Background: Magnetic resonance spectroscopy [MRS] is of value for pediatric neurologist, as it confers relevant information from the clinical point of view. It is worth for brain tumors, infections and disorders of the white matter. MRS metabolites add additional value to the therapeutic solutions when MRS combined with other high-resolution imaging modalities.  
Objective: The current work aimed to assess the role of magnetic resonance spectroscopy in pediatric supratentorial brain lesions.
Patients and methods: This study recruited a convenient sample of thirty patients [21 females and 9 males].  Their age ranged between one and sixteen years. All were submitted to single-voxel H-MR spectroscopy with the same MR unit using point resolved spectroscopy [PRESS] sequence, using short TE [35] and long TE [144] spectra. Then spectrum analysis was performed to obtain the important ratios: choline/N-acetylaspartate, choline/creatine and mI/Cr to reach the diagnosis of the supratentorial lesion.
Result: The choline/N-acetylaspartate [Cho/NAA], choline/creatine [Cho/Cr] and mI/Cr ratios were statistically difference between neoplastic and non-neoplastic lesions at cutoffs 2, 1.6, & 1.15 respectively. The peak of lipid lactate was only present and significant for differentiating high- from low-grade tumors.
Conclusion: MRS is valuable in differential diagnosis of brain lesions, as it differentiates neoplastic from non-neoplastic tumors. It also plays a complementary role with magnetic resonance imaging [MRI] in the follow up of therapeutic response.