This study was designed to investigate the unique magnetic resonance imaging (MRI) appearance of histopathologically-proven glioblastoma multiforme (GBM) with pseudopalisade necrosis and to assess its value for grading gliomas and providing a differential diagnosis. The study included 169 patients with intracranial masses who underwent surgery and had a proven histopatho logical diagnosis: 50 with GBM, 77 with gliomas (46 grade II and 31 grade III) and 42 with other intracranial masses (20 metastases, 14 lymphomas and eight abscesses). All patients underwent preoperative brain MRI including postcontrast T 1 -weighted imaging. The presence of the 'pseudopalisade' sign on post-contrast T 1 -weighted images was compared among the different types of brain mass. The frequency of the 'pseudopalisade' sign in GBMs (94.00%) was significantly higher than that seen in grade II and III gliomas (11.69%) and other intracranial masses (7.14%). The 'pseudopalisade' sign on post-contrast T 1 -weighted images was useful for grading gliomas and for differentiating GBM from other brain masses.
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