MRI findings of multiple malignant gliomas: differentiation from multiple metastatic brain tumors

Multiple malignant gliomas are relatively uncommon, but are sometimes difficult to differentiate from multiple metastatic brain tumors. We analyzed the MR findings of four cases of multiple gliomas, comparing them with 12 cases of multiple metastatic brain tumors. All tumors were pathologically proven by surgical operation or autopsy. Gliomas were located in the deep white matter of the cerebrum, with none found in the posterior fossa. Tumors were relatively large, and irregular, thick, ring-like enhancement was noted after the administration of Gd-DTPA. Intratumoral hemorrhage was noted in only one case. High signal intensity on T2WI around the tumor suggested that edema was greater and more extensive than in metastatic tumors and was seen even in the corpus callosum. One autopsied case that showed this high intensity presented not only edema but also tumor infiltration. Metastatic tumors were located mainly in the corticomedullary junction of the brain. They were relatively small, and eight of 12 tumors showed, nodular or smooth ring-like enhancement. Intratumoral hemorrhage was noted in four cases. Edema was noted mainly around the tumor. We conclude that differential diagnosis between gliomas and metastases is possible to some extent by MRI.