Computed tomography in the diagnosis and differential diagnosis of glioblastomas

Abstract

The CT patterns of 295 glioblastomas examined with pre- and postcontrast scans using an EMI scanner Mark I (Matrix 160/160) have been reviewed and compared with the CT appearances of other brain tumors, metastases and abscesses. There is a great variety of CT patterns with glioblastomas. However, a garland-shaped CT appearance, representing a subgroup of ring-shaped lesions, seems to be most typical for glioblastomas since it was observed in 19% of ring-shaped glioblastomas but in only one out of 172 metastases and in no case of an astrocytoma grade II or an abscess in our series. The initial CT diagnosis, based on the CT finding, the patient's history and the clinical data, was correct in 69.8% of the glioblastomas, 41 recurrent glioblastomas included. In 12% of the cases the presence of a glioblastoma was within differential diagnosis. These results lead to the conclusion that in many cases additional diagnostic methods, such as serial scintigraphy and/or cerebral angiography, are required for a reliable differential diagnosis.

Polycystic and ring-shaped intracranial meningiomas

“…Contrast administration typically enhances the solid portion. Steinhoff et al [16] reported a case of ringshaped meningioma very similar to that of our first patient. From this angle, the marked peripheral enhancement in our first case is an infrequent finding in cystic meningiomas.…”

Determinants and Prognostic Significance of Hematoma Sedimentation Levels in Acute Intracerebral Hemorrhage

“…The present analysis of a broad range of patients with predominantly mildmoderate ICH severity included in INTERACT2 showed a lower frequency of sedimentation level as compared to the aforementioned studies. Sedimentation levels have also been reported in patients with arteriovenous malformation, aneurysm, tumor, and trauma due to bleeding into preexisting cavity or cystic lesion [3,[15][16][17][18][19][20] , but the INTERACT2 purposely excluded those patients. Moreover, although not pre-specified, only a small number of patients with warfarin use were included in INTERACT2.…”

“…Case reports and small series suggest that this sign indicates the likelihood of the use of specific therapeutic agents such as warfarin anticoagulation [4][5][6][7][8][9][10][11] and thrombolysis [12][13][14] , or structural abnormality related to trauma [3] , tumors [15][16][17][18] , ruptured arteriovenous malformation [19] , and ruptured intracranial aneurysm [20] . However, the prognostic significance of sedimentation level in ICH patients remains uncertain.…”

Computer tomographic assessment of perifocal edema surrounding tumors of the cerebral cortex

“…There should be no significant relation between the grade of malignancy or the volume of a tumor and the size of perifocal edema. STEINHOFF et al [5] observe perifocal edema on glioblastomas in 80% of cases. The volume is very variable.…”

“…Grade III and IV (WHO) show perifocal edema in more than 50% of cases. Only a few tumors are surrounded by a Grade II edema [2,5]. Metastases display perifocal edema of various extension, but without any histological correlation.…”