Alberto Duran-Peña1, François Ducray2, Carole Ramirez3, Luc Bauchet4, Jean Marc Constans5, Sylvie Grand6, Jean Sébastien Guillamo7, Delphine Larrieu-Ciron8, Didier Frappaz9, Nadya Pyatigorskaya10, Julien Savatovsky11, Hugues Loiseau12, Nadine Martin Duverneuil10, Florence Laigle-Donadey13. 1. Service de Neurologie 2, Division Mazarin CHU Pitié-Salpêtrière, Paris, France. 2. Service de Neuro-Oncologie, Hôpital Pierre Wertheimer, CHU Lyon, Lyon, France. 3. Service de Neurochirurgie, Hôpital Roger Salengro, CHU Lille, Lille, France. 4. Service de Neurochirurgie, CHU Montpellier, Montpellier, France. 5. Service de Neuroradiologie, CHU Amiens, Amiens, France. 6. Service de Neuroradiologie, CHU Grenoble Alpes, Grenoble, France. 7. Service de Neurologie, CHU Nîmes Caremeau, Nîmes, France. 8. Service de Neurologie, CHU Poitiers, Poitiers, France. 9. Service d'Oncologie, Centre Léon Bérard, Lyon, France. 10. Service de Neuroradiologie, CHU Pitié-Salpêtrière, Paris, France. 11. Service de Neuroradiologie, Fondation Ophtalmologique Rothschild, Paris, France. 12. Service de Neurochirurgie, CHU Bordeaux, Bordeaux, France. 13. Service de Neurologie 2, Division Mazarin CHU Pitié-Salpêtrière, Paris, France. florence.laigle-donadey@aphp.fr.
Abstract
BACKGROUND: Brainstem gliomas are rare in adults. The diagnosis is often difficult, as some teams still consider brainstem biopsies dangerous and often avoid this procedure. The aim of this study was to describe differential diagnoses that can mimic brainstem glioma, to help clinicians avoid diagnostic and therapeutic mistakes, and to propose a diagnostic algorithm according to radiological presentations. METHODS: The French network of adult brainstem gliomas (GLITRAD) retrospectively collected all reported cases of differential diagnoses between 2006 and 2017. The inclusion criteria were as follows: age over 18 years, lesion epicenter in the brainstem, radiological pattern suggestive of a glioma and diagnostic confirmation (histopathological or not, depending on the disease). RESULTS: We identified a total of 68 cases. Most cases (58/68, 85%) presented as contrast-enhancing lesions. The most frequent final diagnosis in this group was metastases in 24/58 (41%), followed by central nervous system lymphoma in 8/58 (14%). Conversely, MRI findings revealed 10/68 nonenhancing lesions. The most frequent diagnosis in this group was demyelinating disease (3/10, 30%). CONCLUSION: The risk of diagnostic mistakes illustrates the need to consider the more systematic use of a brainstem biopsy when reasonably possible. However, we propose an MRI-based approach to the differential diagnosis of gliomas to limit the risk of misdiagnosis in cases where a biopsy is not a reasonable option.
BACKGROUND: Brainstem gliomas are rare in adults. The diagnosis is often difficult, as some teams still consider brainstem biopsies dangerous and often avoid this procedure. The aim of this study was to describe differential diagnoses that can mimic brainstem glioma, to help clinicians avoid diagnostic and therapeutic mistakes, and to propose a diagnostic algorithm according to radiological presentations. METHODS: The French network of adult brainstem gliomas (GLITRAD) retrospectively collected all reported cases of differential diagnoses between 2006 and 2017. The inclusion criteria were as follows: age over 18 years, lesion epicenter in the brainstem, radiological pattern suggestive of a glioma and diagnostic confirmation (histopathological or not, depending on the disease). RESULTS: We identified a total of 68 cases. Most cases (58/68, 85%) presented as contrast-enhancing lesions. The most frequent final diagnosis in this group was metastases in 24/58 (41%), followed by central nervous system lymphoma in 8/58 (14%). Conversely, MRI findings revealed 10/68 nonenhancing lesions. The most frequent diagnosis in this group was demyelinating disease (3/10, 30%). CONCLUSION: The risk of diagnostic mistakes illustrates the need to consider the more systematic use of a brainstem biopsy when reasonably possible. However, we propose an MRI-based approach to the differential diagnosis of gliomas to limit the risk of misdiagnosis in cases where a biopsy is not a reasonable option.
Authors: Katherine A Zukotynski; Sridhar Vajapeyam; Frederic H Fahey; Mehmet Kocak; Douglas Brown; Kelsey I Ricci; Arzu Onar-Thomas; Maryam Fouladi; Tina Young Poussaint Journal: J Nucl Med Date: 2017-03-30 Impact factor: 10.057
Authors: Deanna H Pafundi; Nadia N Laack; Ryan S Youland; Ian F Parney; Val J Lowe; Caterina Giannini; Brad J Kemp; Michael P Grams; Jonathan M Morris; Jason M Hoover; Leland S Hu; Jann N Sarkaria; Debra H Brinkmann Journal: Neuro Oncol Date: 2013-03-03 Impact factor: 12.300