Primary Glioblastoma

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RSNA Case Collection


Final diagnosis:

Primary Glioblastoma :
Imaging findings, as well as the pathology report, confirmed the suspicion for primary glioblastoma. Imaging demonstrates a mass within the left parietotemporal region with the typical findings of primary glioblastoma including large size, hemorrhage, necrosis, mass effect, neovascularity, and surrounding edema/infiltrative tumor spread. The pathology report specifically revealed Glioblastoma, WHO grade IV, IDH wild type, and ATRX (ATP-dependent helicase) expression retained.

Differential diagnoses:Intracranial abscess :
Intracranial abscess characteristically demonstrates peripheral ring enhancing wall on post contrast imaging with central light bulb bright diffusion signal and low ADC value.

Metastasis :
Metastasis are more frequently multiple and tend to occur at the grey-white matter junction. Metastasis usually show a higher degree of surrounding vasogenic edema.Tumefactive demyelinating lesion (TDL) :
Tumefactive demyelinating lesions demonstrate a variable post contrast enhancement pattern, but a pattern of an open ring/horseshoe is characteristic. These lesions tend to be larger with relatively little surrounding vasogenic edema or mass effect.

Primary CNS Lymphoma :
Lymphoma would exhibit solid homogeneous enhancement on post-contrast imaging in immunocompetent patients; atypical lymphomas or lymphomas in immunocompromised patients can exhibit necrotic areas and may mimic GBM.