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Early MRI findings in high grade glioma
1Department of Neurological Surgery, University of Miami School of Medicine, FL 33136, USA.
Abstract:
Magnetic resonance imaging (MRI) is more sensitive than computerized tomography in the detection of many intracerebral lesions; however, the significance of some MRI findings may be unclear. Over four years, nine patients, aged 40-79 years, have been encountered whose initial MRI scans were negative or had minimal abnormalities and soon thereafter had high grade glioma. Initial MRI was performed in eight patients for new-onset seizures and one patient for a focal deficit. MRI was negative in four of the patients and mildly abnormal in five of the patients (small areas of increased T2 and/or minimal enhancement). The initial diagnoses usually included inconclusive differentials of stroke and infection with neoplasm less frequently considered. Radiographic progression leading to the diagnosis of high grade glioma became evident on repeat MRI in 1-8 months with six patients showing progression within three months. All patients underwent surgery and had histologic diagnosis of glioma. Although MRI is quite sensitive, four of the initial scans were negative with reasonable quality studies. Conversely, in five of the initial scans, the tumors were detected when so small that the radiographic findings were not typically diagnostic. Glioma must be considered as a possible cause of initial seizures or new neurologic deficits in adults with normal or minimally abnormal MRI. In this group, seizures were the overwhelming hallmark of presentation. In such a clinical situation, close follow-up with short interval repeat MRI should be performed.
Insights
High-grade gliomas can present with normal or minimally abnormal Magnetic Resonance Imaging (MRI) scans, especially in patients experiencing new-onset seizures. Close follow-up with repeat MRI is crucial for early diagnosis.
Area of Science:
- Neurology
- Radiology
- Oncology
Background:
- Magnetic resonance imaging (MRI) offers superior sensitivity for detecting intracerebral lesions compared to computerized tomography.
- Interpreting subtle or negative MRI findings in the context of new neurological symptoms can be challenging.
Purpose of the Study:
- To investigate the occurrence of high-grade glioma in patients with initially negative or minimally abnormal MRI scans.
- To highlight the diagnostic challenges and recommend follow-up strategies for suspected glioma presenting with subtle imaging findings.
Main Methods:
- Retrospective analysis of nine patients (aged 40-79) with high-grade glioma diagnosed after initial negative or minimally abnormal MRI scans over four years.
- Review of initial MRI findings, clinical presentations (seizures or focal deficits), and subsequent diagnostic progression via repeat MRI.
Main Results:
- Four out of nine patients had completely negative initial MRI scans; five had minimal abnormalities not typically diagnostic of glioma.
- High-grade glioma diagnosis was confirmed via repeat MRI within 1-8 months (6 within 3 months) in all nine patients.
- New-onset seizures were the predominant initial clinical presentation in this cohort.
Conclusions:
- High-grade glioma should be considered in adults presenting with new-onset seizures or focal deficits, even with normal or minimally abnormal initial MRI.
- Close clinical monitoring and short-interval repeat MRI are essential for timely diagnosis in cases with equivocal initial findings.
- Despite MRI's sensitivity, subtle or early-stage gliomas may evade detection on initial scans, necessitating vigilance.