Legend Axial FLAIR, T2W sequences demonstrating a well defined hyperintense focus of signal abnormality in the medial left frontal lobe. There is ill defined pathy intralesional enhancement in the post contrast image. Spectroscopy through the lesion demonstrates normal choline, reduced NAA, and mildly elevated myo-inositol.

Legend Axial images through the same lesion obtained 3 years later demonstrates mild interval increase in size and the lesion appears to be more heterogeneous with abnormal enhancement with is more prominent compared to the prior study. CSI spectroscopy through the lesion demonstrates marked elevation of choline and decrease in NAA indicating change in tumor biology which may include dedifferentiation. Choline is elevated both within the lesion and in the voxels lateral to the mass, indicating infiltration into the adjacent normal-appearing brain tissue. Key words: mri mrs tumor neoplasia

Brain Diagnosis: Fibrillary astrocytoma: Grade 2