Glioblastoma

Glioblastoma MRI T2 axial

General

  • 15% of all brain tumors (~ 50% of all astrocytomas);

  • age after 40 years (peak 65-75 years);

  • aggressive, resistant to therapy with a poor prognosis;

  • primary glioblastomas (occur de novo ~ 90%),

  • secondary glioblastomas - develop from low grade gliomas (~ 10%).

 

Morphology

  • usually large diffusely infiltrating masses of the cerebral hemispheres

  • have thick edges;

  • contrasted with a central zone of necrosis and a hemorrhagic component;

  • surrounded by edema of the vasogenic type with the content of tumor cells ("tumor + edema");

  • located more often supratentorial;

  • tendency to subcortical white matter and basal nuclei, as well as spread along the commissural tracts;

  • glioblastomas are multifocal in 20% of patients.

 

DWI / ADC

• solid component

• WHO IV (glioblastomas) = 745 ± 135 x 10-6mm 2/s

• WHO III (anaplastic astrocytomas) = 1067 ± 276 × 10-6mm 2/s

• WHO II (diffuse astrocytomas) = 1273 ± 293 x 10-6mm 2/s

 

Perfusion

MRI perfusion: rCBV is elevated compared to lower grade tumors and normal brain

 

MR-spectroscopy

↑ Cho, ↑ Lac, ↑ Lip, ↓ NAA ↓ Mio

 

PET 

PET shows FDG accumulation - increased glucose metabolism, more gray matter metabolism.

 

Contrast enhancement

  • contrast enhancement pattern - crown effect

 

Treatment & prognosis

  • removal of the tumor, radiation therapy and chemotherapy.

  • monitoring is usually done within 24-48 hours after surgery (residual tissue assessment) and then every 8-12 weeks.

 

Differential diagnosis

  • cerebral metastasis

  • anaplastic astrocytoma

  • cerebral abscess

  • cerebral toxoplasmosis

  • primary lymphoma CNS

Glioblastoma MRI DWI axial
Glioblastoma MRI T1 contrast enhancement coronal
Glioblastoma CT axial
Glioblastoma MRI Flair axial
Glioblastoma MRI T2 axial_morphology
Glioblastoma MRI DWI/ADC
Glioblastoma CT
Glioblastoma MRI general
Glioblastoma MRI diff diagnosis