RESUMEN
BACKGROUND AND PURPOSE: We report 12 cases of Gliomatosis cerebri (GC), a rare brain neoplasm, to define its semeiologic criteria. Literature was reviewed to clarify its physiopathology. PATIENTS AND METHODS: From 1997 to 2008, 12 histologically proven cases with GC were retrospectively reviewed. Of the 12 patients, nine were male. The mean age was of 54 years. Were performed CT-Scan (n=6), MRI (n=12), diffusion and perfusion weighted images (n=12 and n=4), MR Spectroscopy (n=3), a FDG and a Methionin PET-Scan (n=2 and n=3 respectively). RESULTS: Primary diagnosis was missed in six cases. Most frequent clinical signs were seizure and mental changes. Imaging criteria were: area of high signal intensity on FLAIR and T2-weighted images, involving three or more contiguous lobes with conserved architecture. Frequently a bilateral widespread invasion with involvment of the corpus callosum or the anterior white commissure or both was observed. At diagnosis and in the classical form (type I) of GC, no significant contrast enhancement and decreased rCBV were observed. Focal enhancement and increased rCBV were observed in the focal mass in type II GC. MR Spectroscopy showed an increase of the Cho/Cr ratio and a decrease in the NAA/Cr one. FDG PET showed in type I a decreased avidity for the FDG whereas in type II a increased avidity was observed. MET-PET showed an increased avidity for the tracer in a GC type II and a slight avidity in a GC type I. CONCLUSION: GC is a rare brain entity. Primary diagnosis is often missed. The imaging findings of GC I, a WHO grade III tumor, should be known and include classical MRI but also PWI, MRS and scintigraphic findings.
Asunto(s)
Neoplasias Encefálicas/diagnóstico , Diagnóstico por Imagen , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Ácido Aspártico/análogos & derivados , Ácido Aspártico/metabolismo , Niño , Colina/metabolismo , Creatina/metabolismo , Diagnóstico Diferencial , Imagen de Difusión por Resonancia Magnética , Femenino , Humanos , Procesamiento de Imagen Asistido por Computador , Angiografía por Resonancia Magnética , Imagen por Resonancia Magnética , Espectroscopía de Resonancia Magnética , Masculino , Persona de Mediana Edad , Neoplasias Neuroepiteliales , Tomografía de Emisión de Positrones , Sensibilidad y Especificidad , Tomografía Computarizada por Rayos X , Adulto JovenRESUMEN
BACKGROUND: An 80-year-old male (patient A) felt at home and consequently was admitted to the emergency unit. Following the head trauma, he was bleeding on the right frontoparietal area. The patient was found unconscious and the Glasgow Coma Scale was 9/15. An unenhanced CT scan of the brain was performed. A second patient, an 86-year-old male (patient B) was admitted to the intensive care unit with a degrading Glasgow Coma scale from 14/15 to 8/15. A subdural hematoma was diagnosed on a first CT scan. An unenhanced CT scan of the brain was performed to control the hematoma.