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Dynamic contrast-enhanced T2*-weighted MR imaging of gliomatosis cerebri
Stanley Yang1, Stephan Wetzel, M Law
1Department of Radiology, New York University Medical Center, NY, USA.
Background And Purpose:
MR imaging characteristics of gliomatosis cerebri reiterate the diffuse nature of this tumor but are nonspecific and thus may pose a diagnostic challenge. Because perfusion MR imaging can provide a physiologic map of the microcirculation, we compared the measured relative cerebral blood volume (rCBV) at perfusion imaging with histopathologic findings in gliomatosis cerebri. MR spectroscopic findings were also reviewed.
Methods:
Retrospective analysis was performed of conventional and perfusion MR images from seven patients with proved gliomatosis cerebri. The conventional MR images were evaluated for the presence or absence of contrast enhancement, necrosis, and extent of T2-weighted signal intensity abnormality. Dynamic contrast-enhanced T2*-weighted gradient-echo echo-planar images were acquired during the first pass of a bolus injection of gadopentetate dimeglumine. The rCBV was calculated by using nondiffusible tracer kinetics and expressed relative to normal-appearing white matter. Pathologic findings were reviewed in all patients and compared with the MR perfusion data. Multivoxel 2D chemical shift imaging proton MR spectroscopic data were available for three patients and single-voxel data for one patient.
Results:
Conventional MR images showed diffuse abnormality in all cases and absence of contrast enhancement in all but one case. Average rCBV range was 0.75-1.26 (mean, 1.02 +/- 0.42 [SD]). MR spectroscopic data revealed spectra consistent with presence of tumoral disease. Histopathologic review showed absence of vascular hyperplasia in all specimens.
Conclusion:
The low MR rCBV measurements of gliomatosis cerebri are in concordance with the lack of vascular hyperplasia found at histopathologic examination; thus, perfusion MR imaging provides useful adjunctive information that is not available from conventional MR imaging techniques.
Insights
Perfusion MR imaging reveals low relative cerebral blood volume in gliomatosis cerebri, correlating with absent vascular hyperplasia. This technique offers valuable diagnostic information beyond conventional MR imaging for this rare brain tumor.
Area of Science:
- Neuroradiology
- Neuro-oncology
- Medical Imaging
Background:
- Gliomatosis cerebri presents nonspecific MR imaging characteristics, posing diagnostic challenges.
- Perfusion MR imaging offers insights into microcirculation physiology.
- Relative cerebral blood volume (rCBV) is a key perfusion parameter.
Purpose of the Study:
- To compare MR perfusion findings, specifically rCBV, with histopathologic results in gliomatosis cerebri.
- To evaluate the diagnostic utility of perfusion MR imaging in this condition.
- To review associated MR spectroscopic findings.
Main Methods:
- Retrospective analysis of conventional and perfusion MR images from seven gliomatosis cerebri patients.
- Evaluation of contrast enhancement, necrosis, and T2 signal abnormalities.
- Calculation of rCBV relative to normal white matter and comparison with histopathology.
Main Results:
- Conventional MR showed diffuse abnormalities; contrast enhancement was rare.
- Average rCBV ranged from 0.75-1.26, with a mean of 1.02.
- Histopathology confirmed the absence of vascular hyperplasia in all cases.
Conclusions:
- Low rCBV in gliomatosis cerebri aligns with the lack of vascular hyperplasia.
- Perfusion MR imaging provides crucial adjunctive diagnostic information.
- This technique enhances diagnostic capabilities beyond conventional MR imaging.
