Glioma MRI: Difference between revisions

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{{Glioma}}
{{Glioma}}


{{CMG}}; '''Associate Editor-In-Chief:''' {{CZ}}
{{CMG}}; '''Associate Editor-In-Chief:''' {{CZ}}, {{SR}}


==Overview==
==Overview==
Head and spinal MRI may be the most important test for the diagnosis of glioma
[[Brain]] MRI may be diagnostic of glioma. The MRI findings of glioma vary with the tumor grade and type.<ref name=aaa>Radiological findings of pilocytic astrocytoma. Dr Bruno Di Muzio and Dr Frank Gaillard et al. Radiopaedia.org 2015. http://radiopaedia.org/articles/pilocytic-astrocytoma</ref><ref name=bbb>Radiological findings of low grade infiltrative astrocytoma. Dr Henry Knipe and Dr Frank Gaillard et al. http://radiopaedia.org/articles/low-grade-infiltrative-astrocytoma</ref><ref name=ccc>Radiological findings of anaplastic astrocytoma. Dr Bruno Di Muzio and Dr Frank Gaillard et al. http://radiopaedia.org/articles/anaplastic-astrocytoma</ref><ref name=ddd>Radiological findings of glioblastoma. Dr Dylan Kurda and Dr Frank Gaillard et al. http://radiopaedia.org/articles/glioblastoma</ref><ref name=eee>Radiological findings of oligodendroglioma. Dr Henry Knipe and Dr Frank Gaillard et al. http://radiopaedia.org/articles/oligodendroglioma</ref><ref name=fff>Radiological findings of ependymoma. Dr Bruno Di Muzio and Dr Frank Gaillard et al. Radiopaedia.org 2015. http://radiopaedia.org/articles/ependymoma</ref>


==MRI==
==MRI==
Head and spinal MRI may be the most important test for the diagnosis of glioma
*[[Brain]] MRI may be diagnostic of glioma.
*The MRI findings of glioma vary with the tumor grade and type. Common findings are listed below:<ref name=aaa>Radiological findings of pilocytic astrocytoma. Dr Bruno Di Muzio and Dr Frank Gaillard et al. Radiopaedia.org 2015. http://radiopaedia.org/articles/pilocytic-astrocytoma</ref><ref name=bbb>Radiological findings of low grade infiltrative astrocytoma. Dr Henry Knipe and Dr Frank Gaillard et al. http://radiopaedia.org/articles/low-grade-infiltrative-astrocytoma</ref><ref name=ccc>Radiological findings of anaplastic astrocytoma. Dr Bruno Di Muzio and Dr Frank Gaillard et al. http://radiopaedia.org/articles/anaplastic-astrocytoma</ref><ref name=ddd>Radiological findings of glioblastoma. Dr Dylan Kurda and Dr Frank Gaillard et al. http://radiopaedia.org/articles/glioblastoma</ref><ref name=eee>Radiological findings of oligodendroglioma. Dr Henry Knipe and Dr Frank Gaillard et al. http://radiopaedia.org/articles/oligodendroglioma</ref><ref name=fff>Radiological findings of ependymoma. Dr Bruno Di Muzio and Dr Frank Gaillard et al. Radiopaedia.org 2015. http://radiopaedia.org/articles/ependymoma</ref>


[http://www.peir.net Images shown below are courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology]
{| style="border: 0px; font-size: 90%; margin: 3px; width: 600px" align=center
|valign=top|
|+
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Type of glioma}}
! style="background: #4479BA; width: 400px;" | {{fontcolor|#FFF|MRI findings}}
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
[[Pilocytic astrocytoma]]
| style="padding: 5px 5px; background: #F5F5F5;" |
:1. '''T1''': Iso- to hypointense solid component
:2. '''T2''': Hyperintense solid component
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
[[Astrocytoma|Low-grade astrocytoma]]
| style="padding: 5px 5px; background: #F5F5F5;" |
:1. '''T1''':
:*Isointense to hypointense
:*Confined to the [[white matter]] and causes expansion of the adjacent cortex
:2. '''T2/FLAIR''':
:*Mass-like hyperintense signals
:*Confined to the [[white matter]] and causes expansion of the adjacent cortex
:*Cortex can also be involved in late cases in comparison to the [[oligodendroglioma]], which is a cortical based tumor from the start
:*Microcystic changes along the line of spread
:*High T2 signal (not related to cellularity or cellular [[atypia]], but rather [[edema]], [[demyelination]], and other degenerative changes)
:3. '''DWI''':
:*No restricted diffusion
:*Increased diffusibility
:4. '''T1 C+ (Gd)''': No enhancement
:5. '''MR spectroscopy''':
:*Tumor will show elevated [[choline]] peak, low NAA peak, and elevated [[choline]]/[[creatine]] ratio
:*Lack of the [[lactate]] peak
:6. '''MR perfusion''': No elevation of rCBV
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
[[Astrocytoma|Anaplastic astrocytoma]]
| style="padding: 5px 5px; background: #F5F5F5;" |
:1. '''T1''': Hypointense
:2. '''T2''': Hyperintense but can be heterogeneous, if calcification of blood present
:3. '''T1 C+ (Gd)''':
:*Variable enhancement
:*Presence of ring enhancement suggests central necrosis
:4. '''MR spectroscopy''':
:*Increased [[choline]]/[[creatine]] ratio
:*NAA preserved or mildly depressed
:*No significant [[lactate]]
:*Intermediate levels of myo-inositol (lower than low grade, higher than glioblastoma)
:5. '''MR perfusion''': Elevated cerebral blood volume
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
[[Glioblastoma multiforme]]
| style="padding: 5px 5px; background: #F5F5F5;" |
:1. '''T1''':
:*Hypo- to isointense mass within white matter
:*Central heterogenous signal (necrosis, intratumoral hemorrhage)
:2. '''T1 C+ (Gd)''':
:*Variable enhancement
:*Typically peripheral and irregular with nodular components
:*Completely surrounds [[necrosis]]
:3. '''T2/FLAIR''':
:*Hyperintense
:*Surrounded by vasogenic [[edema]]
:*Flow voids
:4. '''GE/SWI''':
:*Susceptibility artifact on T2 from blood products or calcification
:*Low intensity rim from blood product
:*Located inside the peripheral enhancing component
:*Absent dual rim sign
:5. '''DWI/ADC''':
:*Solid component
:*Elevated signal on DWI is common in solid / enhancing component
:*Diffusion restriction is typically intermediate similar to normal white matter, but significantly elevated compared to surrounding vasogenic edema
:*ADC values correlate with grade:
::*WHO IV (GBM) = 745 ± 135 x 10-6 mm2/s
::*WHO III (anaplastic) = 1067 ± 276 x 10-6 mm2/s
::*WHO II (low grade) = 1273 ± 293 x 10-6 mm2/s
::*ADC threshold value of 1185 x 10-6 mm2/s sensitivity (97.6%) and specificity (53.1%) in the discrimination of high-grade (WHO grade III & IV) and low-grade (WHO grade II) gliomas
:6. '''Non-enhancing necrotic / cystic component''': Vast majority (>90%) have facilitated diffusion (ADC values > 1000 x 10-6 mm2/s)
:7. '''MR perfusion''': rCBV elevated compared to lower grade tumors and normal brain
:8. '''MR spectroscopy''':
:*[[Choline]]: increased
:*[[Lactate]]: increased
:*[[Lipids]]: increased
:*NAA: decreased
:*[[Myo-inositol]]: decreased
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
[[Oligodendroglioma]]
| style="padding: 5px 5px; background: #F5F5F5;" |
:1. '''T1''': Hypointense
:2. '''T2''': Hyperintense
:3. '''SWI''': Calcium seen as areas of "blooming"
:4. '''T1 C+ (Gd)''': Contrast enhancement is common
:5. '''DWI''': No diffusion restriction
:6. '''MR perfusion''': increased vascularity "chicken wire" network of vascularity results in elevated relative cerebral blood volume (rCBV)
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
[[Ependymoma]]
| style="padding: 5px 5px; background: #F5F5F5;" |
:1. '''T1''': Iso- to hypointense solid component
:2. '''T2''': Hyperintense to white matter
:3. '''SWI''': Foci of blooming from [[hemorrhage]] or [[calcification]]
:4. '''T1 C+ (Gd)''': Heterogenous enhancement
:5. '''DWI/ADC''': Restricted diffusion in solid components
:6. '''MR spectroscopy''':
:*Increased [[choline]]
:*Decreased NAA
:*Elevated [[choline]]/[[creatine]] ratio
:*Increased [[lipid]] and [[lactate]]
|}


<div align="left">
<gallery heights="225" widths="225">
Image:Ganglioglioma 1.jpg
Image:Ganglioglioma 2.jpg
</gallery>
</div>




[http://www.peir.net Images shown below are courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology]


<div align="left">
<div align="left">
<gallery heights="225" widths="225">
<gallery heights="225" widths="225">
Image:Ganglioglioma 3.jpg
File:Ganglioglioma 1.jpg|MRI of ganglioglioma
Image:Glioma Optic nerve MRI.jpg
Image:Ganglioglioma 2.jpg|MRI of ganglioglioma
Image:Ganglioglioma 3.jpg|MRI of ganglioglioma
Image:Glioma Optic nerve MRI.jpg|MRI of optic nerve glioma
</gallery>
</gallery>
</div>
</div>
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[[Category:Types of cancer]]
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Latest revision as of 23:37, 26 November 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2], Sujit Routray, M.D. [3]

Overview

Brain MRI may be diagnostic of glioma. The MRI findings of glioma vary with the tumor grade and type.[1][2][3][4][5][6]

MRI

  • Brain MRI may be diagnostic of glioma.
  • The MRI findings of glioma vary with the tumor grade and type. Common findings are listed below:[1][2][3][4][5][6]
Type of glioma MRI findings

Pilocytic astrocytoma

1. T1: Iso- to hypointense solid component
2. T2: Hyperintense solid component

Low-grade astrocytoma

1. T1:
  • Isointense to hypointense
  • Confined to the white matter and causes expansion of the adjacent cortex
2. T2/FLAIR:
  • Mass-like hyperintense signals
  • Confined to the white matter and causes expansion of the adjacent cortex
  • Cortex can also be involved in late cases in comparison to the oligodendroglioma, which is a cortical based tumor from the start
  • Microcystic changes along the line of spread
  • High T2 signal (not related to cellularity or cellular atypia, but rather edema, demyelination, and other degenerative changes)
3. DWI:
  • No restricted diffusion
  • Increased diffusibility
4. T1 C+ (Gd): No enhancement
5. MR spectroscopy:
6. MR perfusion: No elevation of rCBV

Anaplastic astrocytoma

1. T1: Hypointense
2. T2: Hyperintense but can be heterogeneous, if calcification of blood present
3. T1 C+ (Gd):
  • Variable enhancement
  • Presence of ring enhancement suggests central necrosis
4. MR spectroscopy:
  • Increased choline/creatine ratio
  • NAA preserved or mildly depressed
  • No significant lactate
  • Intermediate levels of myo-inositol (lower than low grade, higher than glioblastoma)
5. MR perfusion: Elevated cerebral blood volume

Glioblastoma multiforme

1. T1:
  • Hypo- to isointense mass within white matter
  • Central heterogenous signal (necrosis, intratumoral hemorrhage)
2. T1 C+ (Gd):
  • Variable enhancement
  • Typically peripheral and irregular with nodular components
  • Completely surrounds necrosis
3. T2/FLAIR:
  • Hyperintense
  • Surrounded by vasogenic edema
  • Flow voids
4. GE/SWI:
  • Susceptibility artifact on T2 from blood products or calcification
  • Low intensity rim from blood product
  • Located inside the peripheral enhancing component
  • Absent dual rim sign
5. DWI/ADC:
  • Solid component
  • Elevated signal on DWI is common in solid / enhancing component
  • Diffusion restriction is typically intermediate similar to normal white matter, but significantly elevated compared to surrounding vasogenic edema
  • ADC values correlate with grade:
  • WHO IV (GBM) = 745 ± 135 x 10-6 mm2/s
  • WHO III (anaplastic) = 1067 ± 276 x 10-6 mm2/s
  • WHO II (low grade) = 1273 ± 293 x 10-6 mm2/s
  • ADC threshold value of 1185 x 10-6 mm2/s sensitivity (97.6%) and specificity (53.1%) in the discrimination of high-grade (WHO grade III & IV) and low-grade (WHO grade II) gliomas
6. Non-enhancing necrotic / cystic component: Vast majority (>90%) have facilitated diffusion (ADC values > 1000 x 10-6 mm2/s)
7. MR perfusion: rCBV elevated compared to lower grade tumors and normal brain
8. MR spectroscopy:

Oligodendroglioma

1. T1: Hypointense
2. T2: Hyperintense
3. SWI: Calcium seen as areas of "blooming"
4. T1 C+ (Gd): Contrast enhancement is common
5. DWI: No diffusion restriction
6. MR perfusion: increased vascularity "chicken wire" network of vascularity results in elevated relative cerebral blood volume (rCBV)

Ependymoma

1. T1: Iso- to hypointense solid component
2. T2: Hyperintense to white matter
3. SWI: Foci of blooming from hemorrhage or calcification
4. T1 C+ (Gd): Heterogenous enhancement
5. DWI/ADC: Restricted diffusion in solid components
6. MR spectroscopy:


Images shown below are courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology

  • MRI of ganglioglioma
    MRI of ganglioglioma
  • MRI of ganglioglioma
    MRI of ganglioglioma
  • MRI of ganglioglioma
    MRI of ganglioglioma
  • MRI of optic nerve glioma
    MRI of optic nerve glioma

References

  1. ↑ 1.0 1.1 Radiological findings of pilocytic astrocytoma. Dr Bruno Di Muzio and Dr Frank Gaillard et al. Radiopaedia.org 2015. http://radiopaedia.org/articles/pilocytic-astrocytoma
  2. ↑ 2.0 2.1 Radiological findings of low grade infiltrative astrocytoma. Dr Henry Knipe and Dr Frank Gaillard et al. http://radiopaedia.org/articles/low-grade-infiltrative-astrocytoma
  3. ↑ 3.0 3.1 Radiological findings of anaplastic astrocytoma. Dr Bruno Di Muzio and Dr Frank Gaillard et al. http://radiopaedia.org/articles/anaplastic-astrocytoma
  4. ↑ 4.0 4.1 Radiological findings of glioblastoma. Dr Dylan Kurda and Dr Frank Gaillard et al. http://radiopaedia.org/articles/glioblastoma
  5. ↑ 5.0 5.1 Radiological findings of oligodendroglioma. Dr Henry Knipe and Dr Frank Gaillard et al. http://radiopaedia.org/articles/oligodendroglioma
  6. ↑ 6.0 6.1 Radiological findings of ependymoma. Dr Bruno Di Muzio and Dr Frank Gaillard et al. Radiopaedia.org 2015. http://radiopaedia.org/articles/ependymoma


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