Gliomatosis cerebri in a 74-year-old woman. A, Axial T2-weighted, FLAIR, and enhanced Tl -weighted images demonstrate high signal intensity in the right temporal lobe involving white matter and cortex. The acute clinical presentation suggested infarct. B, Diffusion weighted image and TRACE apparent diffusion coefficient (ADC) map demonstrate increased water diffusion in the lesion (slightly higher values on ADC map, outlined by arrowheads), excluding acute infarction. Note that encephalitis may have a similar MR appearance and diffusion characteristics. (Click to magnify figure)
MR spectroscopy is of value. Markedly elevated Cho and decreased Cr and NAA is hallmark of grade III glioma. If lactate is increased think about GBM and if lipid is elevated think about lymphoma. Lymphomatosis cerebri could have similar appearance.
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