Diffusion-weighted MR Imaging of Intracerebral Masses: Comparison with Conventional MR Imaging and Histologic Findings
Tadeusz W. Stadnik
,a,
Cristo Chaskisa,
Alex Michottea,
Wael M. Shabanaa,
Katrijn van Rompaeya,
Robert Luypaerta,
Lubos Budinskya,
Vladimir Jellusa and
Michel Osteauxa
a From the Departments of Radiology and Medical Imaging (T.W.S., W.M.S., R.L., M.O.). Neurosurgery (C.C., K.V.R.), and Neurology and Pathology (A.M.), University Hospital V.U.B., Brussels, Belgium; and the Laboratory of Tomographic Methods (L.B., V.J.), Institute of Measurement Science, Slovak Academy of Sciences, Bratislava, Slovakia.
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FIG 1. Images from the case of a 34-year-old man with a large grade II astrocytoma in the inferior frontal and parietal area. Differentiation between edema and tumor is unclear on all sequences.
A, Fast T2-weighted spin-echo image.
B, Contrast-enhanced T1-weighted spin-echo image. The stereotactic biopsy was performed in the area of faint contrast material uptake (arrow).
C, Diffusion-weighted echo-planar image acquired with x sensitizing gradient.
D, Diffusion-weighted echo-planar image acquired with y sensitizing gradient.
E, Diffusion-weighted echo-planar image acquired with z sensitizing gradient.
F, Tensor ADC map.
G, Lattice index map. The red/yellow areas represent high/medium anisotropy, and the blue/dark blue areas represent lower anisotropy
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FIG 2. Images from the case of a 52-year-old man with a large glioblastoma.
A, Invasion of corpus callosum and of occipitotemporal white matter is recognized on fast T2-weighted spin-echo image.
B, Invasion of corpus callosum and of occipitotemporal white matter is recognized on contrast-enhanced T1-weighted spin-echo image.
C, Invasion of subinsular white matter is clearly recognized only on the perfusion-weighted echo-planar image (arrow).
D, On the diffusion-weighted image, only cystic components of tumor are clearly shown. There is no clear difference between contrast-enhancing tumor (arrowhead) and edema (arrow).
E, On the ADC map, only cystic components of tumor are clearly shown. There is no clear difference between contrast-enhancing tumor (arrowhead) and edema (arrow).
F, Histologic examination (hematoxylin and eosin; original magnification, x250) shows a medium sized extracellular space and moderate cellularity
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FIG 3. Images from the case of a 72-year-old woman with a cerebral lymphoma. A, Fast T2-weighted spin-echo image shows lesion to be moderately hyperintense. B, T1-weighted spin-echo image shows strong enhancement of lesion after the administration of contrast material. C, Diffusion-weighted image shows the lymphoma also to be hyperintense. D, ADC values are in the range of 0.55 to 0.6, similar to the values described in association with acute infarction. E, Histologic examination (hematoxylin and eosin; original magnification, x250) shows high cellularity and small extracellular space, which was significantly associated with reduced ADC values
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FIG 4. Images from the case of a 70-year-old man with a streptococcus abscess, recent history of acute dizziness, and focal seizures.
A, T2-weighted spin-echo image is consistent with the diagnosis of glioblastoma or necrotic metastasis.
B, Contrast-enhanced T1-weighted spin-echo image is consistent with the diagnosis of glioblastoma or necrotic metastasis.
C, On the diffusion-weighted echo-planar image, however, the "necrotic" area shows high signal intensity (arrow).
D, On the ADC map, very low ADC values (0.29 e-3 mm2/s) are found (arrow). Such behavior was never present in the necrotic parts of gliomas (compare with fig. 3D and E) or metastases and may be highly specific for abscess formation
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