Multivoxel spectroscopy demonstrates normal spectra from normal white matter. The most malignant portion of the tumor demonstrates markedly elevated choline. There are also abnormal spectra from the brain lateral to the visible tumor on the standard MRI images . Metabolic mapping of the spectra allows a rapid assessment of the spectral peaks and the choline map also demonstrates the most malignant site to biopsy. Elevated choline probably represents the cell membrane breakdown secondary to the tumor, while NAA is a metabolite of normal neuronal tissue.
Spectral mapping demonstrates lactic acid in another portion of the tumor indicating necrosis .
Stereotactic brain biopsy was performed using the spectroscopic results for targeting and confirmed the diagnosis of glioblastoma multiforme as suspected. CSF Flow Phase Contrast MRI can demonstrate qualitatively and quantitatively, alterations in CSF flow during the cardiac cycle. This case demonstrates obstruction to downward CSF flow at the C6 level secondary to a post-traumatic syrinx which has expanded the cervical cord and associated adhesions. Lysing the adhesions should collapse the syrinx and obviate surgery of the syrinx itself.