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Ganglioglioma

Last Updated: March 27, 2020

Figure 1: This inferior right temporal ganglioglioma is nearly invisible on T1WI (top row left). The cystic change seen in this lesion on coronal T2WI (top row right) and contrast-enhanced T1WI (bottom) is variably present in this type of lesion. The degree of enhancement is also highly variable, though avid in this patient's lesion.

Figure 2: This complex FLAIR hyperintense (top row left), STIR hyperintense (top row right) ganglioglioma in the left frontal lobe demonstrates areas of low signal intensity hemorrhage medially (an atypical feature) and only a small amount of brighter surrounding edema anteriorly on FLAIR (top row left). Cystic changes are also present in the periphery, most clearly visible on STIR (top row right). Only faint enhancement is present in this example (bottom row left - axial contrast, bottom row right - coronal contrast).

Figure 3: This ganglioglioma involves the medial right frontal lobe in a display of FLAIR hyperintensity (top row left) without any appreciable contrast enhancement (top row right). The lesion is typical in its infiltrative involvement of the cortex and adjacent white matter. There is no restricted diffusion (bottom row left – DWI, bottom row right – ACD) to suggest hypercellularity.

Basic Description

  • Slow-growing, well-differentiated, and cortically-based neuroglial tumor

Pathology

  • WHO grade I or II
  • Anaplastic ganglioglioma (WHO III) rare
  • Dysmorphic ganglion and glial cells

Clinical Features

  • May affect all ages (majority discovered at <30 years)
  • Slight male gender predilection
  • It is the most common tumor-related cause of temporal lobe epilepsy
    • Common symptoms: nausea, vomiting, headaches
    • Focal neurologic deficits
  • Associated with NF-1, NF-2, and Turcot syndrome
  • Treatment: surgical resection, ± chemoradiation for unresectable tumors
  • Prognosis: good prognosis with complete surgical resection, resolution of seizures following surgery is common

Imaging Features

  • General
    • Mixed solid-cystic, enhancing, and cortically based (cyst with mural nodule)
      • May appear entirely solid
    • Temporal lobe >> frontal and parietal lobes
    • May show calcification
    • Associated with adjacent cortical dysplasia, expansion of adjacent cortex
  • CT

    • Variable density and enhancement on contrast-enhanced CT
    • Calcification commonly present, hemorrhage rare
  • MRI

    • T1WI: iso- to hypointense relative to gray matter; ±cortical dysplasia
    • T2WI: usually hyperintense or heterogeneous; lacks adjacent edema
    • T2*/GRE/SWI: black signal blooming secondary to calcification
    • T1WI+C: moderate, heterogeneous enhancement or nonenhancing

Imaging Recommendations

  • MRI with contrast, include coronal T2WI/STIR and coronal FLAIR for temporal lobe evaluation

For more information, please see the corresponding chapter in Radiopaedia.

Contributor: Rachel Seltman, MD

DOI: https://doi.org/10.18791/nsatlas.v1.03.01.16

References

Im SH, et al. Supratentorial ganglioglioma and epilepsy: postoperative seizure outcome. J Neurooncol. 2002;57:59-66.

Kwon JW, Kim IO, Cheon JE, et al. Cerebellopontine angle ganglioglioma: MR findings. AJNR Am J Neuroradiol. 2001;22: 1377-1379.

Louis DN, et al. Ganglioma and gangliocytoma. WHO Classification of Tumours of the Central Nervous System. Lyon: IARC Press. 2007;103-105.

Osborn AG, Salzman KL, Jhaveri MD. Diagnostic Imaging (3rd ed). Philadelphia, PA: Elsevier, 2016.

Provenzale JM, Ali U, Barboriak DP, et al. Comparison of patient age with MR imaging features of gangliogliomas. AJR Am J Roentgenol. 2000;174: 859-862.

Urbach H. MRI of long-term epilepsy-associated tumors. Semin Ultrasound CT MR. 2008;29:40-46.

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