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.

References

• Freund M, Hähnel S, Sommer C, Martmann M, Kiessling M, Tronnier V, Sartor K. CT and MRI findings in gliomatosis cerebri: a neuroradiologic and neuropathologic review of diffuse infiltrating brain neoplasms. Eur Radiol. 2001;11(2):309-16.
• Guzmán-de-Villoria JA, Sánchez-González J, Muñoz L, Reig S, Benito C, García-Barreno P, Desco M. 1H MR spectroscopy in the assessment of gliomatosis cerebri. AJR Am J Roentgenol. 2007 Mar;188(3):710-4.