Computed Tomography
Contrast-enhanced computed tomography scan in a 50-year-old man. This image reveals recurrence of a frontal oligodendroglioma in the right basal ganglia that was excised 6 years earlier.
Computed tomography scan of a low-grade oligodendroglioma. (Same patient as in the 3 MRI Images that follow.) This image reveals a well-demarcated, left frontal hypoattenuating lesion with a small calcification.
Computed tomography scan of a low-grade oligodendroglioma. This image shows left frontal hypoattenuation that mainly involves the white matter.
Computed tomography scan of a low-grade oligodendroglioma. (Same patient as in the angiograph below.) This image shows hypoattenuation of the left frontal lobe without contrast enhancement.
Findings
Oligodendrogliomas are the brain tumors with the highest frequency of calcification. CT scanning must be performed before and after the injection of contrast material to avoid missing the presence of calcifications. Typically, a round or oval, well-limited, and fairly large peripheral lesion is revealed. The tumor matrix is either hypoattenuating or isoattenuating and occasionally hyperattenuating because of tumoral hemorrhage or calcification.
Calvarial erosion in association with slow-growing, peripherally located oligodendrogliomas is occasionally noted. Calvarial erosion also appears to be independent of the tumor grade. Contrast enhancement is sometimes difficult to visualize because of the presence of calcification.
Degree of Confidence
Tumoral calcification, seen in approximately 40% of patients, is better defined on CT scans than on MRIs. It seems to have no direct correlation with the tumor grade.
Magnetic Resonance Imaging
Computed tomography scan of a low-grade oligodendroglioma. (Same patient as in the 3 MRI Images that follow.) This image reveals a well-demarcated, left frontal hypoattenuating lesion with a small calcification.
Axial fluid-attenuated inversion recovery magnetic resonance of a low-grade oligodendroglioma (same patient as in Image above and 2 Images that follow). This image shows heterogeneous high signal intensity in the left frontal lobe.
Axial T1-weighted magnetic resonance image of a low-grade oligodendroglioma (same patient as in the 2 Images above and the Image below). This image shows heterogeneous low signal intensity in the left frontal lobe that involves the cortex and white matter. Note the mass effect on the cortical sulci.
Sagittal gadolinium-enhanced T1-weighted magnetic resonance image of a low-grade oligodendroglioma (same patient as in the 3 Images above). This image demonstrates no contrast enhancement.
Findings
Oligodendrogliomas do not behave specifically; they are usually heterogeneous but have a relatively low intensity on T1-weighted sequences and a high intensity on T2-weighted sequences. Peritumoral edema is nicely depicted with T2-weighted sequences and with fluid-attenuated inversion recovery sequences, which are sensitive, but surrounding vasogenic edema is not common in oligodendrogliomas. Perifocal edema is less often observed in low-grade oligodendrogliomas. Small cystic-appearing regions and hemorrhage are commonly found in the mass.19
Contrast enhancement is better seen with MRI than with CT scanning,20,21,22,23 especially with magnetization-transfer, T1-weighted spin-echo MRI sequences after gadolinium enhancement. The importance of contrast enhancement for the prognosis of these tumors has been emphasized, as it seems to be the strongest negative factor affecting survival. Because the detection of contrast enhancement is of paramount importance, postcontrast MRI should always be performed; however, it appears that the presence or absence of contrast enhancement is not a specific finding for simply discriminating low-grade from anaplastic oligodendrogliomas.21
MR spectroscopy is a new technique to the field that provides spatially encoded chemical information for normal and tumoral tissue in selected regions of the brain. This technique is a safe, noninvasive means of performing biochemical analyses in vivo.
MR diffusion imaging can also be contributive: lower apparent diffusion coefficient (ADC) values that are indicative of water restriction are noted in high-grade tumors compared with the higher ADC values that are seen in low-grade tumors.
MR perfusion imaging is a noninvasive method of assessing the tumor microvasculature.
Such perfusion imaging has been used to calculate the perfusion parameters in gliomas, guide biopsies, provide prognostic information, and demonstrate differences in the vascularity of low-grade astrocytomas and oligodendrogliomas.
Increased vascular density is apparently seen in both low-grade and high-grade oligodendrogliomas. That pattern is in contrast to the pattern noted in fibrillary astrocytomas, for which microvascular proliferation is seen in only the higher-grade tumors.
Perfusion MR results (regional cerebral blood volume [rCBV] measurements) correlate with histologic differences in the tumor vasculature between low-grade oligodendrogliomas and astrocytomas. Low-grade oligodendrogliomas are more vascular than astrocytomas on both histologic evaluation and perfusion MR. Thus, perfusion MR is useful for improving the specificity of the diagnosis of grade II oligodendrogliomas and grade II astrocytomas.
Gadolinium-based contrast agents (gadopentetate dimeglumine [Magnevist], gadobenate dimeglumine [MultiHance], gadodiamide [Omniscan], gadoversetamide [OptiMARK], gadoteridol [ProHance]) have been linked to the development of nephrogenic systemic fibrosis (NSF) or nephrogenic fibrosing dermopathy (NFD). For more information, see the eMedicine topic Nephrogenic Fibrosing Dermopathy. The disease has occurred in patients with moderate to end-stage renal disease after being given a gadolinium-based contrast agent to enhance MRI or MRA scans.
NSF/NFD is a debilitating and sometimes fatal disease. Characteristics include red or dark patches on the skin; burning, itching, swelling, hardening, and tightening of the skin; yellow spots on the whites of the eyes; joint stiffness with trouble moving or straightening the arms, hands, legs, or feet; pain deep in the hip bones or ribs; and muscle weakness. For more information, see the FDA Public Health Advisory or Medscape.
Degree of Confidence
The oligodendroglioma anatomic situation and tumoral limits are better defined on MRI than on CT scanning. A large proportion of oligodendrogliomas is peripherally situated, and the tumor usually involves the whole thickness of the cortex. MRI is particularly reliable for appreciating cortical involvement. The frontal lobes are most often involved, followed by the temporal, parietal, and occipital lobes.
Occasionally, stereotactic biopsy is performed outside of the area of contrast enhancement, leading to a falsely reassuring diagnosis (ie, low-grade oligodendroglioma). The visualization of such a contrast enhancement on MRI modifies the grading of the tumor, which becomes anaplastic. Gradient-echo sequences are highly sensitive to calcification and therefore are a useful adjunct.
False Positives/Negatives
High-grade oligodendrogliomas may be difficult to differentiate from the more frequent glioblastoma multiforme. However, the presence of tumor calcification, a peripheral location, and the sometimes associated calvarial erosion may indicate an oligodendroglioma.
The most difficult lesion to differentiate is the astrocytoma that appears as a hypoattenuating, nonenhancing mass on CT scans. However, these astrocytic tumors tend to be deeper in location, extend along the fiber tracts, and usually lack calcification.
Two other conditions that must be considered in the differential diagnosis are (1) dysembryoplastic neuroepithelial tumor (partial seizures beginning before age 20 y, nonneurologic deficit, cortical tumoral topography on MRI) and (2) central neurocytoma (midline tumor). Immunomarkers and electron microscopy may help in the definitive diagnosis.
Angiography
Computed tomography scan of a low-grade oligodendroglioma. (Same patient as in the angiograph below.) This image shows hypoattenuation of the left frontal lobe without contrast enhancement.
Lateral carotid angiograph of a low-grade oligodendroglioma (same patient as in the Image above). This image shows a vascular void due to the tumor.
Findings
The most frequent finding with angiography is a vascular void (see Images above and Image 22 in Multimedia). A slight hypervascularization that is suggestive of malignant transformation is seldom seen.
More on Oligodendroglioma |
| Overview: Oligodendroglioma |
 Imaging: Oligodendroglioma |
| Multimedia: Oligodendroglioma |
| References |
| Further Reading |
| « Previous Page | Next Page » |
References
Blakeley J, Grossman S. Anaplastic oligodendroglioma. Curr Treat Options Neurol. Jul 2008;10(4):295-307. [Medline].
Zustovich F, Della Puppa A, Scienza R, Anselmi P, Furlan C, Cartei G. Metastatic oligodendrogliomas: a review of the literature and case report. Acta Neurochir (Wien). Jul 2008;150(7):699-702; discussion 702-3. [Medline].
Bailey P, Hiller G. The interstitial tissues of the central nervous system: a review. J Nerv Ment Dis. 1924;59:337-61.
Bailey P, Cushing H. A Classification of the Tumors of the Glioma Group on a Histogenetic Basis With a Correlated Study of Prognosis. Philadelphia, Pa: J.B. Lippincott; 1926:105-65.
Bailey P, Bucy PC. Oligodendrogliomas of the brain. J Pathol Bacteriol. 1929;32:735-51.
Central Brain Tumor Registry of the United States (CBTRUS). Statistical Report: Primary Brain Tumors in the United States, 1998-2002. Hinsdale, Ill: CBTRUS; 2005-2006:19, 34. [Full Text].
Jenkinson MD, Smith TS, Joyce KA, et al. Cerebral blood volume, genotype and chemosensitivity in oligodendroglial tumours. Neuroradiology. Oct 2006;48(10):703-13. [Medline]. [Full Text].
Koeller KK, Rushing EJ. From the archives of the AFIP: Oligodendroglioma and its variants: radiologic-pathologic correlation. Radiographics. Nov-Dec 2005;25(6):1669-88. [Medline]. [Full Text].
Stege EM, Kros JM, de Bruin HG, et al. Successful treatment of low-grade oligodendroglial tumors with a chemotherapy regimen of procarbazine, lomustine, and vincristine. Cancer. Feb 15 2005;103(4):802-9. [Medline].
Thiessen B, Maguire JA, McNeil K, et al. Loss of heterozygosity for loci on chromosome arms 1p and 10q in oligodendroglial tumors: relationship to outcome and chemosensitivity. J Neurooncol. Sep 2003;64(3):271-8. [Medline].
Packer RJ, Sutton LN, Rorke LB, et al. Oligodendroglioma of the posterior fossa in childhood. Cancer. Jul 1 1985;56(1):195-9. [Medline].
Daumas-Duport C, Beuvon F, Varlet P, Fallet-Bianco C. [Gliomas: WHO and Sainte-Anne Hospital classifications]. [French]. Ann Pathol. Oct 2000;20(5):413-28. [Medline].
Daumas-Duport C, Varlet P, Tucker ML, et al. Oligodendrogliomas. Part I: Patterns of growth, histological diagnosis, clinical and imaging correlations: a study of 153 cases. J Neurooncol. Aug 1997;34(1):37-59. [Medline].
Daumas-Duport C, Tucker ML, Kolles H, et al. Oligodendrogliomas. Part II: A new grading system based on morphological and imaging criteria. J Neurooncol. Aug 1997;34(1):61-78. [Medline].
Abrey LE, Louis DN, Paleologos N, et al. Survey of treatment recommendations for anaplastic oligodendroglioma. Neuro Oncol. Jul 2007;9(3):314-8. [Medline].
Hottinger AF, Stupp R. [Therapeutic strategies for the management of gliomas]. Rev Neurol (Paris). Jun-Jul 2008;164(6-7):523-30. [Medline].
Margain D, Peretti-Viton P, Perez-Castillo AM, Martini P, Salamon G. Oligodendrogliomas. J Neuroradiol. 1991;18(2):153-60. [Medline].
Kawai N, Kagawa M, Hatakeyama T, Tamiya T, Noshiyama Y, Yamamoto Y, et al. [11C-methionine positron emission tomography in brain tumor]. No Shinkei Geka. Oct 2008;36(10):847-59. [Medline].
Brown R, Zlatescu M, Sijben A, Roldan G, Easaw J, Forsyth P, et al. The use of magnetic resonance imaging to noninvasively detect genetic signatures in oligodendroglioma. Clin Cancer Res. Apr 15 2008;14(8):2357-62. [Medline].
Cha S, Tihan T, Crawford F, et al. Differentiation of low-grade oligodendrogliomas from low-grade astrocytomas by using quantitative blood-volume measurements derived from dynamic susceptibility contrast-enhanced MR imaging. AJNR Am J Neuroradiol. Feb 2005;26(2):266-73. [Medline]. [Full Text].
White ML, Zhang Y, Kirby P, Ryken TC. Can tumor contrast enhancement be used as a criterion for differentiating tumor grades of oligodendrogliomas?. AJNR Am J Neuroradiol. Apr 2005;26(4):784-90. [Medline]. [Full Text].
Peretti-Viton P, Taieb D, Viton JM, et al. Contrast-enhanced magnetisation transfer MRI in metastatic lesions of the brain. Neuroradiology. Dec 1998;40(12):783-7. [Medline].
Jäger HR, Waldman AD, Benton C, Fox N, Rees J. Differential chemosensitivity of tumor components in a malignant oligodendroglioma: assessment with diffusion-weighted, perfusion-weighted, and serial volumetric MR imaging. AJNR Am J Neuroradiol. Feb 2005;26(2):274-8. [Medline]. [Full Text].
Albert FK, Forsting M, Sartor K, Adams HP, Kunze S. Early postoperative magnetic resonance imaging after resection of malignant glioma: objective evaluation of residual tumor and its influence on regrowth and prognosis. Neurosurgery. Jan 1994;34(1):45-60; discussion 60-1. [Medline].
Bullard DE, Rawlings CE 3rd, Phillips B, et al. Oligodendroglioma. An analysis of the value of radiation therapy. Cancer. Nov 1 1987;60(9):2179-88. [Medline].
Burger PC. Revising the World Health Organization (WHO) Blue Book--'Histological typing of tumours of the central nervous system'. J Neurooncol. 1995;24(1):3-7. [Medline].
Cairncross JG, Macdonald DR. Successful chemotherapy for recurrent malignant oligodendroglioma. Ann Neurol. Apr 1988;23(4):360-4. [Medline].
Cairncross JG, Ueki K, Zlatescu MC, et al. Specific genetic predictors of chemotherapeutic response and survival in patients with anaplastic oligodendrogliomas. J Natl Cancer Inst. Oct 7 1998;90(19):1473-9. [Medline].
Celli P, Nofrone I, Palma L, Cantore G, Fortuna A. Cerebral oligodendroglioma: prognostic factors and life history. Neurosurgery. Dec 1994;35(6):1018-34; discussion 1034-5. [Medline].
Chin HW, Hazel JJ, Kim TH, Webster JH. Oligodendrogliomas. I. A clinical study of cerebral oligodendrogliomas. Cancer. Mar 15 1980;45(6):1458-66. [Medline].
Couldwell WT, Hinton DR. Oligodendroglioma. In: Kaye AH, Laws ER Jr, ed. Brain Tumors: an Encyclopedic Approach. New York, NY: Churchill Livingstone; 1995:479-91.
Daumas-Duport C, Scheithauer B, O'Fallon J, Kelly P. Grading of astrocytomas. A simple and reproducible method. Cancer. Nov 15 1988;62(10):2152-65. [Medline].
Gonzales MF. Classification and pathogenesis of brain tumors. In: Kaye AH and Laws ER Jr, eds. Brain Tumors: an Encyclopedic Approach. New York, NY: Churchill Livingstone; 1995:31-42.
Kleihues P, Burger PC, Scheithauer BW. The new WHO classification of brain tumours. Brain Pathol. Jul 1993;3(3):255-68. [Medline].
Kros JM. Oligodendrogliomas: clinicopathological correlations. J Neurooncol. 1995;24(1):29-31. [Medline].
Lee YY, Van Tassel P. Intracranial oligodendrogliomas: imaging findings in 35 untreated cases. AJR Am J Roentgenol. Feb 1989;152(2):361-9. [Medline]. [Full Text].
Lindegaard KF, Mørk SJ, Eide GE, et al. Statistical analysis of clinicopathological features, radiotherapy, and survival in 170 cases of oligodendroglioma. J Neurosurg. Aug 1987;67(2):224-30. [Medline].
Preul MC, Caramanos Z, Villemure JG, et al. Using proton magnetic resonance spectroscopic imaging to predict in vivo the response of recurrent malignant gliomas to tamoxifen chemotherapy. Neurosurgery. Feb 2000;46(2):306-18. [Medline].
Shimizu KT, Tran LM, Mark RJ, Selch MT. Management of oligodendrogliomas. Radiology. Feb 1993;186(2):569-72. [Medline].
Tice H, Barnes PD, Goumnerova L, Scott RM, Tarbell NJ. Pediatric and adolescent oligodendrogliomas. AJNR Am J Neuroradiol. Nov-Dec 1993;14(6):1293-300. [Medline].
Viader F, Derlon JM, Petit-Taboué MC, et al. Recurrent oligodendroglioma diagnosed with 11C-L-methionine and PET: a case report. Eur Neurol. 1993;33(3):248-51. [Medline].
Further Reading
Related eMedicine topics:
Oligodendroglioma (from Neurology)
Neoplasms, Brain
Brain, Metastases
Brainstem Gliomas
EEG in Brain Tumors
Keywords
oligodendroglioma, oligodendroglial cells, oligodendrocyte, oligodendroglial tumor cells, cerebral oligodendroglioma, oligodendroglia, intramedullary oligodendrogliomas, primary leptomeningeal oligodendrogliomas, Kernohan grading system, Smith grading system, Ringertz grading system, Saint Anne/Mayo (St. Anne-Mayo) grading system, Daumas-Duport grading system
