Glioblastoma multiforme MRI: Difference between revisions

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{{Glioblastoma multiforme}}
{{Glioblastoma multiforme}}
{{CMG}}  
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==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.


==MRI==
==MRI==
<div align="left">
Brain MRI is helpful in the diagnosis of glioblastoma multiforme. On brain [[MRI]], glioblastoma multiforme is characterized by:
<gallery heights="175" widths="175">
 
Image:Glioblastoma - MR sagittal with contrast.jpg|Image 1b. Sagittal [[MRI]] with contrast of a glioblastoma WHO grade IV in a 15-year-old boy
[[File:Glioblastoma-GIF1.gif|thumb|200px|sagital section of brain showing Glioblastoma multiforme  [https://upload.wikimedia.org/wikipedia/commons/b/b2/Animazione_RMN_saggittale_dopo_rimozione_glioblastoma.gif Source:Wikimedia Commons] ]]
Image:Glioblastoma - MR coronal with contrast.jpg|Image 1a. Coronal [[MRI]] with contrast of a glioblastoma WHO grade IV in a 15-year-old boy
 
</gallery>
[[File:GlioblastomaGIF2.gif|thumb|200px|Transverse section of brain showing Glioblastoma multiforme  [https://upload.wikimedia.org/wikipedia/commons/c/ce/Animazione_RMN_trasversale_dopo_rimozione_glioblastoma.gif Source:Wikimedia Commons] ]]
</div>
 
[[File:Glioblastoma multiforme - MRi.jpg|thumb|200px|Transverse section of brain showing Glioblastoma multiforme  [https://upload.wikimedia.org/wikipedia/commons/0/0f/Glioblastoma_multiforme_-_MRT_T2_ax.jpg Source:Wikimedia Commons] ]]
 
{| style="border: 0px; font-size: 90%; margin: 3px; width: 600px" align="center"
| valign="top" |
|+
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|MRI component}}
! style="background: #4479BA; width: 400px;" | {{fontcolor|#FFF|Features}}
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
:T1
| style="padding: 5px 5px; background: #F5F5F5;" |
*Butterfly shaped mass
*Hypo to isointense mass within [[white matter]]
*Central heterogenous signal ([[necrosis]], intratumoral [[hemorrhage]])
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
:T1 C+ (Gd)
| style="padding: 5px 5px; background: #F5F5F5;" |
*Enhancement is variable
*Typically peripheral and irregular with [[nodular]] components
*Usually completely surrounds [[necrosis]]
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
:T2/FLAIR
| style="padding: 5px 5px; background: #F5F5F5;" |
*Hyperintense
*Surrounded by vasogenic [[edema]]
*Flow voids
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
:GE/SWI
| style="padding: 5px 5px; background: #F5F5F5;" |
*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
|-
| rowspan="3" style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |DWI/ADC
| style="padding: 5px 5px; background: #F5F5F5;" |
*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)
|-
| style="padding: 5px 5px; background: #F5F5F5;" |
* 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
|-
| style="padding: 5px 5px; background: #F5F5F5;" |
* Non-enhancing necrotic / cystic component
:* Majority (>90%) have facilitated diffusion (ADC values > 1000 x 10-6 mm2/s)
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
:MR perfusion
| style="padding: 5px 5px; background: #F5F5F5;" |
*rCBV elevated compared to lower grade [[tumors]] and normal [[brain]]
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
:MR spectroscopy
| style="padding: 5px 5px; background: #F5F5F5;" |
*[[Choline]]: increased
*[[Lactate]]: increased
*[[Lipids]]: increased
*[[N-Acetylaspartate|NAA]]: decreased
*[[Myo-inositol]]: decreased
|-
|}
 
<div align="left"></div>


==References==
==References==
{{reflist|2}}
[[Category:Neurosurgery]]
[[Category:Neurosurgery]]
[[Category:Neurology]]
[[Category:Neurology]]
[[Category:Types of cancer]]
[[Category:Types of cancer]]
[[Category:Oncology]]


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Latest revision as of 23:33, 15 April 2019

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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.

MRI

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

sagital section of brain showing Glioblastoma multiforme Source:Wikimedia Commons
Transverse section of brain showing Glioblastoma multiforme Source:Wikimedia Commons
Transverse section of brain showing Glioblastoma multiforme Source:Wikimedia Commons
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

References


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