Gliomatosis cerebri: comparison of MR and CT features

Gliomatosis cerebri is a diffuse infiltrative glial neoplasm frequently involving both cerebral hemispheres. Diagnosis and evaluation of its extent with CT are known to be difficult. The purpose of this study was to compare the MR and CT findings in gliomatosis cerebri.

MR images of nine patients were reviewed retrospectively and compared with CT scans. Pathology was determined by open or stereotaxic biopsy. The MR images included sagittal T1-weighted, axial proton density-weighted, and T2-weighted images. Contrast material was administered in seven patients. Unenhanced and enhanced CT scans were obtained in eight patients.

On proton density-weighted and T2-weighted MR images, the most common findings were poorly defined bilateral areas of diffuse high signal intensity in the cerebral hemisphere. On T1-weighted images, the lesions were isointense to hypointense compared with normal brain. Enhanced T1-weighted images showed focal parenchymal enhancement in three patients and meningeal enhancement in one. On CT scans, the lesions showed poorly defined areas of subtle low density or isodensity, and appeared much smaller than those on T2-weighted MR images. Enhancement was seen in only one case. The extent of disease was evaluated much better on T2-weighted MR images than on T1-weighted MR images and CT scans.

In gliomatosis cerebri, MR imaging is more sensitive than CT for detecting lesions and shows the extent of disease better than CT does. Accordingly, MR imaging should be used as a primary imaging study in the evaluation of gliomatosis cerebri.