Arab Board Radiology Final Written Practice Questions - Arab Board Diagnostic Radiology Final Written Exam (ABHS) Exam

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A 58-year-old male presents with progressive headaches, personality changes, and new-onset seizures. Brain MRI demonstrates an intra-axial mass in the left frontotemporal white matter with a thick, irregular, nodular ring-enhancing wall, central non-enhancing necrosis, extensive surrounding T2/FLAIR vasogenic edema, and marked elevated cerebral blood volume (rCBV) on dynamic susceptibility contrast perfusion MRI. Which imaging feature most reliably differentiates glioblastoma multiforme (GBM) from a pyogenic brain abscess?

Elevated perfusion (high rCBV) and restricted diffusion in the enhancing rim rather than the necrotic center Marked central restricted diffusion on DWI with low ADC within the fluid-filled core Complete, smooth, thin T2-hypointense rim with dual-rim sign Absence of surrounding vasogenic edema on T2/FLAIR sequences

Correct Answer:

Elevated perfusion (high rCBV) and restricted diffusion in the enhancing rim rather than the necrotic center

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