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8 for Cho/NAA and 1 for Cho/Lipid. Cho/NAA > 1.8 and Cho/Lipid > 1, were considered as an indicator of tumor recurrence. Also, we proposed an algorithm shown in figure 1 which uses both Cho/NAA and Cho/Lipid ratios. Figure 1 The algorithm for discrimination between tumor recurrences from radiation necrosis according to spectroscopic data Preparation of biopsy specimens included neutral formalin fixation and paraffin embedding. Histological sections were stained with hematoxylin and eosin and examined with a light microscope. Histone demethylase Tissue sections were analyzed for the presence of tumor and radiation necrosis. Results Surgical resection was performed in all the 33 patients. The histological diagnosis was recurrence in 25 patients and necrosis in 8 patients (Table 1). Typical examples of metabolic spectra obtained in a lesion consistent with radiation injury and in recurrent tumor are given in figures 2 and ?and33. Figure 2 54-year-old woman after surgical resection and radiation for left frontal glioblastoma.(case 22) (a) Axial T1-weighted image after contrast administration shows a new area of contrast enhancement in left frontal lobe. check details (b) Spectra showed prominent lipid ... Figure 3 Magnetic resonance (MR) imaging and MR spectroscopy in a 44-year-old man with glioblastoma and history of surgery and radiotherapy (case 13). (a) Axial T1-weighted contrast-enhanced MR image, shows a left temporal enhancing lesion with mass effect. There ... Mean Cho/NAA in radiation necrosis and recurrent tumors were 1.46 and 2.72 respectively, with a significant difference (P Bcl-2 inhibitor proposed algorithm for detecting tumor recurrence, are shown in table 2. Table 2 Sensitivity, specificity and diagnostic accuracy of proposed algorithm Discussion In patients with intraparenchymal brain tumors and history of surgery and radiotherapy, it is important to differentiate between radiation necrosis and tumor recurrence to choose appropriate treatment and predict prognosis. In both situations, conventional MRI usually shows enhancing lesion with or without mass effect, so it cannot be conclusive.