Korean J Radiol.  2010 Jun;11(3):359-363. 10.3348/kjr.2010.11.3.359.

MR Spectroscopy and Perfusion MR Imaging Findings of Intracranial Foreign Body Granuloma: a Case Report

• Jang SW
• Kim SJ
• Kim SM
• Lee JH
• Choi CG
• Lee DH
• Kim EJ
• Lee JK

• KMID: 946277
• DOI: http://doi.org/10.3348/kjr.2010.11.3.359

Abstract

We report a case of intracranial foreign body granuloma that showed features of a high grade tumor on magnetic resonance (MR) imaging. However, the relative cerebral blood volume was not increased in the enhancing mass on perfusion MRI and the choline/creatine ratio only slightly increased on MR spectroscopy. The results suggest that the lesion is benign in nature. Perfusion MRI and MR spectroscopy may be helpful to differentiate a foreign body granuloma from a neoplastic condition.

Keyword

Magnetic resonance (MR), brain; Magnetic resonance (MR), pseudotumor; Magnetic resonance (MR), perfusion; Magnetic resonance (MR), spectroscopy

MeSH Terms

Adult
Blood Volume
Brain/*pathology/surgery
Contrast Media/diagnostic use
Diagnosis, Differential
Echo-Planar Imaging/*methods
Female
Follow-Up Studies
Gadolinium/diagnostic use
Granuloma, Foreign-Body/*pathology/surgery
Humans
Image Enhancement/methods
Magnetic Resonance Angiography/*methods
Magnetic Resonance Spectroscopy/*methods

Figure

• 

  Fig. 1 Intracranial foreign body granuloma in 35-year-old woman. A. Precontrast CT image shows subtle high attenuated mass lesion (arrow) in right perisylvian inferior frontal superficial portion with surrounding edema and mass effect. B. Upper level precontrast CT image shows tubular shaped calcification (arrow) with surrounding subtle high attenuated lesion and edema. C. On T2-weighted MR image, mass shows primarily low signal intensity (arrow). D. On T1-weighted MR image, mass (high attenuated mass on CT) shows slightly increased signal intensity (arrow). E. On gadolinium-enhanced MR image, mass shows intense enhancement (arrow). F. On perfusion MR image (CBV map), regional cerebral blood volume of enhancing mass is almost equal to contralateral corresponding area (rCBV = 1.04). G. Localizer image for multi-voxel MR spectroscopy. H, I. Proton MR spectroscopy obtained using multivoxel point-resolved spectroscopy sequence technique, in which mass reveals mild increase in choline/creatine ratio (1.43) and mild decrease in N-acetyl aspartate (H) compared to contralateral normal area (I). J. Photomicrographic specimen shows foreign body granuloma containing suspicious Gelfoam (arrow) (Hematoxylin & Eosin; original magnification ×400). K. Photomicrographic specimen shows dense calcification (arrow) around silk (Hematoxylin & Eosin; original magnification ×400).

Reference

1. Ribalta T, McCutcheon IE, Neto AG, Gupta D, Kumar AJ, Biddle DA, et al. Textiloma (gossypiboma) mimicking recurrent intracranial tumor. Arch Pathol Lab Med. 2004. 128:749–758.

2. Djindjian M, Brugieres P, Razavi-Encha F, Allegret C, Poirier J. Post-operative intracranial foreign body granuloma: a case report. Neuroradiology. 1987. 29:497–499.

3. Dinesh SK, Lee SY, Thomas J. A case of mistaken identity: intracranial foreign body reaction after AVM embolisation mimicking a glioma. J Clin Neurosci. 2008. 15:463–465.

4. Brochert A, Reynolds T, Baker R. MRI in a case of muslin-induced granuloma. Neuroradiology. 2003. 45:82–84.

5. Kothbauer KF, Jallo GI, Siffert J, Jimenez E, Allen JC, Epstein FJ. Foreign body reaction to hemostatic materials mimicking recurrent brain tumor. Report of three cases. J Neurosurg. 2001. 95:503–506.

6. Vishteh AG, Apostolides PJ, Dean B, Spetzler RF. Magnetic resonance image of postcraniotomy retained cotton or rayon. Case illustration. J Neurosurg. 1998. 88:928.

7. Bhatti MT, Holder CA, Newman NJ, Hudgins PA. MR characteristics of muslin-induced optic neuropathy: report of two cases and review of the literature. AJNR Am J Neuroradiol. 2000. 21:346–352.

8. Jayasundar R, Singh VP, Raghunathan P, Jain K, Banerji AK. Inflammatory granulomas: evaluation with proton MRS. NMR Biomed. 1999. 12:139–144.

9. Hourani R, Brant LJ, Rizk T, Weingart JD, Barker PB, Horská A. Can proton MR spectroscopic and perfusion imaging differentiate between neoplastic and nonneoplastic brain lesions in adults? AJNR Am J Neuroradiol. 2008. 29:366–372.