Tuesday, April 5, 2011

Gliomatosis Cerebri

Gliomatosis cerebri is a rare diffuse and infiltrative glial neoplasm involving at least two lobes of the brain. It is frequently bilateral and is typically a white matter process.

T2-weighted images typically reveal a homogeneously hyperintense infiltrating mass with mild mass effect on adjacent sulci and ventricles. Minimal or no enhancement is typical (foci of enhancement may represent anaplastic components). Pre-contrast T1-weighted images may reveal an iso- or hypo-intense process. DWI images usually reveal no restricted diffusion. Spectroscopy may reveal marked elevation of the myoinositol peak.

The main differential considerations include:
  • Vasculitis: Usually more patchy; however, biopsy may be needed in some cases.
  • Viral encephalitis: More acute presentation.
  • Anaplastic astrocytoma: May present as an infiltrating process, but is not often diffuse. Enhancement is variable.
Other entities usually included in the differential can be distinguished by their enhancement pattern or distribution.


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