Fact-sheet: Gliomatosis cerebri
Updated on 03/31/2020 at 9:40 AM
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Definition
Primary brain tumor with diffuse infiltration of neoplastic glial cells without alteration of brain architecture.
Involvement of at least two cerebral lobes.
Infiltration of gray matter and white matter tracts.
Location: bihemispheric involvement +++, otherwise mesencephalic, pontine, thalamic, basal ganglia, or cerebellar.
Clinical features
Cognitive impairment, seizures, signs of intracranial hypertension.
CT
Poorly defined hypodense areas
Often normal
MRI
T1: isointense
T1 gadolinium: no enhancement
FLAIR and T2: hyperintense
Diffusion: hyperintense with increased ADC
Perfusion: low rCBV
Spectroscopy: elevated or normal choline, decreased NAA, elevated choline/NAA ratio, elevated creatine peak.
Myo-inositol peak.
Mild mass effect, mild sulcal effacement, minimal ventricular compression.
Management
Difficult surgical and radiotherapeutic management
Differential diagnosis
Low-grade glioma
PML
