Choline peak

Last revised by Dr Calum Worsley on 02 Nov 2021

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 (edema) suggests an infiltrating diffuse glioma rather than a cerebral metastasis
  • glioblastoma progression vs pseudoprogression: elevation favors tumor progression over pseudoprogression, but can be elevated if a strong immune response is present as is seen in immunotherapy 1,2

Due to active myelination with synthesis of membrane constituents, an infant’s brain shows high choline peaks compared to adult spectroscopy 3-6.

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Cases and figures

  • Case 1: low-grade glioma
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  • Case 2: primary CNS lymphoma
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