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Inflammatory granulomas: evaluation with proton MRS

Intracranial inflammatory lesions consisting mainly of tuberculomas (n = 28), neurocysticercosis (NCC) (n = 10), and non‐specific inflammatory granulomas (IG) (n = 22) were evaluated with proton MRS. Water‐suppressed proton spectra were acquired from 60 patients using the STEAM sequence with an echo time of 135 ms and metabolite ratios determined from the spectra. Student's paired t‐test and χ2‐test were used to analyse the data. Statistically significant differences were observed for the following ratios between the three patient categories: NAA/Cr (p < 0.0001), NAA/Cho (p = 0.001) and Cr/Cho (p = 0.02) for the non‐specific IG and NCC, NAA/Cho (p = 0.03) for non‐specific IG and tuberculoma, and NAA/Cr (p < 0.0001) for NCC and tuberculoma. While lipids were seen in 86% of the tuberculomas, they were observed in only 20% of the NCCs (χ2 = 6.81, p = 0.009), and 21% of the non‐specific IGs (χ2 = 10.75, p = 0.0001). While the presence of lipid can be used for differentiating tuberculomas from both non‐specific IG and NCC, the extremely low levels of metabolites together with a poor signal/noise ratio could itself act as a marker for NCC. Copyright © 1999 John Wiley & Sons, Ltd.