Answer for CoW 13 Aug 2017
Left medial temporal lobe Glioma (Low Grade)
Findings
1.6 x 1.1cm T1 hypo/ T2, FLAIR hyperintense lesion involving amygdala, uncus and part of hippocampus in left medial temporal lobe On contrast administration the lesion doesn’t shows enhancement. MR SPECTROSCOPY: Reveals relatively decreased N-acetyl aspartate integral values with significant increase in choline integral values and increased myoinosital peaks. Standard MR Study and MR Spectroscopy features consistent with low grade glioma.
Discussion
In CT,low grade glioma appears as iso/hypodense without any contrast enhancement MRI is the modality of choice to characterise low grade glioma T1- iso/hypointense Confining to white matter causing expansion of adjacent cortex T2- mass like hyperintense signal due to edema,demyelination and other degenerative change. T1 contrast- no enhancement MR spectroscopy- typical elevation of choline peak,low NAA peak,elevated choline:creatinine ratio Elevated myoinositol and ml/cr ratio,lack of acetate peak MR perfusion -no elevation of rCBV PET- FDG uptake similar to normal white matter
Findings
1.6 x 1.1cm T1 hypo/ T2, FLAIR hyperintense lesion involving amygdala, uncus and part of hippocampus in left medial temporal lobe On contrast administration the lesion doesn’t shows enhancement. MR SPECTROSCOPY: Reveals relatively decreased N-acetyl aspartate integral values with significant increase in choline integral values and increased myoinosital peaks. Standard MR Study and MR Spectroscopy features consistent with low grade glioma.
Discussion
In CT,low grade glioma appears as iso/hypodense without any contrast enhancement MRI is the modality of choice to characterise low grade glioma T1- iso/hypointense Confining to white matter causing expansion of adjacent cortex T2- mass like hyperintense signal due to edema,demyelination and other degenerative change. T1 contrast- no enhancement MR spectroscopy- typical elevation of choline peak,low NAA peak,elevated choline:creatinine ratio Elevated myoinositol and ml/cr ratio,lack of acetate peak MR perfusion -no elevation of rCBV PET- FDG uptake similar to normal white matter
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!