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Glioblastoma
Metastasis
Diagnosis please...
Cho
Cr
NAA
Cho
Cr
NAA
FLAIR
CE T1
Cho / Cr
FLAIR
CE T1
Cho / Cr
Grading
ppm
4.0 3.0 2.0 1.0
3.5 2.5 1.5 0.5
NAA
Cho
Grade II glioma
c/oH.-P.Schlemmer,Heidelberg /Tübingen
Grade III / IV glioma
4.0 3.0 2.0 1.0
3.5 2.5 1.5 0.5
ppm
NAA
Cho
Lipids
NAA
4.0 3.0 2.0 1.0
3.5 2.5 1.5 0.5
ppm
Cr
Cr
Cho
Grading in gliomas
Gold standard?
•
Grade determined by highest malignant
component
•
Any biopsy subject to sampling error
FLAIR
1H-MRS (Choline/NAA)
DSC Perfusion
Tumor hetereogeneity
Radiation injury