1H magnetic resonance spectroscopy was used to compare brain metabolism in 540 elderly persons, stratified by sex and age (60-90 years old). An 8 x 8 x 2 cm3 supraventricular brain volume, a transverse plane parallel to the canthomeatal line, was examined by automated 1H chemical shift imaging [point-resolved spectroscopy (PRESS), TE of 35 msec]. Regional choline (Cho), creatine (Cr), and N-acetyl aspartate (NAA) peak areas in the 518 successful examinations (96%) were studied by division through the total area of the particular metabolite in each spectral map. This procedure eliminated intersubject variance, maximized intervoxel variance (26 < or = F < or = 149, P < 0.0001) and reduced the standard deviations in the voxel metabolite signals threefold. Normalized signals in women (n = 257) and men (n = 261) differed in 9 (Cho/sigma Cho), 8 (Cr/sigma Cr), and 10 (NAA/sigma NAA) of 36 voxels examined (P < or = 0.001). In the cingulate gyrus Cho/sigma Cho, Cr/sigma Cr, and NAA/sigma NAA were reduced in men compared with women. These findings are consistent with a sex-related reduction of glucose metabolism in the same brain lobe revealed by positron emission tomography.