Elsevier

Surgical Neurology

Volume 49, Issue 4, April 1998, Pages 436-440
Surgical Neurology

Original Articles
The Significance of Lack of MR Contrast Enhancement of Supratentorial Brain Tumors in Adults: Histopathological Evaluation of a Series

https://doi.org/10.1016/S0090-3019(97)00360-1Get rights and content

Abstract

Background

To correlate magnetic resonance imaging (MRI) findings of non-enhancement of supratentorial brain neoplasms in adults with histopathologic findings.

Methods

Forty adult patients whose preoperative MRI studies demonstrated a non-enhancing supratentorial brain neoplasm were identified retrospectively. Biopsy material for all patients was then reviewed by a board-certified neuropathologist.

Results

Histopathologic examination identified 24 (60%) low-grade gliomas: 4 (10%) low-grade astrocytomas, 10 (25%) low-grade gliomas (not further classified), 8 (20%) low-grade oligodendrogliomas, and 2 (5%) low-grade mixed oligoastrocytomas. However, 16 (40%) nonenhancing lesions were classified as anaplastic gliomas: 12 (30%) anaplastic astrocytomas, 1 (2.5%) anaplastic mixed oligoastrocytoma, 1 (2.5%) anaplastic oligodendroglioma, and 2 (5%) anaplastic infiltrating gliomas of indeterminate subtype.

Conclusion

Non-enhancement of supratentorial brain neoplasms in adults does not equate with low-grade malignancy. This fact should be taken into account when biopsy and treatment are being planned in patients with nonenhancing brain tumors. More aggressive and/or surgical therapy might be indicated for such lesions, particularly those in the nondominant hemisphere or nonmotor areas.

Section snippets

Subjects and Methods

The database of our brain tumor center was searched to identify adult patients with non-enhancing supratentorial parenchymal neoplasms on preoperative MRI examinations. Cases were collected without consideration of or knowledge of diagnosis. Cases were included in this study if either 1) we had the actual scan documenting lack of enhancement (these scans were reviewed by a senior neuroradiologist) or 2) there was a radiology report on file attesting to the lack of enhancement on a preoperative

Results

Non-enhancing lesions arose in the following locations: frontal lobe (13), hypothalamus (1), parietal lobe (4), frontoparietal region (4), temporal lobe (6), frontotemporal region (2), insula (6), temporoparietal region (2), parieto-occipital region (1), and foramen of Monro (1). Histopathologic examination identified 24 (60%) low-grade gliomas: 4 (10%) low-grade astrocytomas, 10 (25%) low-grade gliomas (infiltrating gliomas for which further subclassification was not possible and lacked

Discussion

Confronted with a probable brain tumor, the neuro-oncologist and neurosurgeon face a vexing clinical management problem. Many factors are considered, including the age and condition of the patient; the patient’s feelings about the various treatment options; and particularly the lesion’s location, imaging appearance, and likely histologic nature. Imaging plays an essential role in the preoperative (and postoperative) workup of brain tumors. The CT and MRI literature are replete with excellent

Acknowledgements

We are grateful to Donna Stevenson for secretarial assistance, Melissa Burkett for editorial assistance, and Dennis Johnston of the Department of Biomathematics for help with the statistical analysis.

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