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Adult brainstem glioma differential diagnoses: an MRI-based approach in a series of 68 patients

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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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Acknowledgements

We thank Dr. Laura Rozenblum, from the Department of Nuclear Medicine of Pitie-Salpetriere Hospital, for her expertise and for her help in improving our manuscript.

Funding

None.

Author information

Authors and Affiliations

  1. Service de Neurologie 2, Division Mazarin CHU Pitié-Salpêtrière, Paris, France

    Alberto Duran-Peña & Florence Laigle-Donadey

  2. Service de Neuro-Oncologie, Hôpital Pierre Wertheimer, CHU Lyon, Lyon, France

    François Ducray

  3. Service de Neurochirurgie, Hôpital Roger Salengro, CHU Lille, Lille, France

    Carole Ramirez

  4. Service de Neurochirurgie, CHU Montpellier, Montpellier, France

    Luc Bauchet

  5. Service de Neuroradiologie, CHU Amiens, Amiens, France

    Jean Marc Constans

  6. Service de Neuroradiologie, CHU Grenoble Alpes, Grenoble, France

    Sylvie Grand

  7. Service de Neurologie, CHU Nîmes Caremeau, Nîmes, France

    Jean Sébastien Guillamo

  8. Service de Neurologie, CHU Poitiers, Poitiers, France

    Delphine Larrieu-Ciron

  9. Service d’Oncologie, Centre Léon Bérard, Lyon, France

    Didier Frappaz

  10. Service de Neuroradiologie, CHU Pitié-Salpêtrière, Paris, France

    Nadya Pyatigorskaya & Nadine Martin Duverneuil

  11. Service de Neuroradiologie, Fondation Ophtalmologique Rothschild, Paris, France

    Julien Savatovsky

  12. Service de Neurochirurgie, CHU Bordeaux, Bordeaux, France

    Hugues Loiseau

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  1. Alberto Duran-Peña
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  2. François Ducray
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  3. Carole Ramirez
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  4. Luc Bauchet
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  7. Jean Sébastien Guillamo
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  8. Delphine Larrieu-Ciron
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  9. Didier Frappaz
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  13. Nadine Martin Duverneuil
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  14. Florence Laigle-Donadey
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Corresponding author

Correspondence to Florence Laigle-Donadey.

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Conflicts of interest

The authors declare that they have no conflicts of interest.

Ethical approval

All investigations were carried out according to the Declaration of Helsinki.

Additional information

on behalf of the GLITRAD network (RENOCLIP LOC)

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Duran-Peña, A., Ducray, F., Ramirez, C. et al. Adult brainstem glioma differential diagnoses: an MRI-based approach in a series of 68 patients. J Neurol 269, 4349–4362 (2022). https://doi.org/10.1007/s00415-022-11070-6

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  • DOI: https://doi.org/10.1007/s00415-022-11070-6

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