Neuroimaging of Unusual Glioblastoma Using Diffusion Tensor Imaging

Background: Gliosarcoma refers to an uncommon astrocytic tumor of the central nervous system. These tumors include both glial and mesenchymal components by definition, and are extremely malignant. Gliosarcomas are particular to tumors with distinct gliomatous and sarcomatous constituents, and are distinguished from gliobastomas which have undergone mesenchymal metaplasia. Gliosarcomas encompass 2-8% of all glioblastoma cases and tend to occupy the supratentorial regions of the brain, especially the temporal lobe. Rare infratentorial lesions including the cerebellar hemisphere, intraventricular, and multi-focal tumors have also been reported. Accurate neuroimaging diagnosis is critical and diffusion tensor imaging (DTI) and spectroscopy can be useful to differentiate from inflammatory disease. Methods: We report a 38 year-old Caucasian male with a right parietal lobe glioblastoma. The patient presented with new onset tonic-clonic seizures lasting approximately five minutes associated with postictal confusion and incontinence. The patient had conventional brain MRI scans including DTI. MRI data was processed to obtain tractography and fractional anisotropy (FA) maps. MR images were examined for location and extent of tumor as well as invasion, destruction or displacement of brain parenchyma and white matter tracts. Results: Noncontract CT revealed no abnormality and emergent MR imaging shows a ring-enhancing lesion measuring 3.1x2.2x3.1 cm at the junction of the right parieto-occipital region. The lesion abuts the dural surface, characteristic of gliosarcoma. Extensive surrounding edema causing complete effacement of the posterior horn of the right lateral ventricle, parietal effacement of the anterior floor of the right ventricle, and a 1.2 cm right to left midline shift were observed. Mild diffuse enhancement in the region of the splenium of the corpus callosum was likely compatible with seizure activity. Increased signal intensity of axial FLAIR image was seen in this area after four weeks. Fractional anisotropy is reduced at the tumor site suggesting an aggressive and invasive lesion. Diffusion tensor tractography shows destruction of white matter tracts compatible with destruction rather than invasion of parenchyma. Histopathology confirms gliobastoma multiforme, demonstrating mixed glial and sarcomatous components. However, GFAP was strongly positive in both areas and a reticulin stain was not increased in the sarcomatorus areas excluding the sarcomatous variant of glioblastoma. Conclusion: We report the imaging findings of a rare gliosblastoma radiographically presenting as a gliosarcoma due to its location along the dural surface, but with lack of pathologic findings. Gross total tumor resection was performed and the patient and is undergoing adjuvant radiation therapy with concurrent chemotherapy

Dysembryoplastic neuroepithelial tumor with atypical presentation: MRI and diffusion tensorcharacteristics

We report the neuroimaging findings of a 26-year-old female patient with a biopsy-proven dysembryoplastic neuroepithelial tumor (DNET). DNETs are an uncommon, usually benign, glial-neural cortical neoplasm of children and young adults who typically present with intractable seizures. DNETs may occur in any region of the supratentorial cortex, but have a predilection for the temporal lobes. Accurate neuroimaging diagnosis is essential since patients with DNET benefit from complete resection. However, accurate differentiation from other cortical lesions may be challenging. Typical conventional Magnetic Resonance Imaging (MRI) features can help in the differentiation from other similar cortical tumors. Diffusion tensor imaging can also provide important additional diagnostic information regarding the degree of involvement of adjacent parenchyma and white matter tracts. In this case, tractography and fractional anisotropy maps demonstrated that fiber tracts surrounding the lesion were displaced, but fiber integrity was maintained, which is more suggestive of a DNET rather than a more aggressive neoplasm. Accurate identification of DNETs is essential for the purpose of rendering a timely diagnosis and start appropriate treatment

Neuroimaging of a pilocytic astrocytoma with anaplastic features and diffusion tensor imaging characteristics

We report the magnetic resonance imaging findings of an adult patient with a biopsy-proven pilocytic astrocytoma with anaplastic features. Pilocytic astrocytomas rarely occur in adults, and presentation with anaplastic features such as rapid mitotic activity, hypercellularity, and atypia is particularly uncommon. Accurate neuroimaging diagnosis is essential, but differentiation from more malignant neoplastic lesions may be challenging. Diffusion tensor imaging may potentially provide information on cell proliferation, vascularity, and fiber destruction, which can have implications for treatment and prognosis. In this case, tractography and fractional anisotropy maps demonstrated displacement of adjacent parenchyma and relatively intact fractional anisotropy, which is more suggestive of a pilocytic rather than an anaplastic astrocytoma. However, in the presence of focal anaplasia, long-term monitoring will be necessary, since pilocytic astrocytomas with anaplastic features frequently recur

Infrared target and background radiometric measurements--concepts units and techniques

This report discusses concepts units and techniques for making and describing measurements of radiation from targets and backgrounds.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/32197/1/0000256.pd