Cesare Colosimo MD, Presenter: Nothing to Disclose

Giuseppe M. Di Lella MD, Abstract Co-Author: Nothing to Disclose

Alfonso Cerase MD, Abstract Co-Author: Nothing to Disclose

Armando Tartaro MD, Abstract Co-Author: Nothing to Disclose

Massimo Caulo MD, Abstract Co-Author: Nothing to Disclose

Giulio Maira MD, Abstract Co-Author: Nothing to Disclose

The introduction of MRI resulted in a significant increase in percentage of brain gliomas (BG) presenting as multiple separate lesions due to true multicentric or multifocal tumors and to gliomatosis cerebri (GC), definite differential diagnosis being based on neuropathological evaluation of the entire brains. The purposes of this retrospective study are to define frequency of MG, describe most common MRI features, and report on evolution of clinical and radiological pictures in a large series of pathologically proven BG.

From a retrospective review of Gd-enhanced MRI of 610 patients with pathologically proven primary BG, 53 (8,6%; 31 males and 22 females) were considered to have true MG, since different tumor sites could not be considered disseminated through white matter tracts, due to satellite formation, nor explained by dissemination through CSF and perivascular spaces. 7/53 patients were under 18 years of age at diagnosis. PWI was obtained in 10 patients, fMRI in 7, proton MRS in 8, and FDG-PET in 6. Final pathological diagnosis was GC in 15 patients, and MG in 38. 30 out of 38 MG were entirely astrocytic, 5 mixed, and 3 exclusively oligodendroglial. Duration of clinical and MRI follow-up ranges from 9 months to 13 years.

At first MRI, 10 patients had 2 separate lesions, 26 had 2-4 separate lesions and 17 had >4 separate lesions. 33 patients did not show Gd-enhancement. In 2 patients, PWI showed increased CBV values prior than Gd-enhancement and anaplastic evolution. 24 patients developed a glioblastoma (GBM): 3 are still alive (follow-up range, 18-36 months after first MRI). 21 had a final diagnosis of anaplastic astrocytoma or oligodendroglioma: 5 are still alive (15-49 months). 8 had a final diagnosis of low-grade astrocytomas, oligodendrogliomas, or mixed gliomas: 6 are alive, 2 remains unchanged (6-13 years).

True MG and GC are more frequent than generally considered. In most cases, a differential diagnosis is not possible by MRI. Despite poor prognosis in most patients, there is a considerable percentage of low-grade tumors. Early recognition of anaplastic evolution and/or evolution toward GBM by MRI or PWI may allow prognosis improvement.

Colosimo, C, Di Lella, G, Cerase, A, Tartaro, A, Caulo, M, Maira, G, Multicentric Brain Gliomas and Gliomatosis Cerebri: MRI Findings and Follow-up.  Radiological Society of North America 2004 Scientific Assembly and Annual Meeting, November 28 - December 3, 2004 ,Chicago IL. http://archive.rsna.org/2004/4414490.html