Figure 6.

Diffuse intrinsic pontine glioma (DIPG). DIPGs are readily diagnosed by conventional MR imaging. MR spectroscopy demonstrates a metabolic evolution from a more moderately abnormal profile at presentation (A) to a metabolic pattern that is consistent with high-grade aggressive behavior at progression (C). Transiently, albeit still consistent with viable tumor, a pattern suggestive for a limited response to therapy may be observed, characterized by reduced choline (Cho) and increased myo-inositol (mI) (B). Metabolic changes consistent with progression may precede clinical deterioration and progression on MRI. All spectra were acquired on a 1.5T scanner using SV-PRESS with TE = 35 ms and TR = 1.5 s. Cit = citrate.