Low grade glioma - with MR spectroscopy

Case contributed by Dr Ahmed Abd Rabou

Presentation

Headache, diplopia and vomiting with recent right hemiparesis

Patient Data

Age: 48 years old
Gender: Male

Diffuse involvement of the left insular cortex, medial part of left temporal lobe, left lentiform and caudate nuclei as well as left thalamus with infiltrative process that expands and doesn't distorts these structures which display low T1, high T2/FLAIR signal changes. In a previous unavailable post contrast study there were no enhancement at any of these structures.

The left internal capsule is spared yet there is mass effect upon the lateral ventricles with the ipsilateral ventricle is compressed and contralateral ventricle is dilated with transependymal CSF permeation suggesting subfalcine brain herniation.

MR spectroscopic data reveals mild Cho elevation, NAA reduction, absence of lactate, elevated Cho/Cr ratio and significant rise of myo-inositol (mI) in intermediate echo in keeping with low grade glioma.

Case Discussion

Biopsy from this lesion revealed WHO grade II fibrillary astrocytoma. Presence of myo-inositol and absence of lactate favour low grade rather than high grade glioma.

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Case information

rID: 36657
Case created: 3rd May 2015
Last edited: 15th Dec 2015
Inclusion in quiz mode: Included

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