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

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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

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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

* 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

## References

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