Anaplastic astrocytoma

Case contributed by Dr Pawel Piotrowicz


Second episode of seizures during last 2 weeks, no abnormalities in neurological examination.

Patient Data

Age: 45
Gender: Female

Irregular hiper T2 mass located in the left temporal and frontal lobes afecting white and gray matter, sorounded by edema, displacing ventricular system to the right.

DWI (b1000) images presents slightely increased signal intencity. ADC values of the mass are similar to the white matter, edema shows increased ADC values.

After contrast administration small focal area of enhancement was present in temporal lobe just adjacent to bifurcation of MCA.
Additionally DVA was visualised in the left frontal lobe, near the lesion.


Mass demonstrates slightly increased CBV and CBF on its periphery, additionally on the anterior aspect of the lesion there is linear area of very high CBV and increased MTT probably corresponding with DVA.


First curve, obtained from right frontal region demonstrates normal brain metabolites spectrum.
Second curve from contralateral area affected by the lesion demonstrates pathological brain metabolites spectrum with:
1. increased choline-to-creatine ratio
2. decreased NAA.


Case Discussion

Morphological features of the mass followed by increased CBV and abnormal spectroscopy may suggest high grade glioma although biopsy (preferably from the regions of highest CBV) and genetic profile of the tumor (especially IDH mutation) are necessary to confirm the diagnosis and select proper treatment.

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Case information

rID: 58955
Case created: 14th Mar 2018
Last edited: 14th Mar 2018
Inclusion in quiz mode: Included
Institution: Rydygier's Provincial Policlinic Hospital in Torun

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