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Assessing Cortical Cerebral Microinfarcts on High Resolution MR Images
Published on: November 20, 2015
Perfusion MR imaging and proton MR spectroscopic imaging in differentiating necrotizing cerebritis from glioblastoma
Gabriel Pivawer1, Meng Law, David Zagzag
1Department of Radiology, NYU Medical Center, New York, NY 10016, USA.
Abstract:
We describe a lesion with the magnetic resonance imaging (MRI) characteristics of a glioblastoma mutiforme and demonstrate how perfusion MRI and proton MR spectroscopic imaging can be used to differentiate necrotizing cerebritis from what appeared to be a high-grade glioma. A 43-year-old woman presented to her physician complaining of progressive visual disturbance and headache for several weeks. Conventional MRI demonstrated a parietal peripherally enhancing mass with central necrosis and moderate to severe surrounding T2 hyperintensity, suggesting an infiltrating high-grade glioma. However, advanced imaging, including dynamic susceptibility contrast MRI (DSC MRI) and magnetic resonance spectroscopic imaging (MRSI), suggested a nonneoplastic lesion. The DSC MRI data demonstrated no hyperperfusion within the lesion and surrounding T2 signal abnormality, and the MRSI data showed overall decrease in metabolites in this region, except for lactate. Because of the aggressive appearance to the lesion and the patients' worsening symptoms, a biopsy was performed. The pathologic diagnosis was necrotizing cerebritis. After the commencement of steroid therapy, imaging findings and patient symptoms improved. This report will review the utility of advanced imaging for differentiating inflammatory from neoplastic appearing lesions on conventional imaging.
Insights
Advanced MRI techniques, including dynamic susceptibility contrast MRI (DSC MRI) and magnetic resonance spectroscopic imaging (MRSI), can differentiate necrotizing cerebritis from high-grade glioma. This helps avoid unnecessary biopsies for inflammatory brain lesions.
Area of Science:
- Neuroimaging
- Neuroradiology
- Oncology
Background:
- Conventional magnetic resonance imaging (MRI) can present challenges in distinguishing neoplastic lesions from inflammatory conditions.
- Glioblastoma multiforme often exhibits aggressive imaging features, including peripheral enhancement and central necrosis.
- Necrotizing cerebritis can mimic high-grade gliomas on standard MRI sequences.
Observation:
- A patient presented with symptoms and MRI findings suggestive of a high-grade glioma.
- Advanced imaging, specifically dynamic susceptibility contrast MRI (DSC MRI) and magnetic resonance spectroscopic imaging (MRSI), provided crucial differentiating information.
- The lesion showed no hyperperfusion on DSC MRI and altered metabolite concentrations (decreased metabolites except lactate) on MRSI.
Findings:
- Advanced MRI findings suggested a nonneoplastic etiology, contrasting with the initial suspicion of glioma.
- Pathological diagnosis confirmed necrotizing cerebritis.
- The patient improved significantly with steroid therapy, further supporting the inflammatory diagnosis.
Implications:
- Perfusion MRI and MRSI are valuable tools for differentiating inflammatory brain lesions from high-grade gliomas.
- These advanced techniques can potentially prevent misdiagnosis and unnecessary invasive procedures like biopsies.
- Utilizing advanced neuroimaging can lead to more accurate diagnoses and timely, appropriate treatment for brain pathologies.
