MR spectroscopy of intracranial tuberculomas: A singlet peak at 3.8 ppm as potential marker to differentiate them from malignant tumors

Abstract

A singlet peak at ∼3.8 ppm is present in the majority of tuberculomas and absent in most malignant tumors, potentially a marker to differentiate these lesions. The assignment of the peak is difficult from our analysis; however, guanidinoacetate (Gua) is a possibility. Higher Cho/Cr and mI/Cr ratios should favor malignant lesions over tuberculomas. The presence of lipids and Glx is non-specific.

Calvarial Tuberculosis with Multiple Intracranial Tuberculomas: A Rare Association in a Severely Malnourished Child with Disseminated Tuberculosis

“…It may be due to increased cellular multiplication in tubercular granuloma and formation of excessive epithelioid and giant cells, resulting in increased choline content. 23,24 The Ch/Cr ratio of 1.3 in our case has a sensitivity and specificity of 100 and 63.6% for discriminating tuberculomas from malignant lesions. 23 The low mI/Cr value of 0.7 in our case has a sensitivity and specificity of 86.7 and 81.8% for discriminating tuberculomas from malignant lesions.…”

“…MR spectroscopy finding of a dominant lipid peak has a high sensitivity of 77% in diagnosing tuberculomas, because the mycobacterial wall contains a high concentration of saturated lipids. 23,24 However, the overall specificity of this finding is decreased given that lipids can also be seen in toxoplasmosis or malignant lesions such as lymphoma or glioblastoma. 23 Many authors have described Ch/Cr ratio > 1 in tuberculomas especially those with variegated enhancement (heterogeneous or solid-like enhancement), 22,25 as in our case.…”

“…23,24 However, the overall specificity of this finding is decreased given that lipids can also be seen in toxoplasmosis or malignant lesions such as lymphoma or glioblastoma. 23 Many authors have described Ch/Cr ratio > 1 in tuberculomas especially those with variegated enhancement (heterogeneous or solid-like enhancement), 22,25 as in our case. It may be due to increased cellular multiplication in tubercular granuloma and formation of excessive epithelioid and giant cells, resulting in increased choline content.…”

Multiple peripherally “ring” enhancing lesions of the brain in a young man: A diagnostic dilemma

“…Tuberculomas are associated with a lipid peak and decreased NAA 20 . In addition, TB lesions mostly show a singlet peak ~3.8ppm, which are not found in most malignancies 21 . On the other hand, high Cho/creatine (Cr) and mI/Cr ratios point towards malignancies rather than tuberculomas 21 .…”

“…In addition, TB lesions mostly show a singlet peak ~3.8ppm, which are not found in most malignancies 21 . On the other hand, high Cho/creatine (Cr) and mI/Cr ratios point towards malignancies rather than tuberculomas 21 . Neurocysticercosis lesions show a combination of increased lactate, alanine, succinate, Cho, but decreased NAA and Cr 20 .…”