MRI of temporal lobe pleomorphic xanthoastrocytoma

Pleomorphic xanthoastrocytomas (PXA) are classically supratentorial, peripherally located, well-circumscribed, partially cystic neoplasms, which can enhance on CT following the administration of intravenous contrast agents. Focal calcification may also be seen. Although the CT appearance has been described, we report the MR findings in two cases of histologically documented temporal lobe PXA. The two well-circumscribed lesions were predominantly cystic and both contained a Gd-DTPA enhancing mural nodule. The latter was isointense with gray matter on T1-weighted images and hyperintense on T2-weighted scans. Minimal surrounding edema was present. Histologically, PXA may be confused with glioblastoma multiforme (GBM) due to the pronounced cellular pleomorphism. Because of their potentially more indolent behavior compared with GBM, it is important to recognize the gross morphologic characteristics of this rare tumor on MR. The MR pattern of a cystic lesion with enhancing mural nodule is characteristic of PXA, but not diagnostic, and other lower grade gliomas such as ganglioglioma and pilocytic astrocytoma need to be considered. The MR and CT appearance of PXA can provide critical information for the pathologist, especially when only a small amount of tissue is obtained for histologic evaluation.