Glioblastoma multiforme MRI

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Sujit Routray, M.D. [2]

Overview

Brain MRI is helpful in the diagnosis of glioblastoma multiforme. On brain MRI, glioblastoma multiforme is characterized by a butterfly shaped mass, which is hypointense on T1-weighted MRI and hyperintense on T2-weighted MRI.[1]

MRI

Brain MRI is helpful in the diagnosis of glioblastoma multiforme. On brain MRI, glioblastoma multiforme is characterized by:[1]

MRI component Features
T1
T1 C+ (Gd)
  • Enhancement is variable
  • Typically peripheral and irregular with nodular components
  • Usually completely surrounds necrosis
T2/FLAIR
  • Hyperintense
  • Surrounded by vasogenic edema
  • Flow voids
GE/SWI
  • Susceptibility artifact on T2 from blood products (or occasionally calcification)
  • Low intensity rim from blood product
  • Located inside the peripheral enhancing component
  • Absent dual rim sign
DWI/ADC
  • Solid component
  • Elevated signal on DWI is common in solid / enhancing component
  • Diffusion restriction is typically intermediate similar to normal white matter, but significantly elevated compared to surrounding vasogenic edema (which has facilitated diffusion)
  • ADC values correlate with grade:
  • WHO IV (GBM) = 745 ± 135 x 10-6 mm2/s
  • WHO III (anaplastic) = 1067 ± 276 x 10-6 mm2/s
  • WHO II (low grade) = 1273 ± 293 x 10-6 mm2/s
  • ADC threshold value of 1185 x 10-6 mm2/s sensitivity (97.6%) and specificity (53.1%) in the discrimination of high-grade (WHO grade III & IV) and low-grade (WHO grade II) gliomas
  • Non-enhancing necrotic / cystic component
  • Majority (>90%) have facilitated diffusion (ADC values > 1000 x 10-6 mm2/s)
MR perfusion
  • rCBV elevated compared to lower grade tumors and normal brain
MR spectroscopy

Patient #1: Presented with increasing headaches


Patient #2

References

  1. 1.0 1.1 XYZ of glioblastoma multiforme. Dr Dylan Kurda and Dr Frank Gaillard et al. Radiopaedia 2015. http://radiopaedia.org/articles/glioblastoma

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