Purpose: To compare 3 Tesla (3T) multi-voxel and singlevoxel proton MR spectroscopy (MRS), dynamic susceptibility contrast perfusion MRI (DSC), and diffusionweighted MRI (DWI) for distinguishing recurrent glioma from postradiation injury. Materials and Methods:We reviewed all 3T MRS, DSC and DWI studies performed for suspicion of malignant glioma recurrence between October 2006 and December 2008. Maximum Cho/NAA and Cho/Cr peak-area and peak-height ratios were recorded for both multi-voxel and single-voxel MRS. Maximum cerebral blood volume (CBV) and minimum apparent diffusion coefficient (ADC) were normalized to white matter. Histopathology and clinicalradiologic follow-up served as reference standards. Receiver operating characteristic curves for each parameter were compared.Results: Forty lesions were classified as glioma recurrence (n ¼ 30) or posttreatment effect (n ¼ 10). Diagnostic performance was similar for CBV ratio (AUC ¼ 0.917, P < 0.001), multi-voxel Cho/Cr peak-area (AUC ¼ 0.913, P ¼ 0.002), and multi-voxel Cho/NAA peak-height (AUC ¼ 0.913, P ¼ 0.002), while ADC ratio (AUC ¼ 0.726, P ¼ 0.035) did not appear to perform as well. Single-voxel MRS parameters did not reliably distinguish tumor recurrence from posttreatment effects. Conclusion:A 3T DSC and multi-voxel MRS Cho/Cr peak-area and Cho/NAA peak-height appear to outperform DWI for distinguishing glioma recurrence from posttreatment effects. Single-voxel MRS parameters do not appear to distinguish glioma recurrence from posttreatment effects reliably, and therefore should not be used in place of multi-voxel MRS.

EPHs occur most commonly in high-energy blunt trauma; concomitant injuries are the rule, especially rib fractures. Biconvex hematomas tend to be large, likely resulting from high-pressure bleeding. Consequently, biconvex EPHs more often require surgical intervention. Nonconvex hematomas can usually be managed conservatively.