Imaging in Ganglioglioma

No Results

No Results

processing….

Ganglioglioma was first described by Courville in 1930 as a central nervous system neoplasm containing both astrocytic and neuronal components. ^[1] Gangliogliomas may occur anywhere in the central nervous system but are not encountered commonly.

Similar to other brain tumors, imaging techniques define the location of gangliogliomas and their relationship to adjacent structures. Because of the relative rarity and nonspecific appearance of these lesions, gangliogliomas are only infrequently considered a presurgical diagnosis. ^{[2, 3, 4, 5, 6, 7, 8]}

Magnetic resonance imaging (MRI) with contrast enhancement is more sensitive and specific than other imaging techniques in determining the presence and location of gangliogliomas and in characterizing the lesions’ cystic and/or solid components. ^[9] However, the imaging appearances of these tumors are nonspecific, and the diagnosis is usually established by histology and immunohistochemistry. See the image below.

Usually, plain films do not contribute to the diagnosis of gangliogliomas. Rarely, findings may be related to increased intracranial pressure. Occasionally, gangliogliomas are sufficiently calcified to be visible on plain radiographs.

On CT scans, most of the tumors are hypodense or isodense to brain parenchyma with poor contrast enhancement. The gangliogliomas are usually well circumscribed and located peripherally. However, the imaging appearance is nonspecific. Grossly, one half of the tumors show cystic areas, calcification, and enhancement. Punctate or flecklike calcification is seen in one third of tumors. Surrounding edema is unusual, although a correlation between surrounding edema and anaplasia has been described, and hemorrhage is rarely identified.

Cystic tumors are predominantly found (with decreasing frequency) in the cerebellum, temporal, frontal, and parietal lobes and have a variable appearance from a single large cyst to a cyst with mural nodule to a multicystic mass. Solid tumors usually are seen in the temporal lobe and have more contrast enhancement. Anaplastic tumors have a heterogeneous appearance with excellent contrast enhancement.

Solid enhancing tumors in the temporal lobe in younger patients with seizures may suggest the diagnosis. In addition, ganglioglioma is the most common neoplastic cause of temporal lobe seizures.

Low-grade gliomas may appear similar; calcified lesions may mimic oligodendrogliomas, and cystic tumors may mimic juvenile pilocytic astrocytoma.

MRI is useful in differentiating the cystic and solid components of tumors (see the images below). Most tumors are hypointense on T1-weighted images and hyperintense on T2-weighted images relative to gray matter. An isolated case report demonstrated leptomeningeal spread of the tumor. ^{[10, 11, 12]}

A proton magnetic resonance spectroscopy signal from N -acetylaspartate is an endogenous marker for functioning neurons. The choline-to-creatine ratio is lower and the N -acetylaspartate-to-creatine ratio is higher in gangliogliomas than in gliomas. A high N -acetylaspartate-to-creatine ratio may be due to a neoplastic neuronal component.

In a study of 10 patients, aged 14-67 years, with histologically proven supratentorial gangliogliomas, minimum apparent diffusion coefficient (minADC) values of gangliogliomas (1.45 +/- 0.20 × 10^-3 mm²/s) was found to be significantly higher than the minADC values of astrocytomas. ^[13] Kikuchi et al determined that minADC values accurately reflect the low tumor cellularity of gangliogliomas and may therefore be helpful in the differential diagnosis of the tumors. ^[13]

As with CT scanning, the imaging patterns are nonspecific. Temporal lobe gangliogliomas usually present with temporal lobe seizures: a solid enhancing tumor located in the temporal lobe with no surrounding edema in a younger patient with intractable seizures is highly suggestive of the diagnosis. With the advent of more routine magnetic resonance screening of seizure patients, these tumors are increasingly identified on imaging.

Low-grade gliomas may appear similar; calcified lesions may mimic oligodendrogliomas, and cystic tumors may mimic juvenile pilocytic astrocytoma.

Nuclear medicine studies are not helpful in the diagnosis of gangliogliomas. Solid tumors may show increased radiotracer uptake on single-photon emission CT studies. In a small cohort, fluorodeoxyglucose-positron emission tomography (FDG-PET) scanning and thallium-201 (²⁰¹ Tl) single-photon emission CT (SPECT) scanning reportedly have helped in preoperative grading of these tumors ^[14] ; however, this observation has not been substantiated. Only limited information is available in the literature regarding FDG-PET scan findings in these tumors. Grade I/II gangliogliomas showed hypometabolic or isometabolic changes.

Cerebral angiography provides no additional information apart from confirming the nonvascular nature of the tumors. Rarely, the enhancement pattern of the ganglioglioma may mimic a vascular malformation, and catheter angiography is required to exclude a vascular malformation.

Courville CB. Ganglioglioma tumor of the central nervous system: review of the literature and report of two cases. Arch Neurol Psych. 1930. 24:439-91.

Park SH, Kim E, Son EI. Cerebellar ganglioglioma. J Korean Neurosurg Soc. 2008 Mar. 43(3):165-8. [Medline].

Mpairamidis E, Alexiou GA, Stefanaki K, Sfakianos G, Prodromou N. Brainstem ganglioglioma. J Child Neurol. 2008 Dec. 23(12):1481-3. [Medline].

Aguilar HN, Hung RW, Mehta V, Kotylak T. Imaging characteristics of an unusual, high-grade angiocentric glioma: a case report and review of the literature. J Radiol Case Rep. 2012 Oct. 6(10):1-10. [Medline]. [Full Text].

Hargus G, Bink A, Nagel I, Paulus W, Harder A. Bilateral ganglioglioma of the trigeminal nerve in an 83-year-old man. Neuropathology. 2013 Jul 29. [Medline].

Murakami T, Koyanagi I, Kaneko T, Yoneta A, Keira Y, Wanibuchi M, et al. Intramedullary spinal cord ganglioglioma presenting as hyperhidrosis: unique symptoms and magnetic resonance imaging findings: case report. J Neurosurg Spine. 2013 Feb. 18(2):184-8. [Medline].

Zhang S, Ai L, Chen XZ, Wang K. Radiological Evaluation of Infratentorial Gangliogliomas in Various Anatomic Locations of the Cerebellum and Brainstem. Clin Neuroradiol. 2016 Jan 7. [Medline].

Bader A, Heran M, Dunham C, Steinbok P. Radiological features of infantile glioblastoma and desmoplastic infantile tumors: British Columbia’s Children’s Hospital experience. J Neurosurg Pediatr. 2015 Aug. 16 (2):119-25. [Medline].

Balaji R, Ramachandran K. Imaging of desmoplastic infantile ganglioglioma: a spectroscopic viewpoint. Childs Nerv Syst. 2009 Jan 13. [Medline].

Urbach H. MRI of long-term epilepsy-associated tumors. Semin Ultrasound CT MR. 2008 Feb. 29(1):40-6. [Medline].

Mei PA, de Carvalho Carneiro C, Fraser SJ, Min LL, Reis F. Analysis of neoplastic lesions in magnetic resonance imaging using self-organizing maps. J Neurol Sci. 2015 Dec 15. 359 (1-2):78-83. [Medline].

Derinkuyu BE, Ucar M, Borcek AO, Damar C, Oztunali C, Gul Alimli A, et al. Non-infantile variant of desmoplastic ganglioglioma: Conventional and advanced MR imaging characteristics. Neuroradiol J. 2015 Jun. 28 (3):259-63. [Medline].

Kikuchi T, Kumabe T, Higano S, Watanabe M, Tominaga T. Minimum apparent diffusion coefficient for the differential diagnosis of ganglioglioma. Neurol Res. 2009 Jan 9. [Medline].

Kincaid PK, El-Saden SM, Park SH, Goy BW. Cerebral gangliogliomas: preoperative grading using FDG-PET and 201Tl-SPECT. AJNR Am J Neuroradiol. 1998 May. 19(5):801-6. [Medline].

Adachi Y, Yagishita A. Gangliogliomas: Characteristic imaging findings and role in the temporal lobe epilepsy. Neuroradiology. 2008 Oct. 50(10):829-34. [Medline].

Castillo M. Gangliogliomas: ubiquitous or not?. AJNR Am J Neuroradiol. 1998 May. 19(5):807-9. [Medline].

Castillo M, Davis PC, Takei Y, Hoffman JC Jr. Intracranial ganglioglioma: MR, CT, and clinical findings in 18 patients. AJNR Am J Neuroradiol. 1990 Jan-Feb. 11(1):109-14. [Medline].

Matsumoto K, Tamiya T, Ono Y, et al. Cerebral gangliogliomas: clinical characteristics, CT and MRI. Acta Neurochir (Wien). 1999. 141(2):135-41. [Medline].

Shin JH, Lee HK, Khang SK, et al. Neuronal tumors of the central nervous system: radiologic findings and pathologic correlation. Radiographics. 2002 Sep-Oct. 22(5):1177-89. [Medline].

Tien RD, Tuori SL, Pulkingham N, Burger PC. Ganglioglioma with leptomeningeal and subarachnoid spread: results of CT, MR, and PET imaging. AJR Am J Roentgenol. 1992 Aug. 159(2):391-3. [Medline].

Zentner J, Wolf HK, Ostertun B, et al. Gangliogliomas: clinical, radiological, and histopathological findings in 51 patients. J Neurol Neurosurg Psychiatry. 1994 Dec. 57(12):1497-502. [Medline].

Anil Khosla, MBBS, MD Assistant Professor, Department of Radiology, St Louis University School of Medicine, Veterans Affairs Medical Center of St Louis

Anil Khosla, MBBS, MD is a member of the following medical societies: American College of Radiology, American Roentgen Ray Society, American Society of Neuroradiology, North American Spine Society, Radiological Society of North America

Disclosure: Nothing to disclose.

Bernard D Coombs, MB, ChB, PhD Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand

Disclosure: Nothing to disclose.

C Douglas Phillips, MD, FACR Director of Head and Neck Imaging, Division of Neuroradiology, New York-Presbyterian Hospital; Professor of Radiology, Weill Cornell Medical College

C Douglas Phillips, MD, FACR is a member of the following medical societies: American College of Radiology, American Medical Association, American Society of Head and Neck Radiology, American Society of Neuroradiology, Association of University Radiologists, Radiological Society of North America

Disclosure: Nothing to disclose.

James G Smirniotopoulos, MD Chief Editor, MedPix®, Lister Hill National Center for Biomedical Communications, US National Library of Medicine; Professorial Lecturer, Department of Radiology, George Washington University School of Medicine and Health Sciences

James G Smirniotopoulos, MD is a member of the following medical societies: American College of Radiology, American Society of Neuroradiology, Radiological Society of North America

Disclosure: Nothing to disclose.

Mahesh R Patel, MD Chief of MRI, Department of Diagnostic Imaging, Santa Clara Valley Medical Center

Mahesh R Patel, MD is a member of the following medical societies: American Roentgen Ray Society, American Society of Neuroradiology, Radiological Society of North America

Disclosure: Nothing to disclose.

Imaging in Ganglioglioma

Research & References of Imaging in Ganglioglioma|A&C Accounting And Tax Services
Source

Share on Facebook

Tweet

Follow us