Introduction: Magnetic resonance spectroscopy (MRS) is a means of non- invasive physiological imaging of the brain that measures absolute and relative levels of various brain tissue metabolites. Conventional MR imaging provides highly detailed information for the diagnosis of suspected brain lesions. Proton MRS provides some extra information on the metabolic composition of the lesion under investigation. It provides biochemical picture of the underlying pathology and thus aids in the diagnosis.

Methods: Retrospective study was done on 50 patients with brain lesions diagnosed on MRI in our radiology department of the Sardar Vallabhbhai Patel Institute of Medical Science and Research (SVPIMSR) from March 2022 to Feb 2023.

Result: Analysis of spectra of 50 patients with brain lesions was done. All the lesions had increased choline levels and decreased NAA and Cr levels with increased Cho/NAA and Cho/Cr ratio. MRS of gliomas shows high Cho content, decreased contents of NAA with a decreased level of Cr. High Lac-Lip concentration helps to distinguish high and low grade gliomas. MR spectroscopy can be used to differentiate between ring enhancing granulomatous lesions like tuberculoma and neurocysticercosis. Tuberculomas on MR spectroscopy show lipid lactate peak and neurocysticercosis shows alanine peak. Lipid lactate was increased in high grade gliomas, metastasis and brain abscesses.