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. 2020 Apr 15;11:270. doi: 10.3389/fneur.2020.00270

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Copyright © 2020 Tong, McCullagh and Iv.

This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

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79-years-old patient with left thalamic metastasis from lung cancer treated with stereotactic radiotherapy. (A) Post-contrast T1-weighted image shows the treated enhancing lesion. (B) Multi-voxel 2D magnetic resonance spectroscopy acquired at 3T with grid placed on the lesion. (C) Spectra (from the voxel highlighted in yellow) shows mild elevation of the choline peak, slightly increased Cho/Cr ratio, slightly increased Cho/NAA ratio, and normal NAA/Cr ratio. Subsequent follow-up MRI showed shrinkage of the contrast-enhancing mass (not shown), supporting the diagnosis of radiation necrosis.