Multicentric glioblastomas are uncommon and represent tumours which have multiple discrete areas of contrast-enhancing tumour without connecting T2/FLAIR signal abnormality. They are considered to represent separate synchronous tumours. It must be noted that as imaging has improved, the frequency with which multicentric gliomas have been identified has reduced, as a result of being able to demonstrate connections between enhancing components more readily.
In many cases, the pattern of enhancement strongly suggests that these multiple areas of enhancement actually represent microscopic spread along dominant white matter tracts (e.g. across forceps minor) and, although no bridging abnormally high T2 signal can be seen they thus nonetheless actually represent multifocal tumours rather than being truly multicentric. As such, in practice, the term multicentric should be reserved for tumours with multiple enhancing centres when no connecting high T2 signal is present and the tumours are not in a distribution that suggests a single multifocal tumour.
Differential diagnosis
In contrast, multifocal glioblastomas have connecting T2/FLAIR signal abnormality and represent spread of tumour along white matter tracts.
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