ABSTRACT
Objective The magnetic resonance imaging (MRI) patterns of multiple gliomas are insufficiently understood because the related studies are rarely reported and mostly with small-size samples. This article summarizes the MR manifestations of multiple gliomas, analyzes their imaging features and proposes some diagnostic ideas. Methods We retrospectively reviewed 303 cases of diffuse glioma pathologically confirmed in our hospital from January 2014 to December 2018, including 240 cases of solitary (79.2%) and 63 cases of multiple gliomas (20.8%). We analyzed the MRI manifestations, summarized the MRI patterns, and investigated the differential diagnosis of multiple gliomas. Results According to the growth patterns, 4 of the 63 cases of multiple gliomas were classified as multicentric and the other 59 as multifocal glioma, and of the 59 cases of multifocal glioma, 35 spread along the white matter fiber bundle, 24 along the subependymal and small vessel space, 6 along the meningia-subarachnoid space, and 41 in a mode of direct invasion. The manifestations of cortical involvement included cortical tubers (37.2% [16/43]), multiple cortical tubers with high-intensity signals on T2WI, diffuse cortical swelling (44.2% [19/43]), frontal cortical swelling with high-intensity signals on T2FLAIR, and enhancement along the cortex (37.2% [16/43]). Interfocal heterogeneity was observed in 45 of 63 cases (71.4%). The imaging features of the lesions were classified into 5 types: metastasis (69.8%), granulomatosis (4.8%), abscess (12.7%), encephalitis (6.3%) and metabolic encephalopathy (6.3%). Conclusion The specific MRI presentations of multiple gliomas are cortical involvement and interfocal heterogeneity. The 5 MRI features of multiple gliomas may help improve the differential diagnosis of the lesions.