A 46-year-old man presented with behavioral changes and partial seizures over 20 days. Neurological examination showed mental confusion. Brain MRI showed a ring-shaped lesion in the left frontal lobe (A and B). Surgery was performed (C) and pathology confirmed glioblastoma multiforme. The patient underwent radiotherapy and chemotherapy.
A control MRI (eight months later) showed hyperintense signal in the left pontine base (D and E), suggesting wallerian degeneration or neoplastic dissemination. Four months later, there was a marked increase in lesion size, confirming that the hyperintense signal in the pyramidal tract was neoplastic dissemination (F). Follow-up imaging may differentiate wallerian degeneration from tumor spread 11 . Goebell E, Fiehler J, Ding XQ, et al. Disarrangement of fiber tracts and decline of neuronal density correlate in glioma patients - a combined diffusion tensor imaging and 1H-MR spectroscopy study. AJNR Am J Neuroradiol 2006;27:1426-1431. , 22 . Rees JH, Smirniotopoulos JG, Jones RV, Wong K. Glioblastoma multiforme: radiologic-pathologic correlation. Radiographics 1996;16:1413-1438. .
(A) axial FLAIR; (B) axial T1-weighted brain MRI disclosing an infiltrative lesion, suggesting a brain tumor. Note necrotic center and gadolinium enhancement, surrounded by vasogenic edema in the upper and middle frontal gyri of the left cerebral hemisphere; (C) axial T1-weighted brain MRI demonstrating postoperative imaging; (D) axial T2-weighted brain MRI showing hyperintense signal in the left portion of the paramedian pontine base, in the topography of the pyramidal tract; (E) axial T2-weighted brain MRI; (F) coronal T1-weighted brain MRI disclosing an infiltrative and neoplastic lesion, with a marked hyperintense signal throughout the left pyramidal tract, from the corona radiata to the pontine base.
References
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1Goebell E, Fiehler J, Ding XQ, et al. Disarrangement of fiber tracts and decline of neuronal density correlate in glioma patients - a combined diffusion tensor imaging and 1H-MR spectroscopy study. AJNR Am J Neuroradiol 2006;27:1426-1431.
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2Rees JH, Smirniotopoulos JG, Jones RV, Wong K. Glioblastoma multiforme: radiologic-pathologic correlation. Radiographics 1996;16:1413-1438.
Publication Dates
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Publication in this collection
Nov 2013
History
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Received
19 May 2013 -
rev-received
21 May 2013 -
Accepted
28 May 2013