Multiple glioblastomas: CT and MR features

Abstract

The aim of this study was to analyze the CT and MR features of multiple glioblastomas, and to determine the best imaging modality for the initial diagnosis. The CT (four exams) and MR imaging (eight exams) of eight patients with proven multiple glioblastomas were reviewed by two neuroradiologists. The lesions were always hypo- or isodense on CT and hyperintense on T2-weighted images (100%). They were usually hypo- or isointense on T1-weighted images (90%). Edema and mass effect were very variable. After contrast media administration, the enhancement was mostly strong (71% on CT and 70% on MR), often either heterogeneous or ring-like. The different lesions of a patient often had a different pattern on MR (75% of cases). Meningeal or ventricular enhancement, suggestive of a possible way of dissemination, was rare. In case of multiple cerebral masses, multiple glioblastomas should be considered as a possible diagnosis in addition to the better known diagnosis of brain metastases, abscesses, or multifocal lymphomas. Moderate edema and mass effect on MR associated with strong and heterogeneous enhancement are suggestive of feature of multiple glioblastomas. Magnetic resonance allows rarely the visualization of a dissemination route.

Multifocal Glioblastoma Multiforme

“…Meningeal or ventricular enhancement, suggestive of a possible way of dissemination, is rare. It may be associated with moder¬ate oedema and mass effect (11). There was no evidence of meningeal or ventricular enhancement in present case owever there was presence of associated cerebral oede-ma.…”

Rare Case Report of Multicentric Glioblastoma Multiforme Initially Mimicking With Herpes Simplex Encephalitis on MRI and Its Progression on Serial Imaging

“…Pathognomonic features of GBM include pseudopalisading necrosis and neovascularization [19]. The individual tumors in cases of multicentric GBM usually have the same pathologic appearance [16,20].…”

İntrakranyal Olgu Sunumlari

“…Multifokal glioblastomlarda multipl odaklar genellikle subaraknoid mesafe ya da ventriküle komşu primer kitleden BOS yolu ile ekilime bağlı gelişir. Korpus kallozum gibi beyaz cevher yolları boyunca yayılım da görülebilir [12]. Multifokal ve multisentrik glioblastom ayrımı tedavi planı açısından önemlidir.…”

“…Multifokal ve multisentrik glioblastom ayrımı tedavi planı açısından önemlidir. Eğer primer odaktan BOS ile yayılım ortaya konulursa kraniospinal radyoterapi ve intratekal kemoterapi gibi adjuvan tedaviler uygulanabilir [12]. Multifokal lezyonlar, multisentrik lezyonlara oranla daha kötü prognozludur [11,12].…”

“…Eğer primer odaktan BOS ile yayılım ortaya konulursa kraniospinal radyoterapi ve intratekal kemoterapi gibi adjuvan tedaviler uygulanabilir [12]. Multifokal lezyonlar, multisentrik lezyonlara oranla daha kötü prognozludur [11,12]. Lezyonların çoğu BT'de hipo ya da izodens, T1A görüntülerde hipo ya da izointens, T2A ve FLAIR'de hiperintens görülür.…”