MR spectroscopy in Tumefactive Demyelination vs. High-Grade Glioma

Distinguishing a pseudotumoral demyelinating lesion from a high-grade glioma is notoriously challenging.

While both may show decreased NAA, an increase in glutamine/glutamate strongly suggests a tumefactive demyelinating lesion, whereas highly elevated myoinositol and choline peaks point toward a true glioma.