color scale goes from blue (low signal) to red/orange (high signal)
- The upper slices (posterior fossa / brainstem level) show mostly blue with scattered color
- The middle slices (basal ganglia / white matter level) show a heterogeneous mix of yellow, orange, and red, indicating variable signal across white matter tracts
- The lower slices (cortical level) show prominent red-orange areas, especially bilaterally in the cortex
This type of map is consistent with ASL (Arterial Spin Labeling) perfusion MRI or a relative cerebral blood volume (rCBV) map used in tumor grading.
Clinical Interpretation (for your treating physician to confirm)
The combination of:
- Elevated Cho/NAA ratios in specific brain voxels on MRS
- Abnormal perfusion/metabolic maps on the second page
...is a pattern that is commonly seen in:
- Brain tumor (glioma or other primary neoplasm) - Cho/NAA > 1.8 is often considered evidence of tumor
- Tumor recurrence vs. treatment-related changes (radiation necrosis)
- High-grade inflammation / demyelination in some cases
Important: This is a technical description of the images. Only the treating neurologist or radiologist who has seen the full clinical picture, contrast-enhanced MRI, and patient history can provide a proper diagnosis and management plan. Please consult your doctor for interpretation.
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