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Astrocytoma, case 2

 

This case illustrates the diagnostic difficulty in evaluating post-operative MRI.

Clinical history
This female had been operated on as early as 1983, at the age of 36. At that time, only a biopsy could be performed, and a low grade astrocytoma was diagnosed. As the tumor was considered non-resectable, radiotherapy was delivered.
At the end of 1983, an early MRI was performed at an MR research facility, and the extensive T3-T9, partially cystic tumor was re-evaluated. The Cavitron Ultrasound Surgical Aspirator had recently been introduced, and a repeat surgical procedure was undertaken, based on the MRI findings.
At surgery, almost the entire infiltrating tumor could be resected, with the exception of the previous biopsy site.

Histology
Histology confirmed astrocytoma grade II.

Clinically, the patient's neurological condition improved. She manifests a persistent syringomyelia syndrome over the T4-T12 level, with hypoesthesia of both legs, unimproved to date.

Follow-up MRI (May 1989)
Image 1: Sagittal T1WI. An extensive laminectomy from T4 to T10 is seen, with post-operative spinal cord atrophy. One focal intramedullary nodule is located at T6-T7, corresponding to the previous biopsy site.
Image 2: Sagittal Gd T1WI. After Gd injection, this nodule enhances intensely.
Image 3: Axial T1WI (lower) image and Gd T1WI (upper) image.
Differential diagnosis: persistent tumor versus scar tissue.

Second follow-up MRI (May 1990)
Image 4: Sagittal T1WI.
Image 5: Sagittal Gd T1WI.
Image 6: Axial T1WI.
Image 7: Axial Gd T1WI.
The nodule is still present, and its size and degree of enhancement have not changed. At this time, the diagnosis of scar tissue is more likely.

Third follow-up MRI (March 1993)
Images 8 - 9: Sagittal T1WI. Persistent nodule within the atrophic cord.
Image 10: Sagittal T2WI. The nodule is iso-intense to the spinal cord on this pulse sequence.
Images 11 - 12: Sagittal Gd T1WI. Unchanged enhancing nodule.
Image 13: Axial T1WI. Demonstrates the atrophic, flattened cord.
Images 14 - 15: Axial Gd T1WI. The nodule enhances homogeneously.

Further MRIs until mid 1995 show no interval changes and tumor recurrence is unlikely at this time.

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- Astrocytoma

 

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Fig. 1

Astrocytoma, case 2, Fig. 1
Astrocytoma, case 2, Fig. 2
Astrocytoma, case 2, Fig. 3
Astrocytoma, case 2, Fig. 4
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Astrocytoma, case 2, Fig. 6
Astrocytoma, case 2, Fig. 7
Astrocytoma, case 2, Fig. 8
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Astrocytoma, case 2, Fig. 11
Astrocytoma, case 2, Fig. 12
Astrocytoma, case 2, Fig. 13
Astrocytoma, case 2, Fig. 14
Astrocytoma, case 2, Fig. 15