The histopathological finding was glioblastoma
multiforme. Glioblastoma multiforme is a highly malignant
variety of brain tumor. Typically, it arises from undifferentiated,
fast proliferating glial cells. Microscopically, there is neovascularization
with endothelial proliferation. Due to the tremendous tumor growth
rate, which exceeds the capillary proliferation rate, parts of the
tumor cannot be appropriately supplied with blood. Consequently, necrosis
occurs. The blood-brain barrier is disrupted. This results in contrast
uptake and surrounding edema.
These tumors show up on MRI as cystic masses (central necrosis), surrounded
by an irregular, contrast enhancing margin corresponding to the proliferating,
highly vascular tumor tissue with massive disruption of the blood-brain
barrier. The mass is surrounded by edema, extending fingerlike in
the white matter.
The goal of the surgical procedure is reduction of the mass effect
and removing as much of the enhancing, fast growing margin as possible.
This part of the lesion does not distinctly show up on non-contrast
images. However, after fast IV injection of 20 cc MAGNEVIST® (gadopentetate
dimeglumine injection), it can be readily identified. |
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image to enlarge
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| FIGURE 2.
Intraoperative axial T1-weighted spin echo image
at the same level as in Figure 1, after a IV injection
of MAGNEVIST® (0.1mmol/kg). After contrast
administration, the components of the lesion (central
necrosis, enhancing margin, surrounding edema) became
obvious. TR 600, TE 29, FOV 22, matrix 256x128, NEX 1.
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