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Insights into Imaging
Fig. 6 | Insights into Imaging

Fig. 6

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

Fig. 6

High-grade glioma. Conventional MRI: a, b Axial and coronal post-contrast T1W sequences, showing a well-defined lesion at the ponto-medullary junction. Multiparametric MRI: c ADC map demonstrates low ADC (590 × 10−6 mm2 s−1). d PWI shows high perfusion (rCBV 2.8, arrow). e, f MRS shows a high Cho/Cr ratio (2.9, arrow), low NAA/Cr ratio and presence of lipid peaks. MRI findings of a low ADC (< 1000 × 10−6 mm2 s−1), high rCBV (> 2) and high Cho/Cr ratio (> 1.8) are consistent with a high-grade glioma rather than a granuloma or abscess. The presence of high choline levels in the perilesional area (not shown) favour high-grade glioma over a metastatic lesion. In this patient, an initial biopsy was inconclusive and as a result of the multiparametric MRI findings, a decision to undergo further biopsy was overturned. The patient underwent radiotherapy for presumed glioblastoma

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