Glioblastoma multiforme MRI

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Sujit Routray, M.D. [2]

Overview

Brain MRI is helpful in the diagnosis of glioblastoma multiforme. On brain MRI, glioblastoma multiforme is characterized by a butterfly shaped mass, which is hypointense on T1-weighted MRI and hyperintense on T2-weighted MRI.

MRI

Brain MRI is helpful in the diagnosis of glioblastoma multiforme. On brain MRI, glioblastoma multiforme is characterized by:

sagital section of brain showing Glioblastoma multiforme Source:Wikimedia Commons

Transverse section of brain showing Glioblastoma multiforme Source:Wikimedia Commons

Transverse section of brain showing Glioblastoma multiforme Source:Wikimedia Commons

MRI component	Features
T1	Butterfly shaped mass Hypo to isointense mass within white matter Central heterogenous signal (necrosis, intratumoral hemorrhage)
T1 C+ (Gd)	Enhancement is variable Typically peripheral and irregular with nodular components Usually completely surrounds necrosis
T2/FLAIR	Hyperintense Surrounded by vasogenic edema Flow voids
GE/SWI	Susceptibility artifact on T2 from blood products (or occasionally calcification) Low intensity rim from blood product Located inside the peripheral enhancing component Absent dual rim sign
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 (which has facilitated diffusion)
	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
	Non-enhancing necrotic / cystic component Majority (>90%) have facilitated diffusion (ADC values > 1000 x 10-6 mm2/s)
MR perfusion	rCBV elevated compared to lower grade tumors and normal brain
MR spectroscopy	Choline: increased Lactate: increased Lipids: increased NAA: decreased Myo-inositol: decreased

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