Abstract
Purpose The MRI features of epithelioid glioblastoma (eGBM) were analyzed. The apparent diffusion coefficient (ADC), MR perfusion-weighted imaging (PWI), and magnetic resonance spectroscopy (MRS) findings were quantitatively analyzed.Methods The MRI images of 8 cases of eGBM were analyzed retrospectively. The location and edge, signal, peritumoral edema, adjacent meningeal invasion, and enhancement of the lesions were observed. The ADC value, relative cerebral blood volume (rCBV), relative cerebral blood flow (rCBF), and N-acetylaspartate/acetylcholine (NAA/Cho) value were analyzed.Results Among the 8 patients, the tumors were mainly located in the temporal lobe (n = 3), frontal lobe (n = 3), and parietal lobe (n = 2). The lesion boundary was clear in 6 cases and unclear in 2. The lesions were superficial in 5 cases and in the deep white matter in 3. Internal hemorrhage was observed in 4 cases. There was cystic necrosis in 7 cases, and only 1 case was solid without cystic necrosis. There was no edema around the lesion in 1 case, severe edema in 5, and moderate edema in 2. In 4 cases, the adjacent meninges were involved, and in 1 case, the ependyma was involved. Two patients developed leptomeningeal metastasis within 2 months after the operation. The average ADC value of the tumor parenchyma among all 8 patients was7.15 × 10−4 mm2/s,which was 17.6% lower than that of the contralateral side. The Cho/NAA metabolite ratio was 5.27 and 0.81 in the lesions of 2 patients. The rCBV was 3.51 ml/100 g and 3.32 ml/100 g of lesions in 2 patients; these values were 36% and 29% higher, respectively, than those of the contralateral side. The rCBF was 31.5 ml/100 g/min and 82.1 ml/100 g/min of lesions in two patients; these values were 49% and 203% higher, respectively, than those of the contralateral side.Conclusion eGBM characteristics include a superficial location, easy cyst degeneration, easy necrosis and hemorrhage, and clear boundaries. It easily invades adjacent meninges and shows cerebrospinal fluid dissemination and metastasis. Combining new MR techniques, such as ADC values, PWI, and MRS, could be helpful for improving diagnostic accuracy.
Highlights
In 2016, the World Health Organization (WHO) published a new standard for the classification of tumors in the central nervous system[1]. epithelioid glioblastoma (eGBM) is a new pathological subtype of glioblastoma, isocitrate dehydrogenase (IDH) wild type, and has a pathological grade of IV
Research on the imaging features of eGBM mainly consists of case reports or group cases, and most radiologists are not familiar with its clinical and imaging features
The clinical and imaging data of 8 patients with eGBM who were admitted to the Affiliated Hospital of Qingdao University from October 2016 to November 2018 were collected, and their imaging features were analyzed to improve understanding of this tumor
Summary
In 2016, the World Health Organization (WHO) published a new standard for the classification of tumors in the central nervous system[1]. eGBM is a new pathological subtype of glioblastoma, isocitrate dehydrogenase (IDH) wild type, and has a pathological grade of IV. EGBM is a new pathological subtype of glioblastoma, isocitrate dehydrogenase (IDH) wild type, and has a pathological grade of IV. It is a highly invasive tumor [1, 2] that was named mainly based on the finding that a large number of epithelioid and rhabdoid tumor cells can be seen in the tumor tissue. The clinical and imaging data of 8 patients with eGBM who were admitted to the Affiliated Hospital of Qingdao University from October 2016 to November 2018 were collected, and their imaging features were analyzed to improve understanding of this tumor
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