Neuroimaging features of angiocentric glioma: A case series and systematic review

BACKGROUND AND PURPOSE: Angiocentric gliomas (AGs) are epileptogenic low‐grade gliomas in young patients. We aimed to investigate the MRI findings of AGs and systematically review previous publications and three new cases. METHODS: We searched PubMed, Elsevier's abstract and citation database, and Embase databases and included 50 patients with pathologically proven AGs with analyzable preoperative MRI including 3 patients from our institution and 47 patients from 38 publications (median age, 13 years [range, 2‐83 years]; 35 men). Two board‐certified radiologists reviewed all images. The relationships between seizure/epilepsy history and MRI findings were statistically analyzed. Moreover, clinical and imaging differences were evaluated between supratentorial and brainstem AGs. RESULTS: Intratumoral T1‐weighted high‐intensity areas, stalk‐like signs, and regional brain parenchymal atrophy were observed in 23 out of 50 (46.0%), 10 out of 50 (20.0%), and 14 out of 50 (28.0%) patients, respectively. Intratumoral T1‐weighted high‐intensity areas were observed significantly more frequently in patients with stalk‐like signs (positive, 9/10 vs. negative, 14/40, p = .0031) and regional atrophy (13/14 vs. 10/36, p = .0001). There were significant relationships between the length of seizure/epilepsy history and presence of intratumoral T1‐weighted high‐intensity area (median 3 years vs. 0.5 years, p = .0021), stalk‐like sign (13.5 vs. 1 year, p < .0001), and regional atrophy (14 vs. 0.5 years, p < .0001). Patients with brainstem AGs (n = 7) did not have a seizure/epilepsy history and were significantly younger than those with supratentorial AGs (median, 5 vs. 13 years, p < .0001, respectively). CONCLUSIONS: Intratumoral T1‐weighted high‐intensity areas, stalk‐like signs, and regional brain atrophy were frequent imaging features in AG. We also found that affected age was different between supratentorial and brainstem AGs.