Additional Diagnostic Value of Unenhanced Computed Tomography plus Diffusion-Weighted Imaging Combined with Routine Magnetic Resonance Imaging Findings of Early-Stage Gliblastoma

Figure 3

Magnetic resonance and computed tomography images of the brain and histopathological findings of the lesion. (a) T1-weighted, (b) T2-weighted, (c) diffusion-weighted, and (d) contrast-enhanced magnetic resonance images show a poorly demarcated lesion in the right temporal lobe and hippocampus. The lesion shows homogeneous hypointensity on T1-weighted imaging and homogeneous hyperintensity on T2-weighted imaging relative to the brain without perilesional edema or mass edema. The diffusion-weighted image shows an isointense lesion with ring-like peritumoral hyperintensity. Postcontrast magnetic resonance imaging shows no enhancement. (e) Axial-view head-window unenhanced computed tomography images of the head show a hypoattenuated lesion with an isoattenuated region (arrow) in the right temporal lobe. (f) At the 4-week follow-up, a contrast-enhanced T1-weighted image shows a markedly heterogeneous enhanced mass lesion with adjacent pachymeningeal enhancement. (g) Histopathological examination shows proliferation of atypical cells with irregular cytoplasm and chromatin-condensed heterogeneous nuclei, necrotic changes, and microvascular proliferation (hematoxylin and eosin, ×100). (h) A small number of p53-positive cells are present. (i) Glial fibrillary acidic protein immunostaining is positive. (j) Ki-67 positivity is seen in 30% of all cells.

(a)

(b)

(c)

(d)

(e)

(f)

(g)

(h)

(i)

(j)