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By quantifying metabolites such as N-acetylaspartate, choline, creatine, lactate, and myo-inositol (myo-Ins), MRS offers insight into neuronal integrity, membrane turnover, energy metabolism, inflammation, and necrosis, features that help distinguish between pathologies with greater specificity than anatomic imaging alone.<\/jats:p>\n                  <jats:p>This review presents a clinically focused, systematic approach to brain MRS, addressing indications, acquisition strategies, spectral interpretation, and characteristic metabolic patterns across a broad spectrum of neuropathologies. Key technical factors influencing spectral quality and reproducibility, such as voxel selection, field strength, echo time, and sequence choice, are highlighted. Metabolic signatures of neoplastic, infectious, inflammatory, demyelinating, metabolic, and neurodegenerative disorders are reviewed with an emphasis on practical differentiation in the setting of overlapping imaging appearances. 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