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Clinical brain tumor of MRIClinical brain tumor of MRI
放射診斷科孫柏齡
2007.04.202007.04.20
地點地點 :: 放射診斷科討論室放射診斷科討論室
Case 1Case 1
 Clinical History:Clinical History:
 17-year-old female with a clinical17-year-old female with a clinical
s...
Your diagnosis isYour diagnosis is
Radiologic Findings:Radiologic Findings:
 A T1W image (Fig. 1) shows a hypointense,A T1W image (Fig. 1) shows a hypointen...
Diagnosis:Diagnosis:
 Juvenile pilocytic astrocytoma.Juvenile pilocytic astrocytoma.
Discussion:Discussion:
 Cerebellar juvenile pilocytic astrocytomas are the mostCerebellar juvenile pilocytic astrocytomas...
Case 2Case 2
 Clinical History:Clinical History:
 3-year-old presents with headache and3-year-old presents with headache...
Your Diagnosis is?Your Diagnosis is?
Diagnosis:Diagnosis:
 Ependymoma.Ependymoma.
Findings:Findings:
 Axial CT image demonstrates a right cerebellar andAxial CT image demonstrates a right cerebellar and
...
Discussion:Discussion:
 Ependymomas are the third most common brain tumor in childrenEpendymomas are the third most commo...
Case 3Case 3
 History:History:
 10-year-old presented with 10 days of10-year-old presented with 10 days of
vomiting, uns...
Your diagnosis isYour diagnosis is
Diagnosis:Diagnosis:
 Medulloblastoma (PNET).Medulloblastoma (PNET).
Findings:Findings:
 A sagittal noncontrast T1W image (Image 1) reveals aA sagittal noncontrast T1W image (Image 1) reveal...
Discussion:Discussion:
 Medulloblastoma represents about 25% of childhoodMedulloblastoma represents about 25% of childhoo...
MedulloblastomaMedulloblastoma EpendymomaEpendymoma AstrocytomaAstrocytoma
Unenhanced CTUnenhanced CT HyperHyper IsoIso Hy...
TESTTEST
 What is the most common infratentorialWhat is the most common infratentorial
neoplasm in the pediatric age grou...
Q&AQ&A
1. 請問 Medulloblastoma 、 Ependymoma 、 Astrocytoma 在
CT 上表現特徵差異為何 ?
答 : Medulloblastoma 由於密度比較高,所以 CT 表象比較亮
Clinical brain tumor of MRI
Clinical brain tumor of MRI
Clinical brain tumor of MRI
Clinical brain tumor of MRI
Clinical brain tumor of MRI
Clinical brain tumor of MRI
Clinical brain tumor of MRI
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Clinical brain tumor of MRI

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  1. 1. Clinical brain tumor of MRIClinical brain tumor of MRI 放射診斷科孫柏齡 2007.04.202007.04.20 地點地點 :: 放射診斷科討論室放射診斷科討論室
  2. 2. Case 1Case 1  Clinical History:Clinical History:  17-year-old female with a clinical17-year-old female with a clinical suspicion of cerebellar mass.suspicion of cerebellar mass.
  3. 3. Your diagnosis isYour diagnosis is
  4. 4. Radiologic Findings:Radiologic Findings:  A T1W image (Fig. 1) shows a hypointense,A T1W image (Fig. 1) shows a hypointense, approximately 7cm x 4cm mass in the right cerebellarapproximately 7cm x 4cm mass in the right cerebellar hemisphere, with a moderate amount of mass effect onhemisphere, with a moderate amount of mass effect on the 4th ventricle and cerebellum.the 4th ventricle and cerebellum.  The mass is hyperintense on the T2W image (Fig. 3).The mass is hyperintense on the T2W image (Fig. 3).  The cystic portion of the mass has signal intensity similarThe cystic portion of the mass has signal intensity similar to CSF on the T1W images and T2W images, but isto CSF on the T1W images and T2W images, but is hyperintense to CSF on the proton density weightedhyperintense to CSF on the proton density weighted image (Fig. 2) due to increased protein content.image (Fig. 2) due to increased protein content.  Following Gadolinium administration, T1W images (Fig.Following Gadolinium administration, T1W images (Fig. 4-6) show intense homogeneous enhancement of a4-6) show intense homogeneous enhancement of a mural nodule in the superior aspect of the mass.mural nodule in the superior aspect of the mass.  Although septations within the mass show faintAlthough septations within the mass show faint enhancement, the cystic portion of the mass does notenhancement, the cystic portion of the mass does not show enhancement.show enhancement.
  5. 5. Diagnosis:Diagnosis:  Juvenile pilocytic astrocytoma.Juvenile pilocytic astrocytoma.
  6. 6. Discussion:Discussion:  Cerebellar juvenile pilocytic astrocytomas are the mostCerebellar juvenile pilocytic astrocytomas are the most common infratentorial neoplasm in the pediatric agecommon infratentorial neoplasm in the pediatric age group.group.  Although they commonly form well-defined lobularAlthough they commonly form well-defined lobular masses which contain cysts and a vascular muralmasses which contain cysts and a vascular mural nodule, they may occasionally present a solid massnodule, they may occasionally present a solid mass without a cystic component and may simulate otherwithout a cystic component and may simulate other pediatric posterior fossa masses.pediatric posterior fossa masses.  They have an increased incidence in type IThey have an increased incidence in type I neurofibromatosis.neurofibromatosis.  They have an excellent prognosis following completeThey have an excellent prognosis following complete resection.resection.  The differential diagnosis includes medulloblastoma andThe differential diagnosis includes medulloblastoma and ependymoma in a child.ependymoma in a child.
  7. 7. Case 2Case 2  Clinical History:Clinical History:  3-year-old presents with headache and3-year-old presents with headache and ataxia.ataxia.
  8. 8. Your Diagnosis is?Your Diagnosis is?
  9. 9. Diagnosis:Diagnosis:  Ependymoma.Ependymoma.
  10. 10. Findings:Findings:  Axial CT image demonstrates a right cerebellar andAxial CT image demonstrates a right cerebellar and fourth ventricle mass which is somewhat higher infourth ventricle mass which is somewhat higher in attenuation than the remaining brain parenchyma.attenuation than the remaining brain parenchyma.  In addition, there is marked dilatation of the temporalIn addition, there is marked dilatation of the temporal horns indicating hydrocephalus.horns indicating hydrocephalus.  Axial T1 and T2 weighted images as well as a sagittalAxial T1 and T2 weighted images as well as a sagittal image following the intravenous administration ofimage following the intravenous administration of contrast demonstrates an approximately 4 cm fourthcontrast demonstrates an approximately 4 cm fourth ventricular mass with probable extension toward theventricular mass with probable extension toward the outlets of the fourth ventricle.outlets of the fourth ventricle.  There is very little enhancement following theThere is very little enhancement following the intravenous administration of contrast.intravenous administration of contrast.
  11. 11. Discussion:Discussion:  Ependymomas are the third most common brain tumor in childrenEpendymomas are the third most common brain tumor in children and account for approximately 15% of posterior fossa malignancies.and account for approximately 15% of posterior fossa malignancies.  They classically arise from ependymal cells lining the fourthThey classically arise from ependymal cells lining the fourth ventricle. Commonly, the tumor expands the fourth ventricle andventricle. Commonly, the tumor expands the fourth ventricle and extends through the foramen of Magendie and through the foraminaextends through the foramen of Magendie and through the foramina of Luschka.of Luschka.  The tumors are often calcified and may demonstrate a large cysticThe tumors are often calcified and may demonstrate a large cystic component.component.  Inhomogeneous enhancement is usually seen. Because of theirInhomogeneous enhancement is usually seen. Because of their location, seeding throughout the subarachnoid space can be seen.location, seeding throughout the subarachnoid space can be seen.  Supratentorial ependymomas, however, are usually moreSupratentorial ependymomas, however, are usually more aggressive and have a poorer prognosis.aggressive and have a poorer prognosis.  As stated above, ependyomomas are the third most commonAs stated above, ependyomomas are the third most common posterior fossa tumor in childhood behind juvenile pilocyticposterior fossa tumor in childhood behind juvenile pilocytic astrocytomas and medulloblastomas.astrocytomas and medulloblastomas.
  12. 12. Case 3Case 3  History:History:  10-year-old presented with 10 days of10-year-old presented with 10 days of vomiting, unsteady gait, slurred speech,vomiting, unsteady gait, slurred speech, headache, and diplopia.headache, and diplopia.
  13. 13. Your diagnosis isYour diagnosis is
  14. 14. Diagnosis:Diagnosis:  Medulloblastoma (PNET).Medulloblastoma (PNET).
  15. 15. Findings:Findings:  A sagittal noncontrast T1W image (Image 1) reveals aA sagittal noncontrast T1W image (Image 1) reveals a mildly hypointense mass arising in the 4th ventricle withmildly hypointense mass arising in the 4th ventricle with expansion posteriorly to displace and distort the vermis.expansion posteriorly to displace and distort the vermis.  An axial T1-weighted image after contrast (Image 2)An axial T1-weighted image after contrast (Image 2) demonstrates the loss of definition of the peripheraldemonstrates the loss of definition of the peripheral borders of the enhancing 4th ventricular mass.borders of the enhancing 4th ventricular mass.  No additional abnormalities in the periventricular orNo additional abnormalities in the periventricular or subarachnoid space are identified.subarachnoid space are identified.  The mass is hyperintense to gray and white matter on anThe mass is hyperintense to gray and white matter on an axial T2-weighted image (Image 3). There is a shuntaxial T2-weighted image (Image 3). There is a shunt under the right occipitotemporal scalp.under the right occipitotemporal scalp.
  16. 16. Discussion:Discussion:  Medulloblastoma represents about 25% of childhoodMedulloblastoma represents about 25% of childhood intracranial tumors, with approximately 50% presentingintracranial tumors, with approximately 50% presenting in the first decade.in the first decade.  Medulloblastoma occurs only in the posterior fossa,Medulloblastoma occurs only in the posterior fossa, although it has been grouped with histologically similaralthough it has been grouped with histologically similar tumors arising elsewhere as a primitive neuroectodermaltumors arising elsewhere as a primitive neuroectodermal tumor (PNET).tumor (PNET).  Medulloblastoma generally involves the 4th ventricle andMedulloblastoma generally involves the 4th ventricle and vermis, with a lateral location more common in thevermis, with a lateral location more common in the desmoplastic variant and in older patients.desmoplastic variant and in older patients.  On MR, medulloblastoma involves the 4th ventricle andOn MR, medulloblastoma involves the 4th ventricle and vermis, although eccentric extension to involve thevermis, although eccentric extension to involve the cerebellar hemispheres is not rare.cerebellar hemispheres is not rare.  It is nonspecifically hypo- to isointense on T1W imagesIt is nonspecifically hypo- to isointense on T1W images and hyperintense on T2W images.and hyperintense on T2W images.
  17. 17. MedulloblastomaMedulloblastoma EpendymomaEpendymoma AstrocytomaAstrocytoma Unenhanced CTUnenhanced CT HyperHyper IsoIso HypoHypo EnhancementEnhancement ModerateModerate MininalMininal Nodule enhance, cystNodule enhance, cyst dose notdose not CalificationCalification UncommonUncommon commoncommon UncommonUncommon OriginOrigin VermisVermis 4th ventricle4th ventricle ependyomaependyoma HemisphericHemispheric T2WIT2WI IntermediateIntermediate IntermediateIntermediate BrightBright AgeAge 5-125-12 2-102-10 10-2010-20 Cyst formationCyst formation 10-20%10-20% 15%15% 60-80%60-80% ForaminalForaminal spreadspread NoNo Yes(Luschka,Yes(Luschka, Magendie)Magendie) NoNo
  18. 18. TESTTEST  What is the most common infratentorialWhat is the most common infratentorial neoplasm in the pediatric age group?neoplasm in the pediatric age group?
  19. 19. Q&AQ&A 1. 請問 Medulloblastoma 、 Ependymoma 、 Astrocytoma 在 CT 上表現特徵差異為何 ? 答 : Medulloblastoma 由於密度比較高,所以 CT 表象比較亮
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