High grade glioma: perfusion imaging

Case contributed by Dr Prashant Gupta

Presentation

headache of long standing duration

Patient Data

Age: 50
Gender: Male
Modality: MRI

MRI showed a rim enhancing necrotic mass in left parieto-occipital region with significant surrounding edema.

Note that the edema crosses the splenium of corpus callosum.

Modality: MRI

Spectroscopy was done at the rim of the leison and showed elevated cho/cr ratio, however the ratio was not grossly elevated, further prominent lipid/lactate peaks were found and the Cho/NAA ratio was reduced and not increased as one would expect. 

This feature confounded the diagnosis of a glioma, tuberculoma can show mildly elevated cho/Cr and shows prominent lipid/lactate peaks. Tumefactive demyelination can have a similar picture as well.

Modality: MRI

Perfusion imaging was done to further characterize the lesion. It showed a raised rCBV value of 3.35 compared to contralateral normal brain.

Case Discussion

The operative findings in this case revealed a necrotic whitish mass. Histopathology revealed a high grade glioma (GBM)

Perfusion can be used as a problem solving technique in equivocal cases as well as to confirm radiological suspicion

It can be integrated into an algorithm as given in the excellent article quoted below.

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Case Information

rID: 18860
Case created: 25th Jul 2012
Last edited: 28th Jan 2016
Inclusion in quiz mode: Included

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