Cystic Glioblastoma
Primary Diagnosis
Cystic glioblastoma
Differential Diagnoses
Brain abscess
Solitary metastasis
Tumefactive demyelination
Juvenile pilocytic astrocytoma
Pleomorphic xanthoastrocytoma
Neuroglial cyst
Imaging Findings
Fig. 114.1: (A) Axial FLAIR and (B) Axial DWI demonstrated a hypointense lesion with significant perilesional edema and no restricted diffusion. Fig. 114.2: (A) Axial precontrast T1WI and (B) Axial postcontrast T1WI demonstrated a large irregular and thick ring-enhancing lesion in the right frontal lobe. Fig. 114.3: (A) Perfusion without contrast, arterial spin labeling (ASL), showed increased rCBF in the periphery of the lesion. (B) Contrast-enhanced dynamic susceptibility-weighted perfusion MRI showed significantly elevated CBV at the periphery of the lesion. Fig. 114.4: (A) Axial FLAIR localizer and (B) 3D multivoxel spectroscopy images with TE of 144 ms (not shown) demonstrated increased choline-to-creatine ratio, decreased NAA peak over the enhancement component of the tumor, and a large inverted lactate peak at the non-enhancing central part. Fig. 114.5: (A) Axial FLAIR localizer and (B) 3D multivoxel spectroscopy images with TE of 144 ms (not shown) demonstrated increased choline-to-creatine ratio and decreased NAA peak, and an inverted lactate peak is also noted in the peritumoral area of the FLAIR abnormality beyond the enhancing component.