ISSN: 1859 - 2872
Magnetic resonance imaging characteristics of high-grade gliomas surgically treated at 108 Military Central Hospital
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Abstract
Objective: To describe the conventional magnetic resonance imaging (MRI), proton MR spectroscopy, and diffusion tensor imaging (DTI) characteristics of high-grade gliomas (HGG) surgically treated at the 108 Military Central Hospital, and to compare these features according to histopathological grade and Shinoda functional region classification. Subject and method: A prospective descriptive study was conducted on 55 patients with histologically confirmed HGG (WHO 2021 grades III–IV) who underwent preoperative MRI, including T1W, T2W, FLAIR, contrast-enhanced T1W, and diffusion/ADC sequences. MR spectroscopy and DTI were analyzed when available. Tumor features were assessed regarding location (lobar, hemispheric, Shinoda regions I–III), size, mass effect, midline shift, and enhancement patterns. Metabolite ratios (Cho, NAA, Cr) were quantified on MR spectroscopy, while DTI was evaluated for displacement, infiltration, compression, or disruption of white matter tracts. Result: The frontal lobe was the most frequent location (32.7%), followed by the temporal (20.0%) and parietal (16.4%) lobes; 18.2% involved multiple lobes. Tumors were located in the left hemisphere in 47.3%, right in 43.6%, and bilateral in 9.1%. According to Shinoda classification, region I (frontal-parietal) accounted for 43.6%. Mean tumor diameter was 5.8 ± 1.2cm, with 76.4% > 5cm. Malignant imaging features were highly prevalent: Peritumoral edema (100%), mass effect (96.4%), contrast enhancement (98.2%), and necrosis/hemorrhage (94.5%). Midline shift > 10mm was present in 45.4%. MR spectroscopy showed higher Cho and lower NAA and Cr in grade IV compared with grade III tumors (p<0.05). DTI demonstrated more frequent disruption of white matter tracts in grade IV than grade III (20.0% vs. 5.0%; p<0.05), and the rate increased progressively from Shinoda regions I to III (4.2%→30.8%; p<0.05). Conclusion: High-grade gliomas surgically treated at the 108 Military Central Hospital typically present on MRI as large, ill-defined, heterogeneous masses with strong, inhomogeneous enhancement, extensive peritumoral edema, and significant mass effect. MR spectroscopy and DTI provide complementary biological and functional information, supporting tumor grading and facilitating surgical planning for maximal safe resection.
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References
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