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Adult Brainstem Glioma Differential Diagnoses: An MRI-based Approach in a Series of 68 Patients.

Alberto Duran-Peña 1, 2 François Ducray 3 Carole Ramirez 4 Luc Bauchet 5, 6 Jean Marc Constans 7, 8 Sylvie Grand 9 Jean Sébastien Guillamo 10, 11 Delphine Larrieu-Ciron 12 Didier Frappaz 13 Nadya Pyatigorskaya 14, 1 Julien Savatovsky 15 Hugues Loiseau 16 Nadine Martin Duverneuil Florence Laigle-Donadey 17, 18 
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.
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Soumis le : vendredi 29 juillet 2022 - 15:17:01
Dernière modification le : vendredi 5 août 2022 - 11:25:58



Alberto Duran-Peña, François Ducray, Carole Ramirez, Luc Bauchet, Jean Marc Constans, et al.. Adult Brainstem Glioma Differential Diagnoses: An MRI-based Approach in a Series of 68 Patients.. Journal of Neurology, Springer Verlag, 2022, 269 (8), pp.4349--4362. ⟨10.1007/s00415-022-11070-6⟩. ⟨hal-03740507⟩



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