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Left frontal glioblastoma multiforme

Case Study
Savatovsky, Julien, M.D. Fondation Ophtalmologique Adolphe de Rothschild • France

Patient history

A 27-year-old female with recent onset of seizures and headaches underwent MRI at Foundation Rothschild, Paris, France.

MR examination

The examination was performed on Ingenia 3.0T using a 32-channel dS Head coil. The total scan time (including SmartBrain) was 32:00 minutes.

Images

Click on an image to enlarge.
3D FLAIR Voxels 0.9 x 0.9 x 0.9 mm <br>
Scan time 4:24 min. <br>
<br>3D T1-TSE post contrast Voxels 0.95 x 0.95 x 0.95mm<br>
Scan time 3:56 min. <br>pCASL perfusion Voxels 2.8 x 2.8 x 6 mm<br>
Scan time 2:48 min. <br>
3D FLAIR
3D T1-TSE post contrast
pCASL perfusion
Voxels 0.9 x 0.9 x 0.9 mm
Scan time 4:24 min.

Voxels 0.95 x 0.95 x 0.95mm
Scan time 3:56 min.
Voxels 2.8 x 2.8 x 6 mm
Scan time 2:48 min.
3D FLAIR Voxels 0.9 x 0.9 x 0.9 mm<br>
Scan time 4:24 min.<br>
<br>3D T1-TSE post contrast Voxels 0.95 x 0.95 x 0.95 mm<br>
Scan time 3:56 min. <br>SWI Voxels 0.7 x 0.7 x 0.7 mm<br>
Scan time 2:36 min. <br>
3D FLAIR
3D T1-TSE post contrast
SWI
Voxels 0.9 x 0.9 x 0.9 mm
Scan time 4:24 min.

Voxels 0.95 x 0.95 x 0.95 mm
Scan time 3:56 min.
Voxels 0.7 x 0.7 x 0.7 mm
Scan time 2:36 min.
DWI b2000 Voxels 1.25 x 1.80 x 5 mm<br>
Scan time 0:46 min. <br>
<br>ADC map DTI FA Voxels 2.5 x 2.5 x 2.5 mm <br>
Scan time 3:00 min. <br>
DWI b2000
ADC map
DTI FA
Voxels 1.25 x 1.80 x 5 mm
Scan time 0:46 min.

Voxels 2.5 x 2.5 x 2.5 mm
Scan time 3:00 min.
DTI fiber tracking DTI medium 15 directions b800 <br>
DTI fiber tracking
DTI medium 15 directions b800
MR spectroscopy Spectroscopy single voxel TE 35<br> 
Voxels 15 x 15 x 15 mm<br>
Scan time 1:50 min.<br>
<br>
Spectroscopy multi voxel TE 135 <br>
Voxels 14 x 14 x 15 mm<br>
Scan time 6:30 min.<br>
<br>
MR spectroscopy
Spectroscopy single voxel TE 35
Voxels 15 x 15 x 15 mm
Scan time 1:50 min.

Spectroscopy multi voxel TE 135
Voxels 14 x 14 x 15 mm
Scan time 6:30 min.

3D FLAIR and post-contrast T1-weighted reformats (axial and sagittal) depict an intraaxial mass with a contrast-enhanced component and a non-enhancing, high T2 signal intensity infiltrative component. pCASL perfusion, overlaid on the post-contrast T1W images, displays a highly perfused zone (star) outside the enhanced lesion. Susceptibility weighted imaging demonstrates abnormal vessels (arrow) and small foci of intratumoral susceptibility signal intensities (arrowheads) inside the contrast-enhancing and necrotic component.

 

The contrast-enhancing component is in high DWI signal intensity with heterogeneous apparent diffusion coefficient (ADC), and low fractional anisotropy (FA). Left arcuate fasciculus tracking demonstrates displaced fibers within the non-enhancing component of the lesion.

 

Multi-voxel MR spectroscopy (MRS) is performed with TE 135 ms. High choline (membrane proliferation) and low N-acetyl-aspartate (neuronal loss) are seen in both contrast-enhancing and non-enhancing parts of the lesion. Elevated lipids and lactate in areas are seen close to the contrast-enhancing lesion (necrosis).

Diagnosis

Left frontal glioblastoma multiforme (WHO grade 4)

Clinical impact of using advanced MR techniques

Ring contrast-enhancing lesion has a wide range of etiology, including, various tumors, infections and even some pseudotumoral inflammatory diseases. FLAIR high-signal intensity around an intraaxial enhancing lesion is also nonspecific on morphological imaging alone (edema or infiltrative tumor). Further characterization of both components with MR spectroscopy, susceptibility weighted imaging, diffusion and perfusion imaging helps clinicians to rule out pseudotumoral lesions, approach tumor classification and full extent, in order to optimize therapeutic management. In this patient, the high choline and high CBF on perfusion outside the enhancing lesion are very suggestive of high grade glioma.

Related reading:





Results from case studies are not predictive of results in other cases. Results in other cases may vary.


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Jan 20, 2015

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Case Study
Ingenia 3.0T
Brain, dStream, DTI, DWI, MR spectrocopy, Neuro, Oncology, pCASL, Spectroscopy
 

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