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Gliomatosis cerebri

Gliomatosis cerebri is a diffusely infiltrative glial tumor that involves at least three lobes by definition. There often is an important discordance between clinical and radiological findings, as it may be clinically silent while it appears as a very extensive process radiologically.

Epidemiology

Peak incidence is at 20-40 years of age.

Radiographic features

CT

Can be normal because lesions often isodense to normal brain parenchyma. There is relative lack of mass effect and distortion. There may be an ill defined asymmetry or subtle hypoattenuation to the involved brain parenchyma.

MRI

Mass effect and enhancement are minimal. There is loss of GM/WM differenciation and diffuse gyral thickening.

Diffuse T1 and T2 prolongation throughout both white and grey matter.

  • T1: iso to hypo intense to grey matter 1
  • T2: hyper intense to grey matter 1
  • MR spectroscopy: elevated Cho:Crn and Cho:NAA ratios 2

Prognosis

The condition carries a poor prognosis with an average survival of ≈ 50% at 1 year and 25 % at 3 years. GBM /HAA may occur a few years later

Differential diagnosis

General imaging differential considerations include:


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