Gliomatosis Cerebri (GC) is a rare tumor of the central nervous system. It is defined as a diffuse glial tumor that extensively infiltrates the brain, involving more than two lobes. And it is listed as a subtype of astrocytic tumors according to the newest 2007 (4th edition) WHO classification of tumors of the Central Nervous System. GC can be subdivided into Type I and Type II. Clinical findings for patients with GC are usually subtle and nonspecific. The lesions of GC generally show hypo, or isodensity on CT; a poorly defined diffuse hypoor isointense signal on T1-weighted images, and a scattered diff use hyperintense signal on T2-weighted images. Histological examination of GC reveals widespread infiltration of neoplastic glial cells with minimal destruction of pre-existing structures.Diagnosis of GC can be ascertained on the basis of a combination of clinical, radiological and pathological data. The treatment of GC includes radiotherapy and chemotherapy; however, the optimal therapeutic strategy is still not well established and prognosis of GC remains poor. This report reviews in detail the aspects of GC mentioned above, and three controversial issues are also discussed in the report.
Objective To determine the role of diffusion-weighted magnetic resonance imaging (DW-MRI) and apparent diffusion coefficient (ADC) imaging to guide stereotactic biopsy for the diagnosis of intracranial angiitis. Case presentation In a 28-year-old woman who had experienced inactive headache and right limbs numbness for 4 days, preoperative magnetic resonance (MR) scanning, enhanced scanning, diffusion tensor imaging, magnetic resonance spectroscopy, diffusion-weighted imaging (DWI), and ADC image scanning were performed. Stereotactic biopsy was performed in one target where the area of edema detected with MR FLAIR, and two targets where the area shown as a high-value and a lower value area in the DWI/ADC image. Pathological examinations together with computed tomographic and enhanced MRI scans were conducted after surgery. A preoperative enhanced MRI scan showed a uniform low-intensity lesion in the patient’s left centrum semiovale, with a volume of 3.1 cm3. The DWI and ADC images showed uneven high-intensity signals and different ADC values in the lesion area, respectively. During surgery, tissues around the lesion and the lesion center were sampled at the three selected targets. The postoperative pathological diagnosis was primary angiitis of the central nervous system, and the patient was given anti-inflammatory medication and hormone therapy. The 3-year follow-up confirmed that the patient had recovered well, with a Glasgow Outcome Scale score of five. Conclusion DW-MRI and ADC images can be reliably used to determine the location of small intracranial lesions, and guide stereotactic biopsy to facilitate the diagnosis of primary vasculitis of the central nervous system.
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