Cystic glioblastoma is a descriptive term for one form of glioblastoma that contains a large cystic component, rather than being a pathological subtype.
Please refer to the main article on glioblastoma for a broad discussion on this tumor.
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Radiographic features
The main challenge in discrimination between intracranial cystic lesions is to differentiate benign inflammatory cystic lesions (e.g. cerebral abscess) from malignant cystic lesions (e.g. cystic metastasis and cystic glioma) which have very different management.
CT
- well-defined intra-axial cystic lesion with peripheral ring enhancement
- usually presents with mass effect
- mild perifocal edema
- enhancing margin and soft tissue component
MRI
- T1: homogeneously hypointense
- T1 C+ (Gd): enhancing margin and soft tissue component
- T2: hyperintense
- FLAIR: cystic areas show hyperintensity relative to CSF due to higher protein contents
- DWI/ADC: no restriction for the cystic component; the solid component may show restriction according to the grade
- MR spectroscopy: high Cho/Cr ratio
- MR perfusion: no appreciable perfusion changes are usually seen
Treatment and prognosis
Patients diagnosed with cerebral glioblastoma containing a large cyst survive longer and have a longer period before recurrence than those who lack such a cyst 1,2.
Differential diagnosis
- cerebral abscess
- cystic cerebral metastasis
- intracranial hydatid cyst
- other intra-axial cysts, e.g. intra-axial arachnoid cyst, neuroglial cyst, porencephalic cyst
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