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Glioblastoma Multiforme

Milos J Janicek, MD
Liangge Hsu, MD

March 7, 1996

Presentation

A 66-year-old man presented with 2-month history of headache and right intra-orbital pain.

Imaging Findings

T1-weighted sagittal MRI
T2-weighted axial MRI

Magnetic resonance (MR) imaging reveals a 3 x 3.5 x 2.5 cm round lesion on the right temporal lobe. The sagittal T1-weighted MR image of the lesion demonstrates low intensity (arrow). However, this lesion shows high intensity on T2-weighted images (white arrow) with a suggestion of cerebral necrosis and with extensive vasogenic edema (black arrows). The images show inhomogeneous enhancement of the lesion after gadolinium injection. No other lesions are identified.

Differential Diagnosis

Differential diagnosis includes glioblastoma multiforme, anaplastic astrocytoma, metastatic tumor, and (though less likely) lymphoma, tuberculoma, or abscess.

Diagnosis

Glioblastoma multiforme (GBM)

Discussion

Given the imaging features on MRI, including the extent of edema and irregular enhancement of the lesion, the most likely diagnosis is glioblastoma multiforme (GBM). GBM is the most aggressive form of dedifferentiation of glial cells and accounts for 55% of all primary gliomas. The peak age is 40-60 years. The characteristic feature of GBM is a variegated intensity, representing tumor separated by hemorrhage and necrosis. Radiographically, GBM shows peripheral enhancement with central necrosis, extensive edema and mass effect.

Metastatic foci are smaller, more peripherally located and associated with relatively more edema than would be expected for their size. Lymphomas may demonstrate low signals on T2 images (due to high nuclei to cytoplasma ratio) and tend to enhance homogeneously without necrosis. Abscesses tend to have thinner walls of enhancement. GBM, anaplastic astrocytoma and lymphoma may disseminate along white matter pathways, giving rise to a classic "butterfly" pattern of spread at the corpus callosum. These tumors may spread to leptomeninges, dura and ependymal lining of the ventricles.

References

1) Dahlen R et al. Supratentorial brain tumors. In: Taveras JM, Ferrucci JT, editors. Radiology Diagnosis Imaging Intervention. Philadelphia: Lippincott, 1994:vol.3, ch. 53.

2) Forbes G, et al. Syllabus: Special Course in Neuroradiology. RSNA 1994.

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