File:Anaplastic astrocytoma IDH wild-type (pseudoprogression) (Radiopaedia 42209-45278 Axial T1 C+ 13).png

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Anaplastic_astrocytoma_IDH_wild-type_(pseudoprogression)_(Radiopaedia_42209-45278_Axial_T1_C+_13).png ‎(512 × 512 pixels, file size: 185 KB, MIME type: image/png)

Summary:

Description
  • Radiopaedia case ID: 42209
  • Image ID: 18725772
  • Image stack position: 13/157
  • Plane projection: Axial
  • Aux modality: T1 C+
  • Study description: 28 weeks post-surgery
  • Study findings: MRI study obtained 3 months after the prior study (28 weeks post op, ~4 months post end of Stupp protocol) demonstrates increasing volume of adjacent high FLAIR signal, extending further anteriorly into the frontal lobe and further superiorly to the frontoparietal white matter at the vertex. There is also mild increase in FLAIR hyperintensity into the right cerebral peduncle. There is increasing adjacent peripheral enhancement. The region of contrast enhancement shows significant elevation in choline, reduction in NAA and increase in lactate. There is increasing susceptibility within the area of contrast enhancement in keeping with hemorrhage.
  • Modality: MRI
  • System: Central Nervous System
  • Findings: FLAIR hyperintensity in the right frontal parietal temporal region, with mild FLAIR hyperintensity extending to the ependymal surface of the right lateral ventricle posteriorly is noted, with areas of enhancement embedded within it. Although there is T2 shine through, there are also regions of true diffusion restriction, including at the areas of enhancement but also within the nonenhancing FLAIR hyperintensity. MRS demonstrates moderate choline elevation and small to moderate lactate peaks with reduced NAA. Elevation of cerebral blood volume (CBV) is prominent. Incidental left anterior temporal arachnoid cyst. Conclusion Features are those of a diffuse primary brain tumor. Increased cellularity and perfusion suggest a higher grade (III or IV).
Date Published: 15th Jan 2016
Source https://radiopaedia.org/cases/anaplastic-astrocytoma-idh-wild-type-pseudoprogression
Author Frank Gaillard
Permission
(Permission-reusing-text)		 http://creativecommons.org/licenses/by-nc-sa/3.0/

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