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Diagram shows major pathways in cellular choline metabolism listing only major metabolites (enzymes, precursors, cofactors, and byproducts omitted). Bold type indicates metabolites that contribute to total choline peak during proton MR spectroscopy. Elevated choline concentration in tumors is believed to be primarily due to accumulation of phosphocholine resulting from increases in activity of choline kinase (choline → phosphocholine) and phospholipase (phosphatidylcholine → choline).
