Image-guided localized, water-suppressed in vivo 1H MR spectroscopic studies were performed on the brain tumors in 3 patients. In all 3 patients, in vivo 1H MR spectra in brain neoplastic tissues revealed that the signal intensities of N-acetylaspartate (NAA) choline (Cho) resonances were decreased and increased, respectively, comparing with healthy normal tissue. A distinct lactate signal was identified in all three patients. A ratio that the observed metabolite alterations from localized, water-suppressed in vivo 1H MR spectroscopy can be useful as an index of brain tumors, and that the technique is clinically to highlight as one promising modalities in brain tumors for more accurate diagnosis.