Legend Long TR sequences from inferior to superior demonstrate diffuse signal abnormality involving both grey and white matter centered in the left parietal lobe and extending into the frontal and occipital lobes. A focal cystic mass is identified in the left parietal lobe.

Legend Pre-gad (upper left) along with post gad coronal and axial images reveal ring enhancement of the left parietal lesion, as well as additional parietal parenchymal enhancement.

Legend Single-voxel short and long TE spectra of the ring enhancing lesion reveal evidence for elevated choline, more pronounced on long TE spectrum (right). The doublet at 1.3 ppm inverts on the long TE spectrum, consistent with lactate.

Legend Additional single voxel spectrum of the occipital lesion reveals additional abnormal choline elevation and a small amount of lactate. Key words: mri tumor neoplasia mrs

Brain Diagnosis: Anaplastic astrocytoma