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.
Peak incidence is at 20-40 years of age.
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.
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 hypointense to grey matter 1
- T2: hyperintense to grey matter 1
- MR spectroscopy: elevated Cho:Crn and Cho:NAA ratios 2
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.
General imaging differential considerations include:
- progressive multifocal leukoencephalopathy (in immunocompromised patient): no mass effect
- WHO classification of CNS tumours
- diffuse astrocytic tumours
- diffuse astrocytoma grading
- low grade astrocytoma
- anaplastic astrocytoma
- glioma treatment response assessment in clinical trials
- O6-Methylguanine-DNA methyltransferase (MGMT)
- giant cell glioblastoma
- gliomatosis cerebri
- localised astrocytic tumours
- specific locations
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