Additional Diagnostic Value of Unenhanced Computed Tomography plus Diffusion-Weighted Imaging Combined with Routine Magnetic Resonance Imaging Findings of Early-Stage Gliblastoma

Abstract

Purpose. This study was performed to determine whether diffusion-weighted imaging (DWI) plus unenhanced computed tomography (CT) of the brain increases the diagnostic value of routine magnetic resonance (MR) imaging findings of early-stage glioblastoma. Methods. Postcontrast MR images of eight unenhanced lesions that had been pathologically diagnosed as glioblastoma were retrospectively examined. The location, margin, signal intensity, and attenuation on MR imaging and CT were assessed. Results. On MR imaging, all lesions were ill-defined, small, and isointense to hypointense on T1-weighted images and hyperintense on T2-weighted images. Four patients had perilesional edema. In seven patients, DWI showed an inhomogeneous hyperintense lesion (n = 1) or isointense lesion with a hyperintense region (n = 6). On unenhanced CT, all masses presented as a hypoattenuated lesion with a hyperattenuated region (n = 7) or isoattenuated region (n = 1). The hyperattenuated region (n = 6) or isoattenuated region (n = 1) on CT appeared on DWI as an inhomogeneous hyperintense lesion (n = 1), isointense lesion with a hyperintense region (n = 3), or ring-like peritumoral hyperintensity (n = 3). Conclusions. MR imaging was the most sensitive imaging method for depicting early-stage glioblastoma. The CT finding of a hyperattenuated or isoattenuated region combined with the DWI finding of the same region containing an inhomogeneous hyperintense lesion or isointense lesion with a hyperintense region may be a specific diagnostic sign for early-stage glioblastoma. DWI plus unenhanced CT added diagnostic value to the routine MR imaging findings of early-stage glioblastoma.

Always track the etiology of thromboembolism in younger adults : brain tumor revealed by recurrent pulmonary embolism in a young man

“…The radiological presentation of the mass evoked this diagnosis, even if the final diagnosis is done by histopathologic studies. At the early stage of the disease, MRI of the brain is the most sensitive tool for the diagnostic of Glioblastoma isointensity to hypointensity on T1WI, hyperintense ill-defined lesions on T2WI, little or no mass edema, and no contrast enhancement (12). CT-Scan could evoked hypervascularised brain tumor, but the difference between primitive lymphoma or glioblastoma is difficult by imaging (13).…”

Glioblastoma shortly after a normal conventional brain magnetic resonance imaging: A report of two cases and review of the literature

“…[ 4 ] Typically, GBs might not be radiologically detected until they cause visible changes in the cerebral tissue or structural abnormalities. [ 8 ] Therefore, most often, it is impossible to accurately diagnose occult tumors even though some clues are observed on MRI, such as poorly demarcated lesions; inhomogeneous hyperintensity on T2-weighted images with diffuse perilesional edema;[ 11 ] hyperintensity involving the cortex, subcortical, or both on T2-weighted MRI images;[ 3 ] subtle hyperintense areas;[ 12 ] multiple nonenhancing abnormalities; and T2-weighted hyperintensity. [ 7 ] Moreover, the radiological features of GB lesions are either not recognized or misdiagnosed as a demyelinating process, cerebral infarction,[ 11 13 14 ] encephalitis,[ 11 13 ] and venous thrombosis.…”

“…[ 8 ] Therefore, most often, it is impossible to accurately diagnose occult tumors even though some clues are observed on MRI, such as poorly demarcated lesions; inhomogeneous hyperintensity on T2-weighted images with diffuse perilesional edema;[ 11 ] hyperintensity involving the cortex, subcortical, or both on T2-weighted MRI images;[ 3 ] subtle hyperintense areas;[ 12 ] multiple nonenhancing abnormalities; and T2-weighted hyperintensity. [ 7 ] Moreover, the radiological features of GB lesions are either not recognized or misdiagnosed as a demyelinating process, cerebral infarction,[ 11 13 14 ] encephalitis,[ 11 13 ] and venous thrombosis. [ 13 ] Therefore, a mass exhibiting heterogeneous enhancement, central necrosis, and ill-defined, small isointense-to-hypointense lesions on T1-weighted and hyperintense lesion on T2-weighted images without edema and contrast enhancement should be considered typical for developing GBs.…”

“…[ 13 ] Therefore, a mass exhibiting heterogeneous enhancement, central necrosis, and ill-defined, small isointense-to-hypointense lesions on T1-weighted and hyperintense lesion on T2-weighted images without edema and contrast enhancement should be considered typical for developing GBs. [ 11 13 ]…”

“…[13] Therefore, a mass exhibiting heterogeneous enhancement, central necrosis, and ill-defined, small isointense-to-hypointense lesions on T1-weighted and hyperintense lesion on T2-weighted images without edema and contrast enhancement should be considered typical for developing GBs. [11,13] It was reported that advanced MRI techniques to evaluate the physiological or metabolic properties of lesions, such as diffusion-weighted imaging (DWI) and perfusion-weighted imaging (PWI), and to measure cerebral blood volume, such as dynamic susceptibility contrast MRI, may help to locate the extremely small tumor nests that remain undetected. [15,16] Although Ideguchi et al [13] found no abnormalities in the outcomes of DWI performed on a patient presenting with a headache in the left frontal lobe, Baehring et al [15] showed that increased signal intensity on DWI was very useful in identifying early stage of malignant gliomas.…”