Wednesday, 28 September 2016

MRI notes... biopsy pending. What do you think it sounds like?

Hi -

My friend had her biopsy Monday which went very well.  She is now waiting on the diagnosis and advice from the tumor review board, likely next Tuesday.  I am reading her MRI notes and would love your insights.  I suspect GBM based on "high-grade" and the impression notes.  Anyone else want to take a look and weigh in?  I haven't told her that I think it will be GBM.  We are still hopeful for MS, lymphoma, <anything else>...

Redemonstration of bilateral enhancing lesions, grossly unchanged:
Subcortical enhancing lesion in the right parietal lobe measures approximately
27 x 17 mm (9/139).
Peripherally enhancing and centrally necrotic left occipital lesion measuring
20 x 17 mm (9/84). Grossly unchanged T2/FLAIR abnormality about the left
occipital lesion.

These lesions demonstrated diffusion projection on the previous MRI,
suggestive of high-grade, highly cellular tumors.

Additionally, there is masslike, T2 hyperintense cortical expansion of the
left anterior temporal pole, unchanged.

The ventricles are symmetric. Basal cisterns are patent. No midline shift. No
acute infarction. No intracranial hemorrhage. No extra-axial fluid collection.

Orbits and soft tissues are unremarkable. Visualized vascular flow voids are
maintained. The calvarium is intact. Visualized paranasal sinuses and mastoid
air cells are clear.


Redemonstration of bilateral enhancing lesions in the left occipital and right
parietal lobes, as well as infiltrating T2 hyperintense cortical expansion of
the left anterior temporal pole. The left temporal pole lesion is worrisome
for primary malignancy, with the additional lesions possibly representing
multifocal primary glioma versus less likely metastatic disease. Presence of
some diffusion restriction involving the bilateral enhancing lesions on the
previous exam is suggestive of some high-grade, highly cellular components.


  1. Unfortunately necrosis is a sign of GBM versus lower grades. Better to wait for the biopsy results before drawing a conclusion though. So sorry you are in this situation again with another loved one.

  2. Thank you Stephen, that is my suspicion as well. Will let you know what we learn next week. Hoping she may be a candidate for surgery. I don't know much about the brain, only left parietal lobe :-)

  3. I agree with Stephen. Three tumorous lesions at once might suggest metastases from a cancer arising elsewhere. However, I think the necrosis seen in one of the masses does sound fairly characteristic of glioblastoma. Multi-centric glioma would surely be more likely than a GBM plus simultaneous metastases from a second primary malignancy.

    It's pretty much a dreadful picture, regardless. So very sorry for your friend.

    1. When my husband was dx GBM4 he had 3 tumours spread over the left frontal lobe.

  4. Thank you. I know, it's kind of overwhelming. I was thinking in my head about my GBM timeline. Dad was diagnosed 13 months ago, died 2 months ago. I had *just* last week sent off a huge box of all of my notes on everything from here, internet, UCLA conference, books, etc to a friend whose mother has GBM. I thought there can be no way I deal with this again. I'm in disbelief.

    She did have a body PET scan to rule out metastases to the brain. I'll keep everyone posted after Tuesday. Fuck.