Case 9 - Glioblastoma (ED)

Dr. Yousem has provided the following report as a sample report for your reference. It does not match the case reviewed in the video.

Indication: Brain tumor. One month progressive neck pain, 2 weeks of left upper extremity numbness. One week of left upper extremity weakness. Progressive neck pain. 

TECHNIQUE: MR images of the brain and complete spine were performed before and after administration of gadolinium. 

FINDINGS: 

Brain: 

The signal intensity of the brain is normal. The diffusion weighted scans show no evidence of cytotoxic edema in the brain. There is no evidence of parenchymal hemorrhage. 

Cervical spine: 

Beginning at the cervical medullary junction there is abnormal signal intensity in the cervical spinal cord which extends from the clava to the lower T3 level. The point of maximal expansion of the spinal cord is at the C6 level slightly eccentric to the left side. The diffusion weighted imaging shows lack of restriction within the spinal cord. 

On post gadolinium enhanced imaging there is a 2.6 x superior-inferior by 0.9 anterior posterior by 1.6 cm transverse area of enhancement in the spinal cord at the mid C5 level to the C6-7 junction which is relatively well-defined. 

Enhancement is eccentric to the left side of the spinal cord. 

Thoracic spine: 

Signal intensity abnormality from the cervical region extends to the lower T3 level. Below this level the spinal cord is normal. There is no evidence of abnormal signal intensity nor abnormal enhancement. No significant degenerative changes present. 

Lumbar spine: 

There is focal fat in the filum. Otherwise the examination is normal in appearance. 

IMPRESSION: 

Focal area of enhancement within the cervical spinal cord from mid C5 to the C6-7 level measuring 2.6 x 0.9 x 1.6 cm with associated abnormal signal intensity extending from the medulla to the T3 level most compatible with ependymoma given its well-defined enhancement.

######## ADDENDUM #1 ########

Intraoperatively, the mass was found to be intra-axial, and compatible with high grade glioma. In this context, the right frontal focal area of T2 hyperintensity likely represents a focal area of infiltrative neoplasm.

######## ORIGINAL REPORT ########

MRI brain

HISTORY: Left frontoparietal mass. Headache and vomiting.

TECHNIQUE: MRI of the brain with and without contrast.

COMPARISON: CT head 9/25/2020.

FINDINGS:

Images are motion degraded. Fiducial markers are placed upon the scalp. There is a parasagittal right frontoparietal T2 hyperintense enhancing mass containing large regions of susceptibility, compatible with the hemorrhagic mass seen on the recent CT examination. It broadly abuts the posterior falx. Due to motion artifact, it is difficult to tell whether this is intra-axial or extra-axial. There is mild surrounding vasogenic edema. There is local sulcal effacement. There is mild leftward shift of the falx, and mass effect onto the ventricular system. The mass measures approximately 6.4 x 4.1 cm in axial dimensions.

There is a separate focus of T2 hyperintensity without enhancement involving the cortical and subcortical right frontal lobe inferolateral to the dominant mass.

There are areas of restricted diffusion associated with the dominant mass. There is no acute territorial infarct.

Orbits are normal. There is mild paranasal sinus mucosal thickening. Minimal left mastoid fluid is seen.

IMPRESSION:

Heterogeneous enhancing right parasagittal frontoparietal neoplasm broadly abutting the posterior falx. While due to motion artifact it is difficult to tell whether the mass is intra-axial or extra-axial, the latter is suspected, raising the possibility of aggressive meningeal-based neoplasm or metastasis.

Focus of T2 hyperintensity within the right frontal lobe, without restricted diffusion or enhancement, representing nonspecific focus of vasogenic edema.