Diffuse midline gliomas (DMGs) with the histone H3 K27 mutation is a brand-new tumor according to the 2016 World Health Organization Classification of Tumors of the Central Nervous System. In this case report, we characterize the magnetic resonance imaging (MRI) aspects with the literature review. Instead of biopsy, MRI techniques are used to diagnose the tumor and determine the treatment choice despite the correlation with the prognosis. We present the case of high-grade astrocytic tumors with H3 K27 mutation in a 19- year-old woman. MRI revealed a DMG. There was no paralysis of extremities or cerebellar deficit detected in physical examination. MRI showed a tumor in the pons, which is a hypo intense on T1-weighted imaging and a hyper intense on T2-weighted imaging. A nonenhancing lesion was discovered during a Gd-MRI examination. In perfusion imaging, there was no distinct perfusion rising in the tumor. N-Acetyl-aspartate (NAA):Cr ratio was 0.57, and choline (Cho):Cr ratio was 0.78. In conclusion, perfusion and spectroscopy findings are helpful for nonenhancing DMG diagnosis.
Keywords: Diffuse midline glioma, perfusion MRI, spectroscopy