CLINICAL IMAGAGINGAN ATLAS OF DIFFERENTIAL DAIGNOSISEISENBERG

1. 13Cerebellar Masses on
Magnetic Resonance Imaging

2. CLINICAL IMAGAGING
AN ATLAS OF DIFFERENTIAL DAIGNOSIS
EISENBERG
DR. Muhammad Bin Zulfiqar
PGR-FCPS III SIMS/SHL

3. • Fig SK 13-1 Cystic astrocytoma. (A) Sagittal T1-weighted
image shows a large cerebellar vermian cyst containing
fluid that is more intense than the dilated third ventricle.
There is a central nodule of decreased intensity relative to
the cerebellum. (B) On the axial T2-weighted image, the
cyst fluid is markedly hyperintense. The central nodule has
a somewhat lesser signal intensity.24

4. • Fig SK 13-2 Cystic medulloblastoma. (A) Sagittal T1-
weighted image demonstrates a mottled but
predominantly hypointense cerebellar vermian lesion
compressing the roof of the fourth ventricle. (B) Axial
T2-weighted image shows the solid portion of the
tumor to be hyperintense, whereas the cystic-necrotic
component has an even more marked hyperintensity.24

5. • Fig SK 13-3 Ependymoma. (A) Sagittal T1-
weighted image shows a large hypointense mass
(arrows) in an expanded fourth ventricle. (B) Axial
T2-weighted image shows the markedly
heterogeneous quality of the mass. Note the
extension of peritumoral edema into the adjacent
cerebellar hemisphere.

6. • Fig SK 13-4 Hemangioblastoma. (A) Axial
postcontrast T1-weighted image shows a mostly
cystic left cerebellar lesion with a small nodule
(arrow) of enhancement. (B) In another patient, a
coronal scan shows a solid and enhancing
hemangioblastoma in the left cerebellum.6

7. • Fig SK 13-5 Cystic hemangioblastoma. Axial T1-
weighted scan demonstrates a large cystic mass within
the left cerebellar hemisphere. The cyst is markedly
hypointense and well marginated and has a nodular
component along its medial aspect. Note the virtually
pathognomonic appearance of large arteries feeding
the solid component of this cystic lesion.24

8. • Fig SK 13-6 Metastasis. Coronal MR scan after
gadolinium administration shows an
enhancing right cerebellar lesion with a
pronounced mass effect on midline structures.

9. • Fig SK 13-7 Infarction in the territory of the right
posterior inferior cerebellar artery. The well-
defined lesion is hypointense on the coronal T1-
weighted image (A) and hyperintense on the axial
T2-weighted scan (B).

10. • Fig SK 13-8 Infarction in the territory of the
left posterior inferior cerebellar artery.
Parasagittal T1-weighted image shows
hypointensity of the entire lower half of the
cerebellar hemisphere on that side.

11. • Fig SK 13-9 Resolving hemorrhage. The right
cerebellar mass consists of hyperintense
methemoglobin surrounded by a thin,
hypointense rim of hemosiderin.