Glioblastoma multiforme MRI: Difference between revisions

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==Overview==
==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.<ref name=ddd>XYZ of glioblastoma multiforme. Dr Dylan Kurda and Dr Frank Gaillard et al. Radiopaedia 2015. http://radiopaedia.org/articles/glioblastoma</ref>
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==
Brain MRI is helpful in the diagnosis of glioblastoma multiforme. On brain MRI, glioblastoma multiforme is characterized by:<ref name=ddd>XYZ of glioblastoma multiforme. Dr Dylan Kurda and Dr Frank Gaillard et al. Radiopaedia 2015. http://radiopaedia.org/articles/glioblastoma</ref>
Brain MRI is helpful in the diagnosis of glioblastoma multiforme. On brain MRI, glioblastoma multiforme is characterized by:<ref name="ddd">XYZ of glioblastoma multiforme. Dr Dylan Kurda and Dr Frank Gaillard et al. Radiopaedia 2015. http://radiopaedia.org/articles/glioblastoma</ref>


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{| style="border: 0px; font-size: 90%; margin: 3px; width: 600px" align="center"
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! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|MRI component}}
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*Absent dual rim sign
*Absent dual rim sign
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" rowspan=3 |DWI/ADC
| rowspan="3" style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |DWI/ADC
|style="padding: 5px 5px; background: #F5F5F5;"|
| style="padding: 5px 5px; background: #F5F5F5;" |
*Solid component
*Solid component
:* Elevated signal on DWI is common in solid / enhancing 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)
:* 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;"|
| style="padding: 5px 5px; background: #F5F5F5;" |
* ADC values correlate with grade:  
* ADC values correlate with grade:  
:* WHO IV (GBM) = 745 ± 135 x 10-6 mm2/s
:* WHO IV (GBM) = 745 ± 135 x 10-6 mm2/s
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:* 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
:* 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
|-
|-
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* Non-enhancing necrotic / cystic component
* Non-enhancing necrotic / cystic component
:* Majority (>90%) have facilitated diffusion (ADC values > 1000 x 10-6 mm2/s)
:* Majority (>90%) have facilitated diffusion (ADC values > 1000 x 10-6 mm2/s)
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<div align="left">
<div align="left"></div>
<gallery heights="175" widths="175">
Image:Glioblastoma - MR sagittal with contrast.jpg|Image 1a. Sagittal [[MRI]] with contrast of a glioblastoma WHO grade IV in a 15-year-old boy
Image:Glioblastoma - MR coronal with contrast.jpg|Image 1b. Coronal [[MRI]] with contrast of a glioblastoma WHO grade IV in a 15-year-old boy
</gallery>
</div>


'''Patient #1: Presented with increasing headaches'''
'''Patient #1: Presented with increasing headaches'''
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==References==
==References==
{{reflist|2}}
[[Category:Neurosurgery]]
[[Category:Neurosurgery]]
[[Category:Neurology]]
[[Category:Neurology]]

Revision as of 14:39, 22 March 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:[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


Template:WikiDoc Sources

  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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