• Qing-Ling Huang, Xuan Cao, Xue Chai, Xiao Wang, Chaoyong Xiao, and Juan Wang.
• Department of Radiology, Nanjing Medical University Affiliated Nanjing Brain Hospital, Nanjing, China. Electronic address: hql_nju@163.com.
• World Neurosurg. 2019 Apr 1; 124: e527e532e527-e532.

ObjectiveWe review the radiological imaging features and report histopathological findings of 7 adult patients with epithelioid glioblastoma (eGBM), which was a newly revised subtype of glioblastoma.MethodsSeven adult patients with a diagnosis of eGBM on a brain tissue specimen were retrospectively confirmed by pathology. The tumor magnetic resonance imaging characteristics such as location, number, edema, necrosis, hemorrhage, enhancement, diffusion-weighted image, apparent diffusion coefficient, magnetic resonance spectroscopy, dynamic susceptibility contrast-perfusion-weighted imaging, and histopathological findings were documented.ResultsThe tumors of these patients exhibited iso-hyperintensive signal on the T2-weighted image and iso-hypointensive signal on the T1-weighted image. All the lesions manifested iso-hypointensive signal on the diffusion-weighted image, and 2 cases showed significantly restricted hyperintensive signal (2/7). Peritumoral edema in all cases was mild. Five cases were located in the cortical lobe (5/7) and the other 2 were multifocal (2/7). Four cases showed white matter collapse sign (4/7). These tumors revealed apparent enhancement after contrast injection. In particular, 4 cases displayed capsuled sign (4/7), 2 cases showed dura mater tail sign (2/7), and 1 case showed hemorrhage (1/7). The mean value of apparent diffusion coefficient in 6 cases was 1.09 × 10-3 mm2/s. The mean value of relative cerebral blood volume in 3 cases was 2.84 × 10-3 mm2/s on dynamic susceptibility contrast-perfusion-weighted imaging. The average value of the choline/N-acetyl aspartate ratio in 4 cases was 6.47 × 10-3 mm2/s on magnetic resonance spectroscopy. All cases expressed a BRAF V600E mutation according to molecular characteristics.ConclusionseGBMs that were predominantly located in cortex with mild peritumoral edema, white matter collapse, encapsular sign, and dura mater tail sign could be easily misdiagnosed as cortex-involved intracranial brain tumor such as meningioma, whereas multifocal tumors could be easily misdiagnosed as metastatic tumor and lymphoma. Multimodal images were helpful for the differential diagnosis.Copyright © 2019 Elsevier Inc. All rights reserved.

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