Choline peak
Citation, DOI, disclosures and article data
Citation:
Gaillard F, Sattar A, Worsley C, et al. Choline peak. Reference article, Radiopaedia.org (Accessed on 25 Mar 2025) https://doi.org/10.53347/rID-27823
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rID:
27823
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Disclosures:
At the time the article was created Frank Gaillard had no recorded disclosures.
View Frank Gaillard's current disclosures
Last revised:
Disclosures:
At the time the article was last revised Jeremy Jones had no financial relationships to ineligible companies to disclose.
View Jeremy Jones's current disclosures
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12 contributors -
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Systems:
Choline is a precursor of acetylcholine (ACH) and a cell membrane component which is commonly examined in MR spectroscopy. It resonates at 3.2 ppm chemical shift.
Choline is a marker of cellular membrane turnover and therefore elevated in neoplasms, demyelination, inflammation and gliosis 1.
It is useful in a number of scenarios:
diffuse glioma vs metastasis: elevation in a region of high T2 signal surrounding an enhancing mass (oedema) suggests an infiltrating diffuse glioma rather than a cerebral metastasis
glioblastoma progression vs pseudoprogression: elevation favours tumour progression over pseudoprogression, but can be elevated if a strong immune response is present as is seen in immunotherapy 1,2
toxoplasmosis vs lymphoma: lymphoma typically shows elevated choline peak, while it is reduced in toxoplasmosis
Due to active myelination with synthesis of membrane constituents, an infant’s brain shows high choline peaks compared to adult spectroscopy 3-6.
Quiz questions
References
- 1. Mader I, Rauer S, Gall P, Klose U. (1)H MR Spectroscopy of Inflammation, Infection and Ischemia of the Brain. Eur J Radiol. 2008;67(2):250-7. doi:10.1016/j.ejrad.2008.02.033 - Pubmed
- 2. Aquino D, Gioppo A, Finocchiaro G, Bruzzone M, Cuccarini V. MRI in Glioma Immunotherapy: Evidence, Pitfalls, and Perspectives. J Immunol Res. 2017;2017:5813951. doi:10.1155/2017/5813951 - Pubmed
- 3. Hüppi P, Posse S, Lazeyras F, Burri R, Bossi E, Herschkowitz N. Magnetic Resonance in Preterm and Term Newborns: 1H-Spectroscopy in Developing Human Brain. Pediatr Res. 1991;30(6):574-8. doi:10.1203/00006450-199112000-00017 - Pubmed
- 4. Progressi in RM. Spettroscopia Protonica Cerebrale. (1999) ISBN: 9788879472470 - Google Books
- 5. Groenendaal F, Veenhoven R, van der Grond J, Jansen G, Witkamp T, de Vries L. Cerebral Lactate and N-Acetyl-Aspartate/choline Ratios in Asphyxiated Full-Term Neonates Demonstrated in Vivo Using Proton Magnetic Resonance Spectroscopy. Pediatr Res. 1994;35(2):148-51. doi:10.1203/00006450-199402000-00004 - Pubmed
- 6. Peden C, Cowan F, Bryant D et al. Proton MR Spectroscopy of the Brain in Infants. J Comput Assist Tomogr. 1990;14(6):886-94. doi:10.1097/00004728-199011000-00004 - Pubmed
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- 2-hydroxyglutarate peak: resonates at 2.25 ppm
- alanine peak: resonates at 1.48 ppm
- choline peak: resonates at 3.2 ppm
- citrate peak: resonates at 2.6 ppm
- creatine peak: resonates at 3.0 ppm
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