Board Review 3 – Case 10

Neuroradiology board review. This lecture is geared towards the ABR core exam for residents, but it would be useful for review for the ABR certifying exam or certificate of added qualification (CAQ) exam for neuroradiology.

More description and the answer (spoiler!) are seen below the video.

This case shows a right posterior frontal tumor. There is mild mass effect with infiltrative T2 hyperintensity. On gradient imaging, there is some evidence of internal blood products or hemorrhage. Post-contrast imaging shows a multilobular and enhancing mass with irregular margins and central necrosis.

The diagnosis is: glioblastoma (GBM)

Glioblastoma, formerly known as glioblastoma multiforme, is a grade 4 primary astrocytoma and the most common primary glioma. They have extremely poor prognosis and are characterized by irregular and necrotic enhancing masses. The surrounding T2 abnormality is a result of vasogenic edema and infiltrative tumor.

With any solitary enhancing parenchymal mass, there is a differential diagnosis that should be considered, including:

• glioblastoma
• metastasis
• lymphoma
• abscess (should have bright internal DWI)
• other infections