European Journal of Radiology Extra 64 (2007) 83–86 Preoperative diagnosis of Lhermitte-Duclos disease: MRI and 1 H-MR spectroscopy findings Esra ¨ Ozkavukcu a,* , Pelin Seher ¨ Oztekin b , ˙ Ilhan Erden a a Ankara University School of Medicine, Turkey b Ankara Training and Research Hospital, Turkey Received 3 May 2007; received in revised form 9 August 2007; accepted 22 August 2007 Abstract Lhermitte-Duclos disease (LDD), also known as dysplastic gangliocytoma of the cerebellum, is a rare cerebellar disorder of uncertain etiology. LDD presents with highly typical findings on MRI. Furthermore, 1 H-MR spectroscopy can provide additional information supporting the diagnosis. Herein, we present the MRI and 1 H-MR spectroscopy findings of a 46-year-old LDD patient with a brief review of the relevant literature. The patient had a unilateral, cerebellar hemispheric mass with a layered appearance, resembling “tiger stripes”. On single-voxel 1 H-MR spectroscopy, N-acetyl aspartate (NAA), cholin (Cho), creatinine (Cr) levels and NAA/Cr, Cho/Cr ratios were found to be within reference values, however, lactate level was elevated. In conclusion, although conventional MRI characteristics of LDD are typical, 1 H-MR spectroscopy can provide additional and supportive information, revealing the benign nature of this rare lesion. Hence, preoperative diagnosis of LDD can be made with high accuracy using MRI and 1 H-MR spectroscopy. © 2007 Elsevier Ireland Ltd. All rights reserved. Keywords: Lhermitte-Duclos disease; Magnetic resonance imaging; Magnetic resonance spectroscopy 1. Introduction Lhermitte-Duclos disease (LDD), also known as dysplas- tic gangliocytoma of the cerebellum, is a rare cerebellar disorder of uncertain etiology. LDD presents with highly typical findings on magnetic resonance imaging (MRI). Furthermore, magnetic resonance spectroscopy (MRS) can provide additional information supporting the diagnosis of the lesion. Herein, we present the MRI and 1 H-MRS findings of a LDD patient, which has been confirmed histologically, with a brief review of the relevant literature. 2. Case report A 46-year-old male patient referred to our neurology department with complaints of progressively increasing * Corresponding author at: Ankara ¨ Universitesi Tıp Fak¨ ultesi Cebeci Has- tanesi, Radyoloji B ¨ ol¨ um¨ u, 06590 Cebeci, Ankara, Turkey. Tel.: +90 532 3476156. E-mail address: eozkavukcu@gmail.com (E. ¨ Ozkavukcu). occipital headache lasting for 3 years, blurred vision, and unbalanced gait. Neurological examination revealed ataxia, moderate dysmetria in the right cerebellar tests, and dysdiadokinesia. Romberg test was positive. In the ophtal- mological examination, slight bilateral papillary edema was observed. Initially, cranial MRI examination was planned with a pre- diagnosis of intracranial mass. MRI, which was performed with a 1.5 T system (Signa Advantage, GE Medical Systems, Milwaukee, WI, USA) revealed a striated lesion in the right side of cerebellum, almost occupying the whole hemisphere. The mass lesion was compressing the fourth ventricle and cerebellar aquaduct, displacing the aquaduct slightly to the left. The lesion had layers of hypo- and isointense signals on T1-weighted (T1W) images (Fig. 1a), hyper- and isointense signals on T2-weighted (T2W) images (Fig. 1b). No edema accompanied the lesion. Hydrocephaly was also noted due to the compression of the fourth ventricle and cerebral aquaduct. Afterwards, MRS examination was performed using a Proton Brain Exam/Single Voxel (PROBE/SV) software (GE Medical Systems) added to the Signa MRI system (Signa Advantage, GE Medical Systems, Milwaukee, WI, USA). 1571-4675/$ – see front matter © 2007 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ejrex.2007.08.005