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Insights into Imaging
Fig. 4 | Insights into Imaging

Fig. 4

From: Multiparametric MRI: practical approach and pictorial review of a useful tool in the evaluation of brain tumours and tumour-like lesions

Fig. 4

Malignant transformation of low-grade glioma. a–c T2W, FLAIR and post-contrast T1W sequences demonstrate non-enhancing signal abnormality in the left temporal lobe. Multiparametric MRI: d Heterogeneous ADC values throughout the lesion with focal areas of low ADC (lowest observed 940 × 10−6 mm2 s−1, arrow). e High rCBV throughout the lesion (arrow) compared to normal-appearing white matter (3.5). f Single-voxel spectroscopy shows very high Cho/Cr (2.3, arrow) and Cho/NAA ratios (3.1). g Histopathology from biopsy of the lesion shows low-grade diffuse astrocytoma with mild to moderately pleomorphic astrocytic cells in a fibrillary background. There was discrepancy of histological and genetic classification with morphological features of a low-grade glial neoplasm, but a convincing genetic profile of glioblastoma, overriding the morphological appearances. h Follow-up imaging 6 months later shows contrast enhancement indicating malignant transformation on conventional MRI

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