Dorn Spinal Therapy
1. Barkovich AJ. Pediatric Neuroimaging. 4rd Ed. Philadelphia: Lippincott, Williams and Wilkins, 2005.
2. Castillo M. Neuroradiology Companion. 2nd Ed. Philadelphia: Lippincott, Williams and Wilkins, 1998.
3. Fischbein NJ, Dillon WP, Barkovich AJ. Teaching Atlas of Brain Imaging. New York: Thieme, 2000.
4. Gean AD. Imaging of Head Trauma. New York: Raven, 1994.
Mass |
Location |
Imaging Appearance |
Other Features |
Figures |
Arachnoid cyst |
Posterior fossa Sylvian fissure Middle cranial fossa Suprasellar region |
Homogeneous, isodense and isointense to CSF No enhancement Mass effect may be present Longstanding cysts cause bone remodeling |
Non-neoplastic |
14 |
Choroid plexus tumors |
Intraventricular, along choroid plexus; most commonly in ventricular trigone |
Lobulated mass Intense enhancement Papilloma: iso- or hyperdense, and T1 -isointense and JT2 SI Carcinoma: heterogeneous; invade parenchyma and cause edema Hydrocephalus |
Feeding vessels often visible on post-contrast sequences |
15 |
Epidermoid |
Most commonly in CP angle, pineal region, suprasellar region and middle cranial fossa |
Hypodense, lobulated mass T1 and T2-isointense to CSF Hyperintense on FLAIR and DWI No enhancement |
Rupture can lead to chemical meningitis | |
Dermoid |
Often midline Most commonly in vermis, fourth ventricle, or pineal region |
Fat-density mass Heterogeneous T1 and T2 SI |T1 SI related to fat elements, which become hypointense on fat saturated sequences. No enhancement |
If midline, evaluate for dermal sinus tract Rupture can lead to chemical meningitis |
f = increased; J = decreased; CP = cerebellopontine; CSF = cerebrospinal fluid; DWI = diffusion-weighted imaging; FLAIR = attenuated inversion recovery; SI = signal intensity
Table 8. Continued
Mass
Location
Imaging Appearance
Meningioma
Schwannoma
Teratoma
Along dura, including talx and tentorium
Along cranial nerves, most commonly the 8th cranial nerve
Pineal region Third ventricle Midline posterior tossa
Isodense; lso-T1 and |T2 Homogeneous enhancement
Frequently have characteristic "tail" of dural thickening and enhancement Iso- or hypodense mass T1 -isointense and |T2 SI Prominent enhancement Large tumors can have cystic degeneration Enlarged neural foramina, e.g., internal auditory canal in vestibular schwannomas
Heterogenous mass with fat and calcium Heterogeneous T1 and T2 SI; |T1 SI due to fat Variable enhancement
Very rare in children
Associated with NF2
Bilateral tumors associated with NF2
Most are benign, but few can be highly malignant
f = increased;NF2 = neurofibromatosis type ; SI = signal intensity
Figure 15. Choroid plexus papilloma in the fourth ventricle. Noncommun-icating hydrocephalus with dilation of the temporal horns of the lateral ventricles. (transaxial T1-WI with contrast)
Table 9. Posterior fossa tumors
Tumor Type Location Imaging Appearance Other Features Figures
Table 9. Posterior fossa tumors
Tumor Type Location Imaging Appearance Other Features Figures
Astrocytoma |
Cerebellum, 40% |
Juvenile pilocytic astrocytomas (JPA): cyst with enhancing |
Most common pediatric |
18 |
Cerebrum, 40% |
mural nodule(s), or solid enhancing mass |
brain tumor | ||
Brainstem, 20% |
Higher grade astrocytomas are more heterogeneous and mixed |
Most cerebellar | ||
in density and enhancement; can be cystic and necrotic |
astrocytomas are JPA | |||
Atypical |
Cerebellum |
Mimics medulloblastoma mixed ependymoma |
Earlier age of presentation |
19 |
teratoid / |
Less commonly, in |
Variable pattern of enhancement |
(<2 years) than | |
rhabdoid |
cerebrum, pineal |
medulloblastoma | ||
tumor |
region mixed |
(~6 years) | ||
hypothalamus |
Poor prognosis | |||
Brainstem |
Pons |
Hypodense mass |
Differential diagnosis: |
20 |
glioma, |
Diffuse: >50% maximum |
|T1 and ]J2 SI |
abscess, encephalitis, | |
diffuse |
involvement of |
Heterogeneous enhancement |
demyelination, | |
brainstem in transaxial |
Expands brainstem and can be exophytic |
Langerhans' cell | ||
plane |
Hydrocephalus with obstruction of aqueduct or fourth |
histiocytosis, vascular | ||
ventricle |
malformation | |||
Brainstem |
Medulla, tectum |
Medullary tumors usually enhance uniformly |
Medullary tumors are |
21 |
glioma, |
Focal: <50% brainstem |
Tectal gliomas are discrete, do not enhance, present with |
usually JPA | |
tocal |
involvement, margins |
hydrocephalus |
Tectal gliomas are | |
usually well defined |
grade I |
Î = increased; J = decreased; SI = signal intensity
Î = increased; J = decreased; SI = signal intensity
Tumor Type |
Location |
Imaging Appearance |
Other Features |
Figures |
Ependymoma |
Int'ratentorial, 70% Supratentorial, 30% |
Iso- or hyperdense mass JT1 and heterogeneous T2 SI Enhancement Frequent calcification and cysts Hydrocephalus |
Commonly involve floor of the fourth ventricle and extend into foramina of Luschka and Magendie Can present with subarachnoid seeding |
22 |
Hemangio-blastoma |
Cerebellum or brainstem |
Enhancing nodule with associated flow voids and frequently a nonenhancing cystic component |
Associated with von Hippel-Lindau disease |
23 |
Medullo-blastoma (Posterior tossa PNET) |
Vermis and roof of fourth ventricle, vermis in children Cerebellar hemispheres in adolescents |
Hyperdense, heterogeneous mass JT1 and iso- or JT2 SI Can either enhance or not Occasional calcification Hydrocephalus |
Most common pediatric posterior fossa tumor Spread through the subarachnoid space |
24 |
f = increased; J = decreased; PNET = primitive neuroectodermal tumor; SI = signal intensity f = increased; J = decreased; PNET = primitive neuroectodermal tumor; SI = signal intensity
Table 10. Supratentorial intra-axial tumors
Tumor Type
Location
Imaging Appearance
Other Features
Figures
Astrocytoma
Ependymoma
Dysembryoplastic neuroepithelial tumor (DNET)
Ganglioglioma
Cerebrum, 40% Cerebellum, 40% Brainstem, 20%
Juxtaventricular, off midline Frontal > parietal > temporal lobes
Cortical; frontal > temporal lobes » remainder of cerebrum
Peripheral cerebrum, temporal lobes
Oligodendroglioma Frontal > temporal lobes
Primitive neuroectodermal tumor (PNET)
Cerebrum or in lateral ventricle
Intra-axial mass with J,T1 and fT2 SI Variable enhancement
Higher grade astrocytomas are more heterogeneous and have varying patterns of enhancement Can have cystic and necrotic components JPA: cyst with enhancing mural nodule(s), or solid enhancing mass Iso- or hyperdense mass J,T1 and heterogeneous T2 SI Enhancement
Frequent calcification and cysts
Well-defined lobulated mass
Hypodense
JT1 and fT2 SI
Can be partially cystic
Variable enhancement
Frequent calcification
Iso- or hypodense
Variable T1 and fT2 SI
Variable enhancement
Minimal mass effect and edema
Frequent calcification and cysts
Iso- or hypodense
JT1 and fT2 SI
Variable enhancement
Large well-defined homogeneous or heterogeneous mass
Hyperdense solid components
Variable T1 and T2 SI
Heterogeneous enhancement
Frequent calcification, cysts and necrosis
Most common 25
pediatric brain tumor
Usually are close to ependymal surface CSF metastases are common Benign histology Seizures
Can be adjacent to cortical dysplasia
Rare, slow growing 26
Seizures Associated with mesiotemporal sclerosis Rare, slow growing Seizures
Rare; usually occur 27
<5 years age CSF and distant metastases possible f = increased; J = decreased; CSF = cerebrospinal fluid; JPA = juvenile pilocytic astrocytoma; SI = signal intensity fk * W
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