Which of the following statements about neuroradiologic imaging modalities is/are correct?

A. Diffusion-weighted MRI can differentiate tumor from edema and identify the nonenhancing part of the tumor

C. Myelography is still useful in detecting some diffuse spinal disease such as cerebrospinal fluid (CSF) seeding.

D. For evaluating the bony detail of patients with facial trauma, CT is a better imaging modality than MRI.

E. Decreased amount of N-acetyl aspartate (NAA) and increased amount of lactate can be shown in the MR spectroscopy (MRS) of a patient with acute stroke. 

DISCUSSION: Diffusion-weighted MR is a new development in MR applications and is sensitive to microscopic motion of water protons (Brownian motion). Initial applications have involved imaging of early stroke and neoplasia. Early evidence also suggests that diffusion-weighted imaging can differentiate tumoral edema from tumor and identify the nonenhancing part of the tumor. Doppler sonography, MRA, and CT angiography (CTA) are all useful for evaluating the stenotic condition of carotid bifurcation noninvasively. However, sonography is very operator dependent, and MRA commonly overestimates the degree of carotid stenosis resulting from the turbulence, dephasing at points of stenosis or irregularity. CTA obtained by spiral or helical CT has a good correlation rate with carotid angiography (92%). Conventional carotid angiography remains the most accurate imaging modality for evaluation of the stenosis of carotid bifurcation. Although CT and MRI have taken the place of myelography in evaluating neurologic diseases, it is still useful in detecting diffuse subarachnoid seeding, which may be difficult to identify on MRI. The bone detail and calcification are poorly identified on MR, so in a patient with facial trauma, CT is a better modality than MR. With MRS, metabolites within a selected region of interest (ROI) can be investigated, and spectral peaks that reflect the concentrations of the metabolite within the ROI can be obtained. The metabolites include lactate, neuronal marker (NAA), phosphorus metabolites, creatine, and choline. Reduction in the NAA level and elevation in lactate level could be noted in acute stroke.