Professional Documents
Culture Documents
Radio-graphical
graphical Features of Gliosarcoma
liosarcoma on Computed
Tomography and Magnetic Resonance Imaging
Tamijeselvan. S.
Asst. Professor, Dept. of Radiography,
Mother Theresa Post Graduate and Research
Institute of Health Sciences, Puducherry, India
ABSTRACT INTRODUCTION
Gliosarcoma is a rare type of glioma, a cancer of the Gliosarcomas are a variant of glioblastoma (along
brain that comes from glial, or supportive, brain cells, with epithelioid glioblastoma and giant cell
as opposed to the neural brain cells. Gliosarcoma is a glioblastoma) recognised in the current (2016) WHO
malignant cancer, and is defined as a glioblastoma classification of CNS tumours. They are highly
consisting of gliomatous malignant (WHO grade IV) primary intra-axial
intra
and sarcomatous components. neoplasms
asms with both glial and mesenchymal elements.
The aim of the study is to characterize the The vast majority of gliosarcomas arise from WHO
radiographic features of gliosarcoma, such as grade IV astrocytomas (i.e. glioblastoma), however,
existence nature, content and appearance and rarely they can also arise
enhancement on Computed Tomography and from ependymomas or oligodendrogliomas in which
Magnetic Resonance Imaging. And also to find out case they can be referred to
which is the most effective imaging method to as ependymosarcomas and oligosarcomas
diagnose and categorize gliosarcoma. respectivly.
@ IJTSRD | Available Online @ www.ijtsrd.com | Volume – 1 | Issue – 6 | Sep - Oct 2017 Page: 876
International Journal of Trend in Scientific Research and Development (IJTSRD) ISSN: 2456-6470
Appearance were scannned using a 64 multi slice CT scan using
the protocol of the brain imaging in which the patient
These tumours vary in appearance depending on the was scan in supine position with the head of the
relative amounts of sarcomatous tissue and astrocytic patient is centered and fixed in the Gantry of CT Scan
tissue. When the former is dominant, then these machine. Brain scan was done under selected
lesions appear similar to metastases; well exposure factors with slice thickness of 8 mm and
circumscribed and firm. When the astrocytic intravenous Low Osmolar Water soluble Contrast
component is abundant, then appearances are identical Media (LOCM) was injected to the patients.
to a glioblastoma Interpretation of the brain scan was performed by
consultant radiologists to conform the diagnosis. The
Microscopically, these tumours show both an
remaining six patients of this study were imaged with
astrocytic component identical to glioblastomas and a
1.5 Tesla Magnetic Resonance Imaging (MRI) by
sarcomatous component which is varied in
using the protocol of imaging of the head by MRI in
differentiation, typically with epithelial components
which the following parameters of imaging were
forming squamous tissue or gland-like
selected; 10 mm slice thickness of the brain, T1, T1
structures Differentiation into many other types of
with contrast, T2 and FLAIR weighted images were
tissue is also occasionally encountered (cartilage,
done and the contrast media that used is intravenous
bone, adipose, muscle).
Gadolinium (0.1 ml/kg) according to the weight of the
Radiographic features patient.
Gliosarcomas can be very similar to glioblastomas in The collected data in the study was analysed by using
appearance. They are usually broad-based the SPSS software programme. The study contains
peripherally located lesions with possible direct dural both qualitative and quantitative variable. The
invasion or only reactive dural thickening (dural tail). quantitative were described using numbers,
percentage and tables.
CT
RESULT
Gliosarcomas may be seen on CT as a sharply defined
(often due to sarcomatous component), round or The study included 15 patients that nine patients
lobulated, hyperdense solid mass. They can have (60%) were males while six patients(40%) were
relatively homogeneous contrast enhancement and female. Their age ranged from 12 to 73 years old.
peritumoral oedema. They had been referred for CT scan or MRI
examination of the brain. (Table 1)
MRI
Table 1: Demographic data of the patient (n=15)
Reported signal characteristics include:
Patient No. of Percentage (%)
T1: heterogeneous and hypointense mass Gender respondents
T2: heterogeneous signal due hemorrhagic and Male 9 60
necrotic components
Female 6 40
T1C+ (Gadolinium): thick irregular and rim-like
or ring enhancement
About 12 cases (80%) of the gliosarcoma showed
MATERIALS AND METHODS solid and cystic content, while 2 cases showed
predominant solid content and one obviously cystic
This is a retrospective study conducted during the
(Table 2)
period between 2012 and 2016. In this study, there
were 15 cases of gliosarcoma of the brain and spine
had been selected to satisfy this study of gliosarcoma.
Patients were imaged with either one or two imaging
modalities, Computed Tomography and Magnetic
Resonance Imaging. Nine patients oc this sample
@ IJTSRD | Available Online @ www.ijtsrd.com | Volume – 1 | Issue – 6 | Sep - Oct 2017 Page: 877
International Journal of Trend in Scientific Research and Development (IJTSRD) ISSN: 2456-6470
Eleven of the gliosarcoma cases (73.3 %) showed hypo intense in the T1 weighted image of MRI and two cases
(13.3 %) showed hyper and iso intensity. one case showed iso intensity and one showed hypo and iso intensity.
(Table 3)
In the T2 weighted MRI image of gliosarcoma six cases showed hyper intensity, eight cases showed hyper
intensity and is intensity, and only one case showed mixed intensity. (Table 4)
Mixed 1 6.7
@ IJTSRD | Available Online @ www.ijtsrd.com | Volume – 1 | Issue – 6 | Sep - Oct 2017 Page: 878
International Journal of Trend in Scientific Research and Development (IJTSRD) ISSN: 2456-6470
Figure 1: Selected pre and post-contrast images of brain showing a large cystic and well-defined lesion located
in the right temporoparietal junction. Its content is homogeneously hypoattenuating and there is enhancement of
the entire wall. The tumour promotes an expressive local mass effect characterised sulci effacement, peri-
lesional oedema, right lateral ventricle partial collapse and midline shift to the left.
Figure 2: MRI T1 weighted image on sagital and axial section showing a large cystic and well-defined lesion
located in the right temporoparietal junction. Its content is homogeneously hypo attenuating.
Figure 3: MRI T2 weighted image on axial section Figure 4: MRI FLAIR image on axial section
showing a large cystic and well-defined lesion located showing a large cystic and well-defined lesion
in the right temporoparietal junction. Its content is located in the right temporoparietal junction. Its
homogeneously hyper attenuating. content is homogeneously hypo attenuating.
@ IJTSRD | Available Online @ www.ijtsrd.com | Volume – 1 | Issue – 6 | Sep - Oct 2017 Page: 879
International Journal of Trend in Scientific Research and Development (IJTSRD) ISSN: 2456-6470
Figure 5: MRI T 1 weighted Contrast enhanced Fourteen gliosarcomas were single. One case involved
image on coronal section showing a large cystic and multifocal lesions. The multifocal masses were
well-defined lesion located in the right located in the hypothalamus and temporal and
temporoparietal junction. Its content is occipital lobes on the left side.
homogeneously hypo attenuating with contrast
enhancement in the boundary. Tumors ranged from 2.9 to 12.0 cm in greatest
diameter, with a mean of 5.3 cm. Thirteen lesions had
DISCUSSION at least one dimension greater than 4 cm. Only one
tumor was smaller than 3 cm.
Patients were imaged with either one or two imaging
modalities, Computed Tomography and Magnetic Eleven gliosarcomas had both solid and cystic
Resonance Imaging . All tumors were visualized with components. Two had predominantly solid
contrast-enhanced MRI which proved most sensitive. components, and one tumor in the right cerebellar
Gadolinium di-ethylene triamine penta-acetic acid hemisphere had obvious cystic and/or necrotic areas.
caused bright enhancement of tumors in a distribution All 15 tumors appeared to be relatively well
that consistently corresponded to areas of demarcated from the surrounding normal or
pathologically proved tumor infiltration. Gross and edematous brain parenchyma. Contrast-enhanced T1-
microscopic autopsy findings correlated better with weighted images depicted the boundaries of the
MRI than with CT which tended to produce poorer tumors most clearly. (Figure 5)
resolution and under represent the size of viable
tumor. Gadolinium-enhanced MRI is more accurate Thirteen gliosarcomas were associated with vasogenic
than unenhanced MRI, unenhanced CT, or enhanced edema, as determined by reviewing the extent of
CT in defining the histologic margins of tumors. peritumoral hyperintensity on T2-weighted
images.(Figure 3) Ten tumors had moderate-to-
Gliosarcomas were seen on CT as a sharply defined , extensive adjacent edema, three tumors showed mild
round or lobulated, hypodense solid mass. They can surrounding edema, and two had no apparent
have relatively homogeneous contrast enhancement peritumoral edema.
and peritumoral oedema
@ IJTSRD | Available Online @ www.ijtsrd.com | Volume – 1 | Issue – 6 | Sep - Oct 2017 Page: 880
International Journal of Trend in Scientific Research and Development (IJTSRD) ISSN: 2456-6470
On T1-weighted images, 10 gliosarcomas were 4) Meis JM, Martz Kl, Nelson JS. Mixed
hypointense relative to adjacent normal white matter. glioblastoma multiforme and sarcoma. A
(Figure 2). Two were both hyperintense and clinicopathologic study of 26 Radiation Therapy
isointense, one was isointense, and one was Oncology Group cases. Cancer. 1991;67:2342–9.
hypointense and isointense. One lesion had a mixed 5) Perry JR, Ang LC, Bilbao JM, Muller PJ.
appearance with areas of hypointensity, isointensity, Clinicopathologic features of prima- ry and
and hyperintensity. In addition, three tumors showed postradiation cerebral
scattered hyperintensity due to intratumoral gliosarcoma. Cancer. 1995;75:2910–18.
hemorrhage ). 6) Damodaran O, van Heerden J, Nowak AK,
Bynevelt M, McDonald K, Marsh J. Clinical
On T2-weighted images, six tumors were management and survival outcomes of
hyperintense relative to the surrounding normal brain gliosarcomas in the era of multimodality therapy.
parenchyma. Eight showed areas of hyperintensity J Clin Neurosci. 2014;21:478–81.
and isointensity, and one had mixed high, low, and 7) Lutterbach J, Guttenberger R, Pagenstecher A.
parenchyma-like signal intensity. Gliosarcoma: a clinical study. Radiother
Oncol. 2001;61:57–64.
On FLAIR images, seven lesions were hyperintense to
8) Zhang BY, Chen H, Geng DY, Yin B, Li YX,
normal white matter. One tumor was isointense to
Zhong P, et al. Computed tomography and
hyperintense, and one was isointense.
magnetic resonance features of gliosarcoma: a
Apart from the one gliosarcoma with moderate study of 54 cases. J Comput Assist
heterogeneous enhancement, all tumors showed Tomogr. 2011;35:667–73.
strong heterogeneous enhancement. Thick walls with 9) Khalid AS, Mohamed O, Mohammed EM, Hassan
irregular, strongly enhancing rim and ring-like S, Khalid H, Hamid M. Secondary gliosarcoma
enhancement were observed in 13 (87%) lesions. after the treatment of primary glioblastoma
Seven (47%) showed intratumoral strip and paliform multiforme. North American Journal of Medical
enhancement. Four tumors demonstrated nodular Sciences. 2011;3:527.
enhancement on their walls. In one case, strong 10) Schrantz JL, Araoz CA. Radiation induced
nodular enhancement was accompanied by small meningeal fibro- sarcoma. Arch
pieces of necrosis in the tumor. Images in three cases Pathol. 1972;93:26–33.
showed dural tails after the administration of contrast 11) Han SJ, Yang I, Tihan T, Chang SM, Parsa AT.
medium. Secondary gliosarcoma: a review of clinical
features and pathological diagnosis. J
CONCLUSION Neurosurg. 2010;112:26–32.
12) Kozak KR, Mahadevan A, Moody JS. Adult
Gliosarcoma are more common in male than female. gliosarcoma: epidemiology, natural history, and
The tumor were mostly involving the parietal lobes factors associated with outcome. Neuro
with mass effect depending upon the Oncol. 2009;11:183–91.
grade.Gadolinium-enhanced MRI is more accurate 13) Salvati M, Caroli E, Raco A, Giangaspero F,
than unenhanced MRI, unenhanced CT, or enhanced Delfini R, Ferrante L. Gliosarcomas: analysis of
CT in defining the histologic margins of tumors. 11 cases do two subtypes exist? J
REFERENCE Neurooncol. 2005;74:59–63.
@ IJTSRD | Available Online @ www.ijtsrd.com | Volume – 1 | Issue – 6 | Sep - Oct 2017 Page: 881