MR imaging in cerebral gliomas. Tissue component analysis in correlation with histopathology of whole-brain specimens

A comparative analysis between MR examinations and histopathologic whole-brain sections regarding tumour components was performed in 5 brain specimens from patients with malignant glial brain tumours. All cases were examined with MR imaging in vitro and in 2 cases a close comparison with the MR examinations in vivo was also possible. The most homogeneous hypercellular area in malignant gliomas, giving the highest tumour grade, was not visualised on MR imaging as an isolated entity, either in vitro or in vivo. The most conspicuous tumour component, reflecting the heterogeneity of malignant gliomas, was necrosis. This feature was best depicted in the T2WI. In 4 of 5 cases, distant tumour spread of benign-looking tumour cells was found in areas visualised as normal on T2WI, outside the margins of the peritumoural oedema. In 2 cases, estimation of water content was performed immunohistochemically and a close correlation was found in each case between peritumoural and periventricular hyperintensity on T2WI and areas of pallor on the haematoxylin-eosin-stained whole-brain sections. These areas corresponded to microscopical oedema. MR imaging reflects underlying heterogeneous histopathology in malignant gliomas. The degree of malignancy of the lesion as a whole can thus be assessed by MR imaging. However, the method does not allow malignant gliomas to be correctly delineated.