A 47-year-old woman was admitted for radiation therapy of a left frontal glioblastoma, resected 2 months prior. On enhanced MRI, it was difficult to identify the tumor enhancement due to intrinsic T1 hyperintensity, possibly related to postoperative hemorrhage1 (figure, A–C). However, the iodine overlay image derived from the dual-energy CT technique (figure, D) was revealing: subsequent surgical resection confirmed residual tumor cells along the region that showed the elevated iodine concentration (figure, E). The dual-energy CT iodine overlay technique may be particularly useful in the evaluation of a T1-hyperintense lesion.2
Because the signal intensity at the previous resection site is hyperintense on precontrast T1 image (A) due to hemorrhage (B; T2* gradient recalled echo), it is difficult to identify the tumoral enhancement (C; postcontrast T1). However, dual-energy CT iodine-overlay image (D) reveals the previously undetectable enhancement along the periphery. Biopsy was consistent with glioblastoma multiforme (E; hematoxylin & eosin, ×200).
Footnotes
Author contributions: Y. Lee, H. Seo, B.-K. Je, S.-D. Kim, and H. Oh were involved in the neurologic patient care and analysis and interpretation of clinical results and data. Y. Lee drafted the manuscript. H. Seo, S.-D. Kim, B.-K. Je, and H. Oh revised the manuscript.
Study funding: No targeted funding reported.
Disclosure: The authors report no disclosures relevant to the manuscript. Go to Neurology.org for full disclosures.
- © 2017 American Academy of Neurology
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