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Fig. 2A —7-year-old boy who previously had an ependymoma resected from left frontal lobe. Axial T1-weighted images after contrast administration show areas of irregular contrast enhancement on 36-month follow-up MRI at site of prior resection (A). Two-dimensional chemical shift image shows pathologic spectra with increased Cho/NAA (choline-N-acetyl aspartate) and Cho/Cr (choline-creatine) ratios, 3.21 and 3.24, respectively, and a decrease in the NAA/Cr ratio, 1.01, consistent with tumor recurrence (B and C). Patient underwent additional resection, and recurrent ependymoma was confirmed at histopathology.