Journal of Neuro-Oncology

, Volume 140, Issue 1, pp 107–113 | Cite as

Features of diffuse gliomas that are misdiagnosed on initial neuroimaging: a case control study

  • M. D. Maldonado
  • P. Batchala
  • D. Ornan
  • C. Fadul
  • D. Schiff
  • J. N. Itri
  • R. Jain
  • S. H. PatelEmail author
Clinical Study



The neuroimaging diagnosis of diffuse gliomas can be challenging owing to their variable clinical and radiologic presentation. The purpose of this study was to identify factors that are associated with imaging errors in the diagnosis of diffuse gliomas.


A retrospective case–control analysis was undertaken. 18 misdiagnosed diffuse gliomas on initial neuroimaging (cases) and 108 accurately diagnosed diffuse gliomas on initial neuroimaging (controls) were collected. Clinical, pathological, and imaging metrics were tabulated for each patient. The tabulated metrics were compared between cases and controls to determine factors associated with misdiagnosis.


Cases of misdiagnosed diffuse glioma (vs controls) were more likely to undergo initial triage as a stroke workup [OR 14.429 (95% CI 4.345, 47.915), p < 0.0001], were less likely to enhance [OR 0.283 (95% CI 0.098, 0.812), p = 0.02], were smaller (mean diameter 4.4 vs 6.0 cm, p = 0.0008), produced less midline shift (median midline shift 0.0 vs 2.0 mm, p = 0.003), were less likely to demonstrate necrosis [OR 0.156 (95% CI 0.034–0.713), p = 0.008], and were less likely to have IV contrast administered on the initial MRI [OR 0.100 (95% CI 0.020, 0.494), p = 0.008].


Several clinical and radiologic metrics are associated with diffuse gliomas that are missed or misdiagnosed on the initial neuroimaging study. Knowledge of these associations may aid in avoiding misinterpretation and accurately diagnosing such cases in clinical practice.


Diffuse glioma Glioblastoma Diagnostic error MRI CT Neuroimaging 



Isocitrate dehydrogenase


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional committee and 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

The requirement for informed consent was waived by our institutional IRB for this retrospective study of patient data.

Supplementary material

11060_2018_2939_MOESM1_ESM.tif (201 kb)
Supplemental Figure 1: Case and control selection (TIF 201 KB)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • M. D. Maldonado
    • 1
  • P. Batchala
    • 1
  • D. Ornan
    • 1
  • C. Fadul
    • 2
  • D. Schiff
    • 2
  • J. N. Itri
    • 3
  • R. Jain
    • 4
    • 5
  • S. H. Patel
    • 1
    Email author
  1. 1.Division of Neuroradiology, Department of Radiology and Medical ImagingUniversity of Virginia Health SystemCharlottesvilleUSA
  2. 2.Division of Neuro-Oncology, Department of NeurologyUniversity of Virginia Health SystemCharlottesvilleUSA
  3. 3.Department of RadiologyWake Forest Baptist HealthWinston-SalemUSA
  4. 4.Department of RadiologyNYU School of MedicineNew YorkUSA
  5. 5.Department of NeurosurgeryNYU School of MedicineNew YorkUSA

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