1) Wilhelm Roentgen discovered X-rays in 1895 and Arthur Schiiller studied skull X-rays systematically, establishing neuroradiology. 2) Advances like ventriculography and cerebral angiography in the early 20th century allowed visualization of the brain. 3) Magnetic resonance imaging was developed in the 1940s-1980s and became the preferred method for evaluating brain tumors due to its superior soft tissue contrast compared to CT.
Medulloblastoma- A primitive neuroectodermal tumors (PNETs) is the most common malignant brain tumor of childhood (WHO IV)
arising from the vermis in the inferior medullary velum.
It comprises up to 18% of all pediatric brain tumors.
WNT and Shh pathway plays major role in its pathogenesis.
c-erbB-2 (HER2/neu) oncogene expression has prognostic value. Norcantharidin, Vismodegib, Sonidegib are the future in medulloblastoma.
This document provides an overview of brain tumors, with a focus on glial tumors (gliomas). It discusses the different cell types that can give rise to gliomas and common glioma subtypes, including their incidence, associations, classifications, and radiographic features. In particular, it describes astrocytomas in depth, noting they represent 80% of gliomas. Key glioma subtypes addressed include low-grade astrocytomas, anaplastic astrocytomas, glioblastoma multiforme, brain stem gliomas, and other less common astrocytoma variants. Diagnostic imaging findings for each glioma subtype are emphasized.
Sellar, Suprasellar and Pineal tumor final pk .pptDr pradeep Kumar
this is very good presentation slide for radiologist and radiology resident. our references is authentic and most are from osborn brain imaging 2nd edition. This deal with sellar, suprasellar and pineal tumor . This help alot. thanks
This document discusses various types of intraventricular lesions that can be seen on different imaging modalities like CT and MRI. It describes the typical appearance and characteristics of common intraventricular masses like choroid plexus papilloma, astrocytoma, subependymal giant cell astrocytoma, ependymoma, meningioma, metastases and others. It also discusses vascular malformations, cysts and other rare lesions that can involve the lateral, third or fourth ventricles. Imaging findings for each type of lesion are provided along with examples of relevant images.
Pediatric brain tumors account for 20-30% of childhood cancers. Common types include astrocytomas, medulloblastomas, and choroid plexus papillomas. Imaging plays an important role in analyzing potential brain tumors. On CT, tumors may appear as hypodense lesions that enhance with contrast. On MRI, they are often hypointense on T1-weighted imaging and hyperintense on T2-weighted imaging, with variable enhancement. Location, appearance on different sequences, and effects on surrounding structures provide clues to tumor type and diagnosis.
1) Medulloblastoma is the most common malignant brain tumor in children. It arises in the cerebellum and has a tendency to metastasize through the CSF pathways.
2) It is classified into molecular subgroups - WNT, SHH, Group 3, and Group 4 - which have different characteristics and predict survival outcomes.
3) Treatment involves maximal safe surgical resection followed by craniospinal radiation and chemotherapy based on risk stratification into standard-risk and high-risk groups. Modified radiation schedules are being studied to reduce long-term side effects.
MRI imaging of brain tumors. A practical approach. hazem youssef
This document provides an overview of MRI protocols for imaging brain tumors and what each sequence reveals. It discusses how conventional sequences can identify tumors versus other lesions and provide histological information. Post-contrast T1-weighted imaging reveals enhancement patterns related to tumor angiogenesis and blood-brain barrier disruption. Perfusion MRI demonstrates neoangiogenesis which correlates with tumor grade. Susceptibility weighted imaging visualizes microvessels and intratumoral susceptibility signals associated with grading. Magnetic resonance spectroscopy identifies metabolite levels indicative of tumor type and grade. Diffusion weighted imaging correlates restricted diffusion with cellularity and tumor aggressiveness.
1) Wilhelm Roentgen discovered X-rays in 1895 and Arthur Schiiller studied skull X-rays systematically, establishing neuroradiology. 2) Advances like ventriculography and cerebral angiography in the early 20th century allowed visualization of the brain. 3) Magnetic resonance imaging was developed in the 1940s-1980s and became the preferred method for evaluating brain tumors due to its superior soft tissue contrast compared to CT.
Medulloblastoma- A primitive neuroectodermal tumors (PNETs) is the most common malignant brain tumor of childhood (WHO IV)
arising from the vermis in the inferior medullary velum.
It comprises up to 18% of all pediatric brain tumors.
WNT and Shh pathway plays major role in its pathogenesis.
c-erbB-2 (HER2/neu) oncogene expression has prognostic value. Norcantharidin, Vismodegib, Sonidegib are the future in medulloblastoma.
This document provides an overview of brain tumors, with a focus on glial tumors (gliomas). It discusses the different cell types that can give rise to gliomas and common glioma subtypes, including their incidence, associations, classifications, and radiographic features. In particular, it describes astrocytomas in depth, noting they represent 80% of gliomas. Key glioma subtypes addressed include low-grade astrocytomas, anaplastic astrocytomas, glioblastoma multiforme, brain stem gliomas, and other less common astrocytoma variants. Diagnostic imaging findings for each glioma subtype are emphasized.
Sellar, Suprasellar and Pineal tumor final pk .pptDr pradeep Kumar
this is very good presentation slide for radiologist and radiology resident. our references is authentic and most are from osborn brain imaging 2nd edition. This deal with sellar, suprasellar and pineal tumor . This help alot. thanks
This document discusses various types of intraventricular lesions that can be seen on different imaging modalities like CT and MRI. It describes the typical appearance and characteristics of common intraventricular masses like choroid plexus papilloma, astrocytoma, subependymal giant cell astrocytoma, ependymoma, meningioma, metastases and others. It also discusses vascular malformations, cysts and other rare lesions that can involve the lateral, third or fourth ventricles. Imaging findings for each type of lesion are provided along with examples of relevant images.
Pediatric brain tumors account for 20-30% of childhood cancers. Common types include astrocytomas, medulloblastomas, and choroid plexus papillomas. Imaging plays an important role in analyzing potential brain tumors. On CT, tumors may appear as hypodense lesions that enhance with contrast. On MRI, they are often hypointense on T1-weighted imaging and hyperintense on T2-weighted imaging, with variable enhancement. Location, appearance on different sequences, and effects on surrounding structures provide clues to tumor type and diagnosis.
1) Medulloblastoma is the most common malignant brain tumor in children. It arises in the cerebellum and has a tendency to metastasize through the CSF pathways.
2) It is classified into molecular subgroups - WNT, SHH, Group 3, and Group 4 - which have different characteristics and predict survival outcomes.
3) Treatment involves maximal safe surgical resection followed by craniospinal radiation and chemotherapy based on risk stratification into standard-risk and high-risk groups. Modified radiation schedules are being studied to reduce long-term side effects.
MRI imaging of brain tumors. A practical approach. hazem youssef
This document provides an overview of MRI protocols for imaging brain tumors and what each sequence reveals. It discusses how conventional sequences can identify tumors versus other lesions and provide histological information. Post-contrast T1-weighted imaging reveals enhancement patterns related to tumor angiogenesis and blood-brain barrier disruption. Perfusion MRI demonstrates neoangiogenesis which correlates with tumor grade. Susceptibility weighted imaging visualizes microvessels and intratumoral susceptibility signals associated with grading. Magnetic resonance spectroscopy identifies metabolite levels indicative of tumor type and grade. Diffusion weighted imaging correlates restricted diffusion with cellularity and tumor aggressiveness.
This document provides an overview of common pediatric brain tumors located in the posterior fossa (infratentorial region). It discusses the most frequently used MRI sequences for evaluating these tumors and provides clinical and imaging features of the most common tumor types, including medulloblastoma, ependymoma, pilocytic astrocytoma, and brainstem glioma. Differential diagnoses are also reviewed. Key sequences discussed are T1WI, T2WI, FLAIR, DWI, and post-contrast T1WI. Common features and imaging findings are highlighted for each tumor type in 1-3 sentences.
Its important to recognise the myelination pattern in neonates and infants. This presentation talks about the myelination pattern and imaging of white matter diseases in children.
The document discusses posterior fossa tumors. It begins by outlining the anatomy of the posterior fossa and then provides background information on posterior fossa tumors. It states that 60-70% of pediatric brain tumors and 15-20% of adult brain tumors originate in the posterior fossa. The document then covers various tumor types found in the posterior fossa, including hemangioblastoma, brain metastases, and medulloblastoma. It provides details on the clinical presentation, imaging, pathology, treatment and prognosis for each of these tumor types.
In this presentation, i have explained different modalities available for radiological evaluation of cns tumors. How to approach to a radiographic image and how to approach to a patient of cns tumors radiologically.
Presentation1.pptx sellar and para sellar massesAbdellah Nazeer
The document provides information on imaging techniques and differential diagnosis for sellar and parasellar masses. CT and MRI techniques are described for imaging the sella turcica region with details on slice thickness, field of view, and contrast usage. An anatomic approach is outlined to analyze sellar masses which involves identifying the pituitary gland, lesion location and characteristics, and establishing a differential diagnosis. Common pathologies that can occur in the sella and surrounding structures are then described individually, including the pituitary gland, stalk, optic chiasm, hypothalamus, carotid artery, cavernous sinus, and meninges. Imaging examples of lesions such as pituitary adenomas, craniopharyngiomas, and meningi
WHO BRAIN TUMOR CLASSIFICATION 5th EDITIONKanhu Charan
The document summarizes some of the key changes in the 2021 5th edition of the WHO brain tumor classification compared to previous editions. Some notable changes include recognizing the distinction between adult and pediatric diffuse gliomas, adding 22 new tumor types, revising the terminology for 13 tumor types, introducing essential and desirable diagnostic criteria, and classifying tumors based on a combination of histopathological and molecular features. Sellar tumors, meningiomas, and ependymomas were also revised in the new classification system.
Meningiomas are the most common non-glial tumors of the central nervous system. They are typically benign, slow-growing tumors that appear as well-circumscribed masses attached to the dura on imaging. CT often shows hyperattenuation and enhancement, while MRI demonstrates isointensity to gray matter and enhancement. Typical features include calcification, hyperostosis, and dural tail sign. Atypical features like cysts, hemorrhage or edema are less common. Advanced MRI techniques may help differentiate aggressive from non-aggressive meningiomas. Differential diagnosis includes other dural-based lesions.
1) Brain tumors are the 20th most common malignancy worldwide and their incidence varies based on factors like age, sex, and race.
2) Diagnostic workup involves imaging like MRI and CT scans, cerebrospinal fluid examination, and biopsy when needed. Molecular testing helps classify tumors.
3) Treatment depends on tumor type and grade but generally involves surgery, radiation, chemotherapy, and targeted therapies. Management of symptoms is also important.
4) Prognosis depends on tumor specific factors and can range from months to over 10 years depending on the tumor characteristics.
1) The document discusses imaging in stroke, focusing on various modalities including CT, CT angiography, CT perfusion, MRI, diffusion weighted imaging, and perfusion weighted imaging.
2) These modalities are used to assess the brain parenchyma, vasculature, perfusion, and penumbra (area of reversible ischemia surrounding the irreversibly damaged core).
3) Identification of the penumbra is especially important as this region may be salvageable with early reperfusion and helps guide treatment decisions.
BASICS OF NEUROANATOMY & BRAIN TUMOR RADIOLOGYKanhu Charan
The document discusses the basics of neuroanatomy and common brain tumors. It provides information on various sulci and gyri in the brain and their importance. The key sulci and gyri discussed include the central sulcus, which separates the frontal and parietal lobes; the intraparietal sulcus, which separates the superior and inferior parietal lobules; and the calcarine sulcus, which separates the cuneus and lingual gyrus. Understanding the location and relationships of sulci and gyri is important for interpreting neuroimaging of the brain.
Evolution of treatment strategies of brain tumorsAnil Gupta
The document discusses the evolution of treatment strategies for brain gliomas. It begins by providing background on gliomas and their classification. It then discusses advances in surgery, including neuronavigation, fluorescent guided resection, and intraoperative imaging. It also covers the evolution of radiotherapy techniques from early 2D approaches to modern 3D conformal radiotherapy and intensity modulated radiotherapy. Adjuvant therapies like chemotherapy and targeted drugs are also mentioned. Overall the document traces the development of surgical and radiation based approaches for glioma treatment over time.
A variety of neoplasms can arise in the ventricular system, including ependymomas, medulloblastomas, subependymomas, central neurocytomas, subependymal giant cell astrocytomas (SGCA), choroid plexus papillomas, choroid plexus carcinomas, and intraventricular meningiomas. These lesions present variably with increased intracranial pressure, focal neurologic deficits, or incidentally found on imaging. Location within the ventricles and patient age, gender, and underlying conditions can help narrow the differential diagnosis.
The document discusses primary retroperitoneal neoplasms. It notes that 70-80% of primary retroperitoneal neoplasms are malignant in nature. The retroperitoneum contains mesodermal neoplasms, neurogenic tumors, germ cell and sex cord tumors, and lymphoid neoplasms. The most common primary retroperitoneal sarcomas are liposarcoma, leiomyosarcoma, and malignant fibrous histiocytoma. Neurogenic tumors such as schwannomas and neurofibromas are usually benign and occur in a younger age group. Teratomas are germ cell tumors that may contain fat, calcium, or sebum levels on imaging.
Meningiomas account for 15% of all intracranial tumors and originate from the dura or arachnoid membranes. They are most common in middle-aged adults and affect women twice as often as men. Meningiomas are typically benign, slow-growing tumors that indent the brain as they enlarge. On CT imaging, meningiomas appear well-circumscribed, homogeneous, and hyperdense, and may induce hyperostosis of adjacent bone. MRI often reveals a characteristic "dural tail" sign of enhancement. Other histologic variants include hemangiopericytomas, which have a narrow dural attachment and lobulated shape.
This document describes a case of neuroblastoma in a 16-month-old boy presenting with fever, poor appetite, and abdominal distension. Imaging including ultrasound, CT, and MRI revealed a large heterogeneous mass arising from the left adrenal gland, compressing local structures. Biopsy showed poorly differentiated neuroblastoma. Treatment and prognosis depend on risk stratification based on age, stage, biology. High-risk disease requires intensive chemotherapy with stem cell transplant while low-risk cases may only require surgery or observation.
Primitive neuroectodermal tumor (PNET) is a highly malignant tumor composed of small round cells of neuroectodermal origin that affects soft tissue and bone. PNETs are classified into groups depending on location, with peripheral PNET (pPNET) occurring in soft tissue and bone outside the central nervous system. pPNET includes Ewing sarcoma and Askin tumor. Diagnosis involves ruling out other small round cell tumors through molecular cytogenetic studies showing translocation between chromosomes 11 and 22. PNET most commonly presents in adolescents and young adults with pain, swelling, and mass effect. Prognosis depends on tumor site, volume, and presence of metastasis. Treatment involves complete surgical resection when possible along with
Presentation2, radiological imaging of phakomatosis.Abdellah Nazeer
Von Hippel-Lindau disease is characterized by the development of numerous benign and malignant tumors in different organs due to mutations in the VHL tumor suppressor gene. Common manifestations include renal cell carcinomas, renal cysts, pheochromocytomas, pancreatic cysts and tumors, retinal hemangioblastomas, and cerebellar hemangioblastomas. Patients may develop tumors in the kidneys, pancreas, liver, adrenal glands, and brain. The variety of lesions that can occur has led to the mnemonic "HIPPEL" to remember the key features of VHL disease.
This presentation reviews the current neurosurgical management of patients with medulloblastoma, including the data on molecular subtyping; uses “medulloblastoma” as a springboard to discuss other topics / tumor cell biology in general; and formulates research questions to further advance neurosurgical basic science.
This document contains summaries of three gastrointestinal pathology cases and additional information about achalasia, oesophageal carcinoma, small bowel malrotation, and midgut volvulus. Case 1 describes dilatation and narrowing of the esophagus resembling a rat tail or bird beak. Case 2 describes abnormal positioning of the duodenum and small bowel. Case 3 shows irregular narrowing and lack of peristalsis in the colon. Additional sections provide details on the causes, presentations, investigations and treatments of these conditions.
This document discusses imaging in abdominal trauma. It begins by outlining the mechanisms and types of abdominal injuries from blunt and penetrating trauma. It then describes the FAST (Focused Assessment with Sonography for Trauma) exam and its role in the initial assessment of hemodynamically unstable patients. For stable patients, CT is typically used to further evaluate injuries suggested on clinical exam or FAST. The document outlines key CT findings for various intra-abdominal injuries and hemorrhage.
This document provides an overview of common pediatric brain tumors located in the posterior fossa (infratentorial region). It discusses the most frequently used MRI sequences for evaluating these tumors and provides clinical and imaging features of the most common tumor types, including medulloblastoma, ependymoma, pilocytic astrocytoma, and brainstem glioma. Differential diagnoses are also reviewed. Key sequences discussed are T1WI, T2WI, FLAIR, DWI, and post-contrast T1WI. Common features and imaging findings are highlighted for each tumor type in 1-3 sentences.
Its important to recognise the myelination pattern in neonates and infants. This presentation talks about the myelination pattern and imaging of white matter diseases in children.
The document discusses posterior fossa tumors. It begins by outlining the anatomy of the posterior fossa and then provides background information on posterior fossa tumors. It states that 60-70% of pediatric brain tumors and 15-20% of adult brain tumors originate in the posterior fossa. The document then covers various tumor types found in the posterior fossa, including hemangioblastoma, brain metastases, and medulloblastoma. It provides details on the clinical presentation, imaging, pathology, treatment and prognosis for each of these tumor types.
In this presentation, i have explained different modalities available for radiological evaluation of cns tumors. How to approach to a radiographic image and how to approach to a patient of cns tumors radiologically.
Presentation1.pptx sellar and para sellar massesAbdellah Nazeer
The document provides information on imaging techniques and differential diagnosis for sellar and parasellar masses. CT and MRI techniques are described for imaging the sella turcica region with details on slice thickness, field of view, and contrast usage. An anatomic approach is outlined to analyze sellar masses which involves identifying the pituitary gland, lesion location and characteristics, and establishing a differential diagnosis. Common pathologies that can occur in the sella and surrounding structures are then described individually, including the pituitary gland, stalk, optic chiasm, hypothalamus, carotid artery, cavernous sinus, and meninges. Imaging examples of lesions such as pituitary adenomas, craniopharyngiomas, and meningi
WHO BRAIN TUMOR CLASSIFICATION 5th EDITIONKanhu Charan
The document summarizes some of the key changes in the 2021 5th edition of the WHO brain tumor classification compared to previous editions. Some notable changes include recognizing the distinction between adult and pediatric diffuse gliomas, adding 22 new tumor types, revising the terminology for 13 tumor types, introducing essential and desirable diagnostic criteria, and classifying tumors based on a combination of histopathological and molecular features. Sellar tumors, meningiomas, and ependymomas were also revised in the new classification system.
Meningiomas are the most common non-glial tumors of the central nervous system. They are typically benign, slow-growing tumors that appear as well-circumscribed masses attached to the dura on imaging. CT often shows hyperattenuation and enhancement, while MRI demonstrates isointensity to gray matter and enhancement. Typical features include calcification, hyperostosis, and dural tail sign. Atypical features like cysts, hemorrhage or edema are less common. Advanced MRI techniques may help differentiate aggressive from non-aggressive meningiomas. Differential diagnosis includes other dural-based lesions.
1) Brain tumors are the 20th most common malignancy worldwide and their incidence varies based on factors like age, sex, and race.
2) Diagnostic workup involves imaging like MRI and CT scans, cerebrospinal fluid examination, and biopsy when needed. Molecular testing helps classify tumors.
3) Treatment depends on tumor type and grade but generally involves surgery, radiation, chemotherapy, and targeted therapies. Management of symptoms is also important.
4) Prognosis depends on tumor specific factors and can range from months to over 10 years depending on the tumor characteristics.
1) The document discusses imaging in stroke, focusing on various modalities including CT, CT angiography, CT perfusion, MRI, diffusion weighted imaging, and perfusion weighted imaging.
2) These modalities are used to assess the brain parenchyma, vasculature, perfusion, and penumbra (area of reversible ischemia surrounding the irreversibly damaged core).
3) Identification of the penumbra is especially important as this region may be salvageable with early reperfusion and helps guide treatment decisions.
BASICS OF NEUROANATOMY & BRAIN TUMOR RADIOLOGYKanhu Charan
The document discusses the basics of neuroanatomy and common brain tumors. It provides information on various sulci and gyri in the brain and their importance. The key sulci and gyri discussed include the central sulcus, which separates the frontal and parietal lobes; the intraparietal sulcus, which separates the superior and inferior parietal lobules; and the calcarine sulcus, which separates the cuneus and lingual gyrus. Understanding the location and relationships of sulci and gyri is important for interpreting neuroimaging of the brain.
Evolution of treatment strategies of brain tumorsAnil Gupta
The document discusses the evolution of treatment strategies for brain gliomas. It begins by providing background on gliomas and their classification. It then discusses advances in surgery, including neuronavigation, fluorescent guided resection, and intraoperative imaging. It also covers the evolution of radiotherapy techniques from early 2D approaches to modern 3D conformal radiotherapy and intensity modulated radiotherapy. Adjuvant therapies like chemotherapy and targeted drugs are also mentioned. Overall the document traces the development of surgical and radiation based approaches for glioma treatment over time.
A variety of neoplasms can arise in the ventricular system, including ependymomas, medulloblastomas, subependymomas, central neurocytomas, subependymal giant cell astrocytomas (SGCA), choroid plexus papillomas, choroid plexus carcinomas, and intraventricular meningiomas. These lesions present variably with increased intracranial pressure, focal neurologic deficits, or incidentally found on imaging. Location within the ventricles and patient age, gender, and underlying conditions can help narrow the differential diagnosis.
The document discusses primary retroperitoneal neoplasms. It notes that 70-80% of primary retroperitoneal neoplasms are malignant in nature. The retroperitoneum contains mesodermal neoplasms, neurogenic tumors, germ cell and sex cord tumors, and lymphoid neoplasms. The most common primary retroperitoneal sarcomas are liposarcoma, leiomyosarcoma, and malignant fibrous histiocytoma. Neurogenic tumors such as schwannomas and neurofibromas are usually benign and occur in a younger age group. Teratomas are germ cell tumors that may contain fat, calcium, or sebum levels on imaging.
Meningiomas account for 15% of all intracranial tumors and originate from the dura or arachnoid membranes. They are most common in middle-aged adults and affect women twice as often as men. Meningiomas are typically benign, slow-growing tumors that indent the brain as they enlarge. On CT imaging, meningiomas appear well-circumscribed, homogeneous, and hyperdense, and may induce hyperostosis of adjacent bone. MRI often reveals a characteristic "dural tail" sign of enhancement. Other histologic variants include hemangiopericytomas, which have a narrow dural attachment and lobulated shape.
This document describes a case of neuroblastoma in a 16-month-old boy presenting with fever, poor appetite, and abdominal distension. Imaging including ultrasound, CT, and MRI revealed a large heterogeneous mass arising from the left adrenal gland, compressing local structures. Biopsy showed poorly differentiated neuroblastoma. Treatment and prognosis depend on risk stratification based on age, stage, biology. High-risk disease requires intensive chemotherapy with stem cell transplant while low-risk cases may only require surgery or observation.
Primitive neuroectodermal tumor (PNET) is a highly malignant tumor composed of small round cells of neuroectodermal origin that affects soft tissue and bone. PNETs are classified into groups depending on location, with peripheral PNET (pPNET) occurring in soft tissue and bone outside the central nervous system. pPNET includes Ewing sarcoma and Askin tumor. Diagnosis involves ruling out other small round cell tumors through molecular cytogenetic studies showing translocation between chromosomes 11 and 22. PNET most commonly presents in adolescents and young adults with pain, swelling, and mass effect. Prognosis depends on tumor site, volume, and presence of metastasis. Treatment involves complete surgical resection when possible along with
Presentation2, radiological imaging of phakomatosis.Abdellah Nazeer
Von Hippel-Lindau disease is characterized by the development of numerous benign and malignant tumors in different organs due to mutations in the VHL tumor suppressor gene. Common manifestations include renal cell carcinomas, renal cysts, pheochromocytomas, pancreatic cysts and tumors, retinal hemangioblastomas, and cerebellar hemangioblastomas. Patients may develop tumors in the kidneys, pancreas, liver, adrenal glands, and brain. The variety of lesions that can occur has led to the mnemonic "HIPPEL" to remember the key features of VHL disease.
This presentation reviews the current neurosurgical management of patients with medulloblastoma, including the data on molecular subtyping; uses “medulloblastoma” as a springboard to discuss other topics / tumor cell biology in general; and formulates research questions to further advance neurosurgical basic science.
This document contains summaries of three gastrointestinal pathology cases and additional information about achalasia, oesophageal carcinoma, small bowel malrotation, and midgut volvulus. Case 1 describes dilatation and narrowing of the esophagus resembling a rat tail or bird beak. Case 2 describes abnormal positioning of the duodenum and small bowel. Case 3 shows irregular narrowing and lack of peristalsis in the colon. Additional sections provide details on the causes, presentations, investigations and treatments of these conditions.
This document discusses imaging in abdominal trauma. It begins by outlining the mechanisms and types of abdominal injuries from blunt and penetrating trauma. It then describes the FAST (Focused Assessment with Sonography for Trauma) exam and its role in the initial assessment of hemodynamically unstable patients. For stable patients, CT is typically used to further evaluate injuries suggested on clinical exam or FAST. The document outlines key CT findings for various intra-abdominal injuries and hemorrhage.
Role of mdct in blunt abdominal trauma Dr. Muhammad Bin Zulfiqar
Briefly Describes the role of Ct in Diagnosis of Blunt Abdominal trauma.
Major organs injuries are discussed
Oleh discusses imaging techniques for evaluating abdominal trauma in children. Key points include:
1. Computed tomography (CT) is the imaging method of choice for abdominal trauma due to its ability to detect injuries to solid organs and cavities. Sonography can also detect free fluid but has limitations.
2. Common injuries seen in children include liver lacerations and hematomas, splenic injuries like lacerations and fragmentation, and renal injuries such as contusions, lacerations, and hematomas.
3. Injuries are graded based on severity using standardized scales to determine need for intervention. Close monitoring is important as some injuries like smaller liver hematomas may resolve without surgery.
This document provides an overview of imaging for abdominal trauma. It summarizes that FAST has high sensitivity for detecting free fluid but lower sensitivity for organ injuries compared to CT. CT is nearly 100% accurate for detecting hemoperitoneum and organ injuries and can help guide management. The document recommends performing FAST first in hemodynamically unstable patients and CT in stable patients, with CT also indicated for penetrating injuries to the back/flank and potentially the anterior abdomen.
1) Tumors of the central nervous system (CNS) can be classified based on the cell type they arise from, including glial cells, neurons, meninges, and other tissues.
2) The most common CNS tumors include gliomas such as astrocytomas, oligodendrogliomas, and ependymomas. Astrocytomas are further classified based on grade from pilocytic astrocytoma to glioblastoma.
3) CNS tumor characteristics vary based on histology, location in the brain or spine, patient age, and other factors. Malignant tumors tend to grow quickly and infiltrate surrounding brain tissue, while benign tumors are often slow
This document provides information on bone tumors, including their classification, locations, and radiographic features. It discusses benign bone forming tumors like bone islands and osteoblastomas. It also covers cartilage forming tumors such as enchondromas and osteochondromas, as well as fibrous lesions including fibrous dysplasia. Malignant tumors described include osteosarcoma, chondrosarcoma, and malignant fibrous histiocytoma. For each tumor type, the document provides details on incidence, anatomical distribution, and characteristic imaging appearance to aid in diagnosis.
The document provides information about FAST (Focused Assessment with Sonography in Trauma) scans. It begins with an overview of what a FAST scan is used for - to identify fluid in the abdomen or pelvis where it is not normally found, which can indicate injury. It then details the anatomy visualized in a standard FAST scan and describes the technique. Examples are provided of free fluid appearing in different locations like Morrison's pouch or the pelvis. The document discusses interpreting FAST scans and explores limitations and advantages of the procedure. In under 3 sentences, the document provides an overview of the FAST scan for trauma patients to quickly identify free fluid that could indicate internal injury.
The document discusses bone tumors. It begins by stating that the most common bone tumor is secondary tumors from other sites, while the most common primary bone tumor is multiple myeloma. It then covers the WHO classification of bone tumors including bone-forming, cartilage-forming, marrow, vascular, and other tumors. Diagnosis involves clinical examination, imaging like radiographs, CT, MRI and bone scans, as well as laboratory tests and biopsy. Staging is discussed including the Enneking system based on aggressiveness and spread. Management depends on staging and includes wide excision for low grade lesions and more radical resection or palliative treatment for high grade or metastatic tumors.
This document discusses various types of brain tumors and how they appear on different types of MRI sequences. It provides information on distinguishing between intra-axial and extra-axial tumors and describes signs that suggest a tumor's location and origin. Key tumor types are discussed like gliomas, metastases and meningiomas. The document also outlines characteristics of tumors visible on T1-weighted, T2-weighted, diffusion weighted and post-contrast scans that can help determine a tumor's properties and aid in diagnosis.
General Basic knowledge of Brain tumour explained in brief of classification, pathogenesis, clinical features, CT, MRI, management, Radiotherapy. Best for MBBS and PG preparation student.
Normal & abnormal radiology of brain part ivMohammed Fathy
1. Brain tumors can be either intra-axial (within the brain parenchyma) or extra-axial (outside the brain).
2. Key differences are that extra-axial tumors displace brain tissue and widen CSF spaces, while intra-axial tumors infiltrate brain tissue.
3. Common extra-axial tumors are meningiomas and schwannomas, while common intra-axial tumors in adults are gliomas and metastases. Location helps to distinguish tumor type and guide differential diagnosis.
Brain tumors are the most common primary tumors in the central nervous system. The two most common primary brain tumors are meningiomas and glioblastomas. Brain metastases occur in around 15% of cancer patients, most commonly from lung and breast cancers. Primary brain tumors are graded on a scale of I to IV based on factors like growth rate and malignancy. Glioblastoma is a grade IV tumor and is the most aggressive type of astrocytoma. Standard treatment for glioblastoma involves maximal surgical resection followed by radiation therapy with concurrent temozolomide chemotherapy and then adjuvant temozolomide for 6 months. Temozolomide is an oral chemotherapy that can cross the blood-brain barrier and has
This document provides a classification and overview of central nervous system (CNS) tumors. It discusses several primary CNS tumors including gliomas such as astrocytomas, oligodendrogliomas, ependymomas and others. It describes the histopathological features, grading, molecular markers and differential diagnosis of these tumor types. In particular, it focuses on pilocytic astrocytoma, diffuse astrocytoma, anaplastic astrocytoma, glioblastoma and their progression. Prognosis worsens with increased grade from II to IV for these astrocytic tumors. Molecular changes involving genes like IDH are also discussed.
This document provides information about brain tumors, including:
- The two main types are malignant (cancerous) tumors and benign tumors. Malignant tumors can be primary or spread from other sites.
- Common tumor types include gliomas (e.g. astrocytomas, oligodendrogliomas, ependymomas), neuronal tumors, embryonal tumors, and meningiomas.
- Symptoms vary depending on the tumor type and location but often include headaches, seizures, sensory and motor changes, and cognitive/behavioral issues.
- Diagnosis involves imaging like CT/MRI scans and biopsy. Treatment involves surgery, radiation, chemotherapy, or a combination. Prognosis depends
The document discusses various types of central nervous system (CNS) tumors. It notes that CNS tumors comprise 10% of all tumors and are most common in children and the fifth decade of life. Primary CNS tumors are infiltrative while metastases are well-demarcated. Common primary tumor types include meningiomas, gliomas such as astrocytomas and oligodendrogliomas, and nerve sheath tumors like schwannomas. Clinical features can include increased intracranial pressure, neurological deficits, and seizures. Microscopic features help distinguish tumor types, such as psammoma bodies in meningiomas and pseudopalisades in glioblastomas.
The document discusses various types of brain tumors categorized by location, age of patient, and other distinguishing features. It provides details on meningiomas, epidermoid tumors, glioblastomas, oligodendrogliomas, hemangioblastomas, and medulloblastomas including typical locations, appearances on imaging, and other characteristics. Example cases are presented and differential diagnoses are discussed.
Intracranial neoplasms can be benign or malignant tumors that form within the cranial or spinal cavity. There are two main types - primary tumors that originate from brain cells, and secondary tumors that metastasize from other organs like the lung or breast. Symptoms arise from the tumor infiltrating and compressing brain tissue. Diagnosis involves neuroimaging to identify the mass and contrast enhancement. Treatment options depend on the tumor type, with more invasive tumors requiring surgery and radiation therapy while palliative care is used for metastatic tumors.
Spinal tumors can be classified based on their point of origin as being intramedullary, intradural-extramedullary, or extradural. Common intramedullary tumors include ependymomas, astrocytomas, gangliogliomas, and hemangioblastomas. Ependymomas typically appear as well-circumscribed lesions on MRI and may contain intratumoral or polar cysts. Astrocytomas tend to infiltrate the spinal cord eccentrically and demonstrate heterogeneous enhancement. Gangliogliomas commonly involve multiple vertebral segments and may contain calcifications. Hemangioblastomas are highly vascular tumors that can be either intramedullary or intradural-extra
The document discusses the different cell types found in the central nervous system and lists tumors that can arise from these cells. It covers 10 major types of brain tumors, including gliomas arising from neuroglial cells, neuronal tumors, meningiomas from meningeal cells, and metastatic tumors. Key tumor types discussed in more detail include astrocytomas, glioblastoma, medulloblastoma, meningioma, and pilocytic astrocytoma. Grading systems and histopathological features of these tumors are also summarized.
This document discusses brain tumors including their classification, imaging, and characteristics. It notes that cerebral tumors predominantly affect adults aged 55-65 and are relatively uncommon in children. Primary brain tumors can occur at any age but certain tumor types mainly affect specific age groups. Gliomas are the most common primary brain tumor in adults, comprising 45-65% of cases. Low-grade gliomas typically present with seizures and appear hypo-iso intense on CT and homogenously hyperintense on T2 MRI with little enhancement. Anaplastic astrocytomas present similarly but enhance strongly and inhomogenously on imaging. The document provides detailed information on tumor classification, imaging features, and characteristics.
Brain and spinal cord tumors are the second most common cancers in children. They often present with non-specific symptoms, so diagnosis can be delayed. The most common tumor types are pilocytic astrocytomas and medulloblastoma in children aged 0-14, and pituitary/craniopharyngeal tumors and pilocytic astrocytomas in adolescents aged 15-19. Tumors are graded on a scale of I to IV based on malignancy. Treatment involves surgery along with radiation and chemotherapy depending on tumor type and grade. Prognosis depends on factors like extent of surgical resection and tumor location.
This document discusses spinal cord tumors. It describes different types of intramedullary and extramedullary spinal cord tumors, including meningiomas, schwannomas, neurofibromas, ependymomas, astrocytomas, and hemangioblastomas. It provides details on the characteristics, locations, imaging appearance, and surgical treatment of these tumors. The goal of surgery is safe removal or biopsy of the tumor while preserving neurological function. Monitoring is used during surgery to help identify the tumor and midline.
Pediatric solid tumors are a diverse group of cancers that arise in children. They account for 60% of pediatric malignant neoplasms and can originate from mesoderm, endoderm or ectoderm tissues. The most common types are brain tumors, neuroblastoma, rhabdomyosarcoma, Wilms' tumor, and osteosarcoma. Presentation depends on tumor location and type but may include masses, compression symptoms, metastases, and paraneoplastic effects. Diagnosis involves imaging, biopsy and laboratory tests. Treatment involves surgery, chemotherapy and/or radiation depending on tumor characteristics and stage. Prognosis depends on specific tumor type and stage.
This document discusses the classification, clinical features, pathology, genetics, and treatment of brain tumors. It covers the major types of gliomas including diffuse astrocytomas, anaplastic astrocytomas, glioblastoma, oligodendrogliomas, and oligoastrocytomas. It describes their histopathological features, genetic alterations, imaging appearance, prognosis, and treatment approaches. Ependymomas are also summarized, noting their occurrence along the ventricular system in children and young adults.
Meningioma is a type of tumor that arises from the meninges, the membranes surrounding the brain and spinal cord. It is the most common non-cancerous brain tumor, accounting for 20% of all primary brain tumors. The standard treatment is surgical resection if the tumor is symptomatic or growing in size. For inoperable or recurrent tumors, radiation therapy and medical therapies may be options, though medical therapies have limited effectiveness. The prognosis depends on the tumor grade, with lower grade tumors having better outcomes.
A brain tumor is a collection of abnormal cells in the brain. Symptoms depend on the tumor's size, type, and location and may include headaches, nausea, vomiting, vision changes, and more. Diagnosis involves imaging tests like CT scans and MRIs. Treatment options include surgery to remove the tumor, chemotherapy, and radiation therapy. The goals of surgical removal are to confirm diagnosis, remove as much of the tumor as possible, relieve pressure in the brain, and provide access for additional treatments.
Similar to Approach to CNS tumors Dr. Muhammad Bin Zulfiqar (20)
Dislocation of joint is very tricky. In this presentation radiological evaluation of Dislocation of various joints will be discussed.
This is one of the best pictoral review of important joint dislocations
Renal Color Doppler Ultrasound.
After studying this presentation one will be able to perform and interpret ultrasound.
This presntation in my opinion is best short analog to text.
Bone age assessment is performed to evaluate growth in pediatric patients and diagnose endocrine disorders. It relies on visual evaluation of hand and wrist skeletal development compared to standard references. Key applications include diagnosing growth disorders and predicting final adult height. Skeletal development is divided into stages from infancy to post-puberty based on characteristics like appearance of ossification centers and epiphyseal fusion. Bone age is assessed by comparing a patient's hand and wrist radiograph to standardized images for their age and sex.
Role of medical imaging in developemental dysplasia of Hip Dr muhammad Bin Zu...Dr. Muhammad Bin Zulfiqar
In this presentation we will discuss the role of medical imaging---plain Radiography, Ultrasound,Arthrography, CT and MRI in the evaluation of Developemental dysplasia of hip. Our main focuss will be on Sonographic evaluation.
In this presentation we will discuss the basic of axial trauma from head to pelvis. We will discuss the important key points that aids in the diagnosis of axial trauma
This is a chapter from Grainger and Allison. I have Coolected all images from chapter 21 with caption in this presentation.
In my opinion it will be very benificial to have this in your android.
This presentation is the first series of the MR imaging of Knee.
In this presentation MRI anatomy has been discussed. As we all know good knowledge of medical imaging three dimensional anatomy is key for good reporting.
Hope we all get benifitted.
Suggestions are most welcome
This is a chapter from Grainger and Allison. I have Coolected all images from chapter 20 with caption in this presentation.
In my opinion it will be very benificial to have this in your android. ,
This presentation is almost a complete Pictoral view of Radiograph chest.
This presentation will help radiologist in daily reporting.
This presentation will help physicians, surgeons, anesthetist and almost all medical professionals in diagnosing commonly presenting cardiac diseases.
This will also help all in preparaing TOACS examination.
This is a chapter from Grainger and Allison. I have Coolected all images from chapter 19 with caption in this presentation.
In my opinion it will be very benificial to have this in your android. ,
In this presentation we will discuss about the
Anatomy of Prostate
Technique of Transrectal US
Carcinoma Prostate and
Different modes of prostatic biopsy.
This document lists and briefly describes several eponymous fractures. Some of the fractures described include:
- Colles fracture - A distal radius fracture with dorsal displacement of the distal fragment.
- Jones fracture - A fracture of the base of the fifth metatarsal distal to the tuberosity.
- Segond fracture - A proximal tibial epiphysis fracture associated with anterior cruciate ligament rupture.
- Barton's fracture - A fracture of the articular surface of the radius with dorsal or ventral displacement.
The document provides brief 1-2 sentence descriptions of over 30 different eponymous fractures. It includes diagrams to illustrate some of the fracture patterns.
In this presentation all images of Chapter 18 from Grainger and Allison have been discussed.
Our aim is to discuss authentic material .
This is only for educational purposes.
In this chapter air space infilteration have been discussed. Ground glass haze and consolidation are discussed in detail.
This presentation is a selection of images from 17th chapter of grainger and allison.
Our aim is to provide standard and proved cases of the disease process.
This all is for educational purpose
This document provides an overview of basic brain CT, including its principles, anatomy, common pathologies, and interpretation. It discusses how CT uses X-rays to reconstruct cross-sectional images and analyze tissue density. Key points covered include the appearance of skull fractures, hemorrhages, infarcts, tumors, infections and other intracranial abnormalities. Understanding normal anatomy is emphasized to aid in detecting abnormalities.
16 High Resolution Computed Tomography of Interstitial and Occupational Lung ...Dr. Muhammad Bin Zulfiqar
This presentation is collection of images from chapter 16 of Grainger and Allison.
Inthis we will discuss the ILD.
This is only for educational purposes.
This Presentation is a collection of chapter 5 images from Grainger and Allison.
Our aim is to study authentic data.
This is only for educational purposes
In this presentation we will discuss role of high resolution in characterizing normal variant and pathologies of spinal pathologies.
This is a pictoral review.
This presentation provides sufficient material for anyone who wants is interested in interventional radiology. Here we will discuss the available facilities, mechanisms and equipments.
In my opinion this presentation will prove a footstep in interventional radiology
Hepatocellular carcinoma—role of interventional radiologist Dr. Muhammad Bin ...Dr. Muhammad Bin Zulfiqar
Hepatocellular carcinoma is a leading cause of cancer death worldwide. Interventional radiologists play an important role in diagnosing and treating hepatocellular carcinoma. They can perform biopsies to determine disease, facilitate surgical treatment through techniques like portal vein embolization to increase eligibility for resection, and provide locoregional therapies for patients who are not surgical candidates like radiofrequency ablation, transarterial chemoembolization, and radioembolization. While offering palliation, these minimally invasive treatments can achieve local tumor control and prolong survival for some patients with hepatocellular carcinoma.
PGx Analysis in VarSeq: A User’s PerspectiveGolden Helix
Since our release of the PGx capabilities in VarSeq, we’ve had a few months to gather some insights from various use cases. Some users approach PGx workflows by means of array genotyping or what seems to be a growing trend of adding the star allele calling to the existing NGS pipeline for whole genome data. Luckily, both approaches are supported with the VarSeq software platform. The genotyping method being used will also dictate what the scope of the tertiary analysis will be. For example, are your PGx reports a standalone pipeline or would your lab’s goal be to handle a dual-purpose workflow and report on PGx + Diagnostic findings.
The purpose of this webcast is to:
Discuss and demonstrate the approaches with array and NGS genotyping methods for star allele calling to prep for downstream analysis.
Following genotyping, explore alternative tertiary workflow concepts in VarSeq to handle PGx reporting.
Moreover, we will include insights users will need to consider when validating their PGx workflow for all possible star alleles and options you have for automating your PGx analysis for large number of samples. Please join us for a session dedicated to the application of star allele genotyping and subsequent PGx workflows in our VarSeq software.
Giloy in Ayurveda - Classical Categorization and SynonymsPlanet Ayurveda
Giloy, also known as Guduchi or Amrita in classical Ayurvedic texts, is a revered herb renowned for its myriad health benefits. It is categorized as a Rasayana, meaning it has rejuvenating properties that enhance vitality and longevity. Giloy is celebrated for its ability to boost the immune system, detoxify the body, and promote overall wellness. Its anti-inflammatory, antipyretic, and antioxidant properties make it a staple in managing conditions like fever, diabetes, and stress. The versatility and efficacy of Giloy in supporting health naturally highlight its importance in Ayurveda. At Planet Ayurveda, we provide a comprehensive range of health services and 100% herbal supplements that harness the power of natural ingredients like Giloy. Our products are globally available and affordable, ensuring that everyone can benefit from the ancient wisdom of Ayurveda. If you or your loved ones are dealing with health issues, contact Planet Ayurveda at 01725214040 to book an online video consultation with our professional doctors. Let us help you achieve optimal health and wellness naturally.
Fexofenadine is sold under the brand name Allegra.
It is a selective peripheral H1 blocker. It is classified as a second-generation antihistamine because it is less able to pass the blood–brain barrier and causes lesser sedation, as compared to first-generation antihistamines.
It is on the World Health Organization's List of Essential Medicines. Fexofenadine has been manufactured in generic form since 2011.
Can Traditional Chinese Medicine Treat Blocked Fallopian Tubes.pptxFFragrant
There are many traditional Chinese medicine therapies to treat blocked fallopian tubes. And herbal medicine Fuyan Pill is one of the more effective choices.
CLASSIFICATION OF H1 ANTIHISTAMINICS-
FIRST GENERATION ANTIHISTAMINICS-
1)HIGHLY SEDATIVE-DIPHENHYDRAMINE,DIMENHYDRINATE,PROMETHAZINE,HYDROXYZINE 2)MODERATELY SEDATIVE- PHENARIMINE,CYPROHEPTADINE, MECLIZINE,CINNARIZINE
3)MILD SEDATIVE-CHLORPHENIRAMINE,DEXCHLORPHENIRAMINE
TRIPROLIDINE,CLEMASTINE
SECOND GENERATION ANTIHISTAMINICS-FEXOFENADINE,
LORATADINE,DESLORATADINE,CETIRIZINE,LEVOCETIRIZINE,
AZELASTINE,MIZOLASTINE,EBASTINE,RUPATADINE. Mechanism of action of 2nd generation antihistaminics-
These drugs competitively antagonize actions of
histamine at the H1 receptors.
Pharmacological actions-
Antagonism of histamine-The H1 antagonists effectively block histamine induced bronchoconstriction, contraction of intestinal and other smooth muscle and triple response especially wheal, flare and itch. Constriction of larger blood vessel by histamine is also antagonized.
2) Antiallergic actions-Many manifestations of immediate hypersensitivity (type I reactions)are suppressed. Urticaria, itching and angioedema are well controlled.3) CNS action-The older antihistamines produce variable degree of CNS depression.But in case of 2nd gen antihistaminics there is less CNS depressant property as these cross BBB to significantly lesser extent.
4) Anticholinergic action- many H1 blockers
in addition antagonize muscarinic actions of ACh. BUT IN 2ND gen histaminics there is Higher H1 selectivitiy : no anticholinergic side effects
TEST BANK For Brunner and Suddarth's Textbook of Medical-Surgical Nursing, 14...Donc Test
TEST BANK For Brunner and Suddarth's Textbook of Medical-Surgical Nursing, 14th Edition (Hinkle, 2017) Verified Chapter's 1 - 73 Complete.pdf
TEST BANK For Brunner and Suddarth's Textbook of Medical-Surgical Nursing, 14th Edition (Hinkle, 2017) Verified Chapter's 1 - 73 Complete.pdf
TEST BANK For Brunner and Suddarth's Textbook of Medical-Surgical Nursing, 14th Edition (Hinkle, 2017) Verified Chapter's 1 - 73 Complete.pdf
Nano-gold for Cancer Therapy chemistry investigatory projectSIVAVINAYAKPK
chemistry investigatory project
The development of nanogold-based cancer therapy could revolutionize oncology by providing a more targeted, less invasive treatment option. This project contributes to the growing body of research aimed at harnessing nanotechnology for medical applications, paving the way for future clinical trials and potential commercial applications.
Cancer remains one of the leading causes of death worldwide, prompting the need for innovative treatment methods. Nanotechnology offers promising new approaches, including the use of gold nanoparticles (nanogold) for targeted cancer therapy. Nanogold particles possess unique physical and chemical properties that make them suitable for drug delivery, imaging, and photothermal therapy.
Receptor Discordance in Breast Carcinoma During the Course of Life
Definition:
Receptor discordance refers to changes in the status of hormone receptors (estrogen receptor ERα, progesterone receptor PgR, and HER2) in breast cancer tumors over time or between primary and metastatic sites.
Causes:
Tumor Evolution:
Genetic and epigenetic changes during tumor progression can lead to alterations in receptor status.
Treatment Effects:
Therapies, especially endocrine and targeted therapies, can selectively pressure tumor cells, causing shifts in receptor expression.
Heterogeneity:
Inherent heterogeneity within the tumor can result in subpopulations of cells with different receptor statuses.
Impact on Treatment:
Therapeutic Resistance:
Loss of ERα or PgR can lead to resistance to endocrine therapies.
HER2 discordance affects the efficacy of HER2-targeted treatments.
Treatment Adjustment:
Regular reassessment of receptor status may be necessary to adjust treatment strategies appropriately.
Clinical Implications:
Prognosis:
Receptor discordance is often associated with a poorer prognosis.
Biopsies:
Obtaining biopsies from metastatic sites is crucial for accurate receptor status assessment and effective treatment planning.
Monitoring:
Continuous monitoring of receptor status throughout the disease course can guide personalized therapy adjustments.
Understanding and managing receptor discordance is essential for optimizing treatment outcomes and improving the prognosis for breast cancer patients.
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdfOsvaldo Bernardo Muchanga
GASTROINTESTINAL INFECTIONS AND GASTRITIS
Osvaldo Bernardo Muchanga
Gastrointestinal Infections
GASTROINTESTINAL INFECTIONS result from the ingestion of pathogens that cause infections at the level of this tract, generally being transmitted by food, water and hands contaminated by microorganisms such as E. coli, Salmonella, Shigella, Vibrio cholerae, Campylobacter, Staphylococcus, Rotavirus among others that are generally contained in feces, thus configuring a FECAL-ORAL type of transmission.
Among the factors that lead to the occurrence of gastrointestinal infections are the hygienic and sanitary deficiencies that characterize our markets and other places where raw or cooked food is sold, poor environmental sanitation in communities, deficiencies in water treatment (or in the process of its plumbing), risky hygienic-sanitary habits (not washing hands after major and/or minor needs), among others.
These are generally consequences (signs and symptoms) resulting from gastrointestinal infections: diarrhea, vomiting, fever and malaise, among others.
The treatment consists of replacing lost liquids and electrolytes (drinking drinking water and other recommended liquids, including consumption of juicy fruits such as papayas, apples, pears, among others that contain water in their composition).
To prevent this, it is necessary to promote health education, improve the hygienic-sanitary conditions of markets and communities in general as a way of promoting, preserving and prolonging PUBLIC HEALTH.
Gastritis and Gastric Health
Gastric Health is one of the most relevant concerns in human health, with gastrointestinal infections being among the main illnesses that affect humans.
Among gastric problems, we have GASTRITIS AND GASTRIC ULCERS as the main public health problems. Gastritis and gastric ulcers normally result from inflammation and corrosion of the walls of the stomach (gastric mucosa) and are generally associated (caused) by the bacterium Helicobacter pylor, which, according to the literature, this bacterium settles on these walls (of the stomach) and starts to release urease that ends up altering the normal pH of the stomach (acid), which leads to inflammation and corrosion of the mucous membranes and consequent gastritis or ulcers, respectively.
In addition to bacterial infections, gastritis and gastric ulcers are associated with several factors, with emphasis on prolonged fasting, chemical substances including drugs, alcohol, foods with strong seasonings including chilli, which ends up causing inflammation of the stomach walls and/or corrosion. of the same, resulting in the appearance of wounds and consequent gastritis or ulcers, respectively.
Among patients with gastritis and/or ulcers, one of the dilemmas is associated with the foods to consume in order to minimize the sensation of pain and discomfort.
Spontaneous Bacterial Peritonitis - Pathogenesis , Clinical Features & Manage...Jim Jacob Roy
In this presentation , SBP ( spontaneous bacterial peritonitis ) , which is a common complication in patients with cirrhosis and ascites is described in detail.
The reference for this presentation is Sleisenger and Fordtran's Gastrointestinal and Liver Disease Textbook ( 11th edition ).
Milan J. Anadkat, MD, and Dale V. Reisner discuss generalized pustular psoriasis in this CME activity titled "Supporting Patient-Centered Care in Generalized Pustular Psoriasis: Communications Strategies to Improve Shared Decision-Making." For the full presentation, please visit us at www.peervoice.com/HUM870.
Supporting Patient-Centered Care in Generalized Pustular Psoriasis: Communica...
Approach to CNS tumors Dr. Muhammad Bin Zulfiqar
1. Approach to CNS Tumors
DR MUHAMMAD BIN ZULFIQAR
PGR III FCPS Services institute of Medical
Sciences/ Services Hospital Lahore
Special thanks to RA
2. Analysis of Brain Tumors
• Age
• Location
– Intraaxial / Extraaxial
– What compartment
– Crossing midline or not
• CT and MR Characteristics
– Calcification, fat, Cystic
– T1, T2, DWI
• Contrast enhancement
• Effect on surrounding structures
– Mass effect, edema
• Solitary or multiple
• Pseudo tumor
3. Incidence of CNS Tumors
• One-third of CNS tumors
are metastatic lesions,
• One third are gliomas and
• One-third is of nonglial
origin.
4. Glioma
• In glioma tumors originate from glial cells
– Astrocytes,
– Oligodendrocytes,
– Ependymal and
– Choroid plexus cells.
• Astrocytoma is the most common glioma and can be
subdivided
– low-grade pilocytic type,
– the intermediate anaplastic type
– high grade malignant glioblastoma multiforme (GBM).
• GBM is the most common type (50% of all astrocytomas).
The nonglial cell tumors are a large heterogenous group of
tumors of which meningioma is the most common.
5. Age wise Distribution
• Under the age of 2--Choroid plexus papillomas,
Anaplastic astrocytomas and Teratomas.
• First decade-- Medulloblastomas, Astrocytomas,
Ependymomas, Craniopharyngeomas and Gliomas are
most common, while Metastases are very rare.
When they do occur at this age, metastases of a
Neuroblastoma are the most frequent.
• In adults--about 50% of all CNS lesions are metastases.
Other common tumors in adults are Astrocytomas,
Glioblastoma multiforme, Meningiomas,
Oligodendrogliomas, Pituitary adenomas and
Schwannomas.
• Astrocytomas occur at any age, but glioblastoma
multiforme is mostly seen in older people.
6. • In a Nutshell
– Astrocytoma any age.
– Below 20 years---Craniopharyngioma, Medulloblastoma
and Ependymoma
– Middle age---Oligodendroglioma, pituitary Adenoma
– Old Age--- Meningioma, Metastasis
7. Common Intraaxial Tumors in
Pediatrics
Supratentorial Infratentorial
Astrocytoma Juvenile Pilocytic Astrocytoma
Pleomorphic Xanthoastrocytoma PNET (Medulloblastoma)
PNET Ependymoma
DNET Brainstem Astrocytoma
Ganglioglioma
Although cancer is rare in children, brain tumors are
the most common type of childhood cancer after
leukemia and lymphoma.
8. Common Intraaxial Tumors in Adults
Supratentorial Infratentorial
Metastasis Metastasis
Gliomas
Fibrillary Astrocytoma
Anaplastic Astrocytoma
Glioblastoma Multiforme
Oligodendroglioma
Hemangioblastoma
9. Tumor Location / Spread
• Intraaxial or Extraaxial
• Cortical based tumors
• Local Tumor Spread
• Midline Crossing
10. Signs of Extraaxial Location
CSF cleft
Displaced subarachnoid vessels
Cortical gray between mass and white matter
Displaced and expanded subarachnoid spaces
Broad dural base
Bony reaction
11. • The T2W-images show a schwannoma located in the
cerebellopontine angle (CPA).
• CSF Cleft (yellow arrow)
• Displaced subarachnoid Space (blue arrow)
• Gray Matter between mass and White matter (curved
arrow)
• Wide CSF spaces (long arrow)
• In the region of the CPA 90% of the extra-axial tumors are
schwannomas.
12. Image shows meningioma (Enplaque Meningioma)
broad dural base and a dural tail of enhancement(blue arrow)
There is hyperostosis in the adjacent bone (yellow arrow)
lesion enhances homogeneously (Extra-axial tumors are not derived
from brain tissue and do not have a blood-brain-barrier, so most of
them enhance homogeneously)
13. Tumor Spread
Astrocytomas spread along the white matter tracts and
do not respect the bounderies of the lobes. Because of
this infiltrative growth, in many cases the tumor is
actually larger than can be depicted with MR.
Ependymomas of the fourth ventricle in children tend
to extend through the foramen of Magendie to the
cisterna magna and through the lateral foramina of
Luschka to the cerebellopontine angle.
Oligodendrogliomas typically show extension to the
cortex.
14. A hyperintense contrast enhancing lesion with
extension to the prepontine area (blue arrows)
and into the foramen magnum (red arrow).
This Lesion proved to be Ependymoma
15. Subarachnoid seeding
•
Some tumors show subarachnoid seeding and form
tumoral nodules along the brain and spinal cord.
• This is seen in PNET, ependymomas, GBMs,
lymphomas, oligodendrogliomas and choroid plexus
papillomas.
Primitive neuroectodermal tumours (PNET) form a rare
group of tumors, which develop from primitive or
undifferentiated nerve cells. e.g.
medulloblastomas
pineoblastomas.
16. • Imaging in different planes help a lot in suggesting full
extension of mass lesion, as most of time it is greater
than expected.
• Above images show that tumor is situated in the
pterygopalatine fossa and extends into the orbit and
middle cranial fossa
17. Mass effect and edema
• Primary brain tumors are derived from brain
cells and often have less mass effect for their
size than expected, due to their infiltrative
growth.
• This is not the case with metastases and extra-
axial tumors like meningiomas or
schwannomas, which have more mass effect
due to their expansive growth.
18. Above image shows a diffusely infiltrating intra-axial tumor occupying
most of the right hemisphere with only a minimal mass effect.
This is typical for the infiltrative growth seen in primary brain tumors.
There is no enhancement so this would probably be a low-grade
astrocytoma.
19. Midline Crossing
Glioblastoma multiforme (GBM) frequently
crosses the midline by infiltrating the white
matter tracts of the corpus callosum.
Radiation necrosis can look like recurrent
GBM and can sometimes cross the midline.
Meningioma is an extra-axial tumor and can
spread along the meninges to the
contralateral side.
Continued
21. Midline Crossing
Lymphoma is usually located near the
midline.
Epidermoid cysts can cross the midline via the
subarachnoid space.
MS can also present as a mass lesion in the
corpus callosum.
Continued
24. Multifocal Disease
• Multiple tumors in the brain usually indicate metastatic
disease.
• Primary brain tumors are typically seen in a single
region, but some brain tumors like lymphomas,
multicentric glioblastomas and gliomatosis cerebri can
be multifocal.
• Some tumors can be multifocal as a result of seeding
metastases: this can occur in medulloblastomas (PNET-
MB), ependymomas, GBMs and oligodendrogliomas.
Meningiomas and schwannomas can be multiple,
especially in neurofibromatosis type II.
25. Multifocal Disease
Multiple brain tumors can be seen in phacomatoses:
– Neurofibromatosis I: optic gliomas and astrocytomas
– Neurofibromatosis II: meningiomas, ependymomas,
choroid plexus papillomas (figure)
– Tuberous Sclerosis: subependymal tubers, intraventricular
giant cell astrocytomas, ependymomas
– von Hippel Lindau: hemangioblastomas
Many non tumorous diseases like small vessel disease,
infections (septic emboli, abscesses) or demyelinating
diseases like MS can also present as multifocal disease.
27. Cortical based tumors
• Most intra-axial tumors are located in the white
matter.
• Some tumors, however, spread to or are located
in the gray matter.
• The differential diagnosis for these cortical based
tumors includes Oligodendroglioma,
ganglioglioma and Dysembryoplastic
Neuroepithial Tumor (DNET).
• A DNET is a rare benign neoplasm, usually in a
cortical and temporal location.
• Patients with a cortically based tumor usually
present with complex seizures.
28. There is a non-enhancing, cortically based tumor.
This is a ganglioglioma.
The differential diagnosis includes DNET and
pilocytic astrocytoma.
29. The CT shows a mass with
calcifications, which
extends all the way to the
cortex.
Although this is a large
tumor there is only limited
mass effect on surrounding
structures, which indicates
that this is an infiltrating
tumor.
The most likely diagnosis is
Oligodendroglioma.
The differential diagnosis
includes a malignant
astrocytoma or a
glioblastoma.
30. CT & MR Characteristics
• Fat has a low density on CT (- 100HU).
• On MR, fat has a high signal intensity on both T1- and T2WI.
• On sequences with fat suppression fat can be differentiated from high
signal caused by subacute hematoma, melanin, slow flow etc.
• When you see high signal on T1WI always look for chemical shift artefact,
as this indicates the presence of fat. The chemical shift artefact occurs as
alternating bands of high and low signal on the boundaries of a lesion and
is seen only in the frequency encoding direction.
• Fat within a tumor is seen in lipomas, dermoid cysts and teratomas.
Some tumors can have a high density on CT.
This is typically seen in lymphoma, colloid cyst and PNET-MB
(medulloblastoma).
32. Calcifications
• Oligodendroglioma nearly always have
calcifications.
• However an intraaxial calcified tumor in the brain
is more likely to be an astrocytoma than a
oligodendrogliomas, since astrocytomas,
although less frequently calcified, are far more
common.
A pineocytoma itself does not calcify, but instead
it 'explodes' the calcifications of the pineal gland.
33. • A calcified mass seen in the suprasellar region, causing obstructive
hydrocephalus.
• This location in the suprasellar region and the calcification are typical for a
craniopharyngioma.
• Craniopharyngiomas are slow growing, extra-axial, squamous epithelial,
calcified, cystic tumors arising from remnants of Rathke's cleft.
• They are located in the suprasellar region and primarily seen in children
with a small second peak incidence in older adults.
34. • On the left are images of a tumor with a small
calcification.
• The calcification is not appreciated on the MR images,
but is easily seen on CT.
• The calcification and the extension of the tumor to the
cortex are very typical for an oligodendroglioma.
An astrocytoma should be in the differential.
35. • On the coronal and sagittal TW1I there is a
large mass centered around the sella with a
broad dural base.
• There is extension into the sella.
• CT shows densely calcified tumor.
36. Cystic versus Solid
• There are many cystic lesions that can simulate a CNS
tumor.
• These include epidermoid, dermoid, arachnoid,
neuroenteric and neuroglial cysts.
• Even enlarged perivascular spaces of Virchow Robin
can simulate a tumor.
In order to determine whether a lesion is a cyst or
cystic mass look for the following characteristics:
– Morphology
– Fluid/fluid level
– Content usually isointense to CSF on T1, T2 and FLAIR
– DWI: restricted diffusion
37. Cystic versus Solid
• An arachnoid cyst is isointense to CSF on all
sequences.
• Tumor necrosis may sometimes look like a
cyst, but it is never completely isointense to
CSF.
38. • Craniopharyngioma shows an enhancing rim
surrounding the cystic component.
• Neuroenteric cyst with the contents of which
have the same signal intensity as CSF.
• Glioblastoma multiforme (GBM) with a central
cystic component.The enhancement in GBM is
usually more irregular.
39. High Intensity on T1
• Most tumors have a low or intermediate signal intensity on
T1WI.
• Exceptions to this rule can indicate a specific type of tumor.
• Calcifications are mostly dark on T1WI, but depending on
the matrix of the calcifications they can sometimes be
bright on T1.
• Especially on gradient echo images slow flow can be seen
as bright signal on T1WI and should not be confused with
enhancement. This is particularly pronounced on gradient
echo images.
• If you only do an enhanced scan, remember that high signal
is not always enhancement.
40. High Intensity on T1
Methemoglobin Pituitary apoplexy
Hemorrhagic tumor or metastasis
Thrombosed aneurysm
High protein Cyst with proteineous fluid e.g.
Neuroenteric cyst, dermoid cyst
Fat Lipoma
Dermoid cyst
Cholesterol Colloid cyst
Melanin Melanoma metastasis
Flow effects Slow flow
Paramagnetic cations (Cu, Mn, etc)
41. • Above are some images of tumors with high signal
intensities on T1WI.
• On the far left images of a patient who presented with
apoplexy.
The high signal is due to hemorrhage in a pituitary
macroadenoma.
• The patient in the middle has a glioblastoma multiforme,
which caused a hemorrhage in the splenium of the corpus
callosum.
• On the right is a patient with a metastasis of a melanoma.
The high signal intensity is due to the melanin content.
42. Low Signal Intensity on T2W Images
• Most tumors will be bright on T2WI due to a high water content.
• When tumors have a low water content they are very dense and
hypercellular and the cells have a high nuclear to cytoplasmasmic
ratio. These tumors will be dark on T2WI.
The classic examples are CNS lymphoma and PNET (also hyperdense
on CT).
Calcifications are mostly dark on T2WI.
• Paramagnetic effects cause a signal drop and are seen in tumors
that contain hemosiderin.
• Proteinaceous material can be dark on T2 depending on the content
of the protein itself. A classic example of this is the colloid cyst.
• Flow voids are also dark on T2 and indicate the presence of vessels
or flow within a lesion. This is seen in tumors that contain a lot of
vessels like hemangioblastomas, but also in non-tumorous lesions
like vascular malformations.
43. Low Signal Intensity on T2W Images
Hypercellularity Lymphoma, Meningioma, PNET, Germinoma, GBM,
Oligodendroglioma, Mucinous-adeno metastasis (GI,
Lung, Breast, GU)
Calcification See above
Blood Old hemorrhage in tumor or vascular malformation
Protein Colloid cyst
Melanin Melanoma metastasis
Flow void Hemangioblastoma, vascular malformation
44. Melanoma GBM PNET
• Melanoma metastases have a low SI on T2WI as a
result of the melanin.
• GBM can have a low SI on T2WI because sometimes
they have a high nuclear cytoplasmic ratio. Most
GBM's, however, are hyperintense on T2WI.
• PNET typically has a high nuclear cytoplasmic ratio.
PNET is mostly located in the region of the 4th
ventricle, but another, less common, location is in the
region of the pineal gland.
45. Mucinous Ca Lymphoma Lymphoma Flair
• Mucinous metastases can have a low SI on
T2WI because they often contain
calcifications.
46. Oligodendroglioma Ependymoma Meningioma
• Meningiomas are mostly of intermediate signal.
They can have a high SI on T2WI if they contain a
lot of water.
They can have a low SI on T2WI if they are very
dense and hypercellular or when they contain
calcifications.
47. • We see restriction in above left extreme image as
it is hyperintense, while lower extreme left image
shows no restriction.
48. Diffusion weighted imaging
• Normally water protons have the ability to diffuse
extracellularly and loose signal.
High intensity on DWI indicates restriction of the ability
of water protons to diffuse extracellularly.
Restricted diffusion is seen in abscesses, epidermoid
cysts and acute infarction (due to cytotoxic edema).
• In cerebral abscesses the diffusion is probably
restricted due to the viscosity of pus, resulting in a high
signal on DWI.
In most tumors there is no restricted diffusion - even in
necrotic or cystic components.
This results in a normal, low signal on DWI.
49. Perfusion Imaging
• Perfusion imaging can play an important role in
determining the malignancy grade of a CNS
tumor.
• Perfusion depends on the vascularity of a tumor
and is not dependent on the breakdown of the
blood-brain barrier.
• The amount of perfusion shows a better
correlation with the grade of malignancy of a
tumor than the amount of contrast
enhancement.
51. Contrast Enhancement
• The brain has a unique triple layered blood-brain barrier (BBB) with
tight endothelial junctions in order to maintain a consistent internal
milieu.
• Contrast will not leak into the brain unless this barrier is damaged.
Enhancement is seen when a CNS tumor destroys the BBB.
• Extra-axial tumors such as meningiomas and schwannomas are not
derived from brain cells and do not have a blood-brain barrier.
Therefore they will enhance.
• There is also no blood-brain barrier in the pituitary, pineal and
choroid plexus regions.
• Some non-tumoral lesions enhance because they can also break
down the BBB and may simulate a brain tumor. These lesions
include like infections, demyelinating diseases (MS) and infarctions.
52. Contrast Enhancement
• On the T2WI there is a lesion in the left temporal lobe, found
incidentally. There was no enhancement and the DWI was normal.
During follow-up there was a slight increase in size.
This was diagnosed as a low-grade astrocytoma.
• Contrast enhancement cannot visualize the full extent of a tumor in
cases of infiltrating tumors, like gliomas.
53. Contrast Enhancement
• In gliomas - like astrocytomas, oligodendrogliomas
and glioblastoma multiforme - enhancement usually
indicates a higher degree of malignancy.
• Therefore when during the follow up of a low-grade
glioma the tumor starts to enhance, it is a sign of
malignant transformation.
• Gangliogliomas and pilocytic astrocytomas are the
exceptions to this rule: they are low-grade tumors,
but they enhance vividly.
54. • Low grade tumors with enhancement:
ganglioglioma (right) and a pilocytic
astrocytoma (left)
55. Contrast Enhancement
• The amount of enhancement depends on the
amount of contrast that is delivered to the
interstitium.
• In general, the longer we wait, the better the
interstitial enhancement will be.
• The optimal timing is about 30 minutes and it
is better to give contrast at the start of the
examination and to do the enhanced T1WI at
the end.
56. • Schwannoma extending into the middle
cranial fossa with homogeneous enhancement
(right).Primary Lymphoma shows vivid
enhancement (left).
57. Contrast Enhancement
• No enhancement is seen in:
• Low grade astrocytomas
• Cystic non-tumoral lesions:
– Dermoid cyst
– Epidermoid cyst
– Arachnoid cyst
58. • Above image shows an intra-axial tumor in an adult. It is centered in
the temporal lobe and involves the cortex. Although there is
massive infiltrative growth involving a large part of the right
cerebral hemisphere, there is only minimal mass effect.
There is no enhancement. These features are typical for a low
grade astrocytoma.
59. Contrast Enhancement
• Homogeneous enhancement can be seen in:
• Metastases
• Lymphoma
• Germinoma and other pineal gland tumors
• Pituitary macroadenoma
• Pilocytic astrocytoma and hemangioblastoma
(only the solid component)
• Ganglioglioma
• Meningioma and Schwannoma
62. Contrast Enhancement
• Patchy enhancement can be seen in:
• Metastases
• Oligodendroglioma
• Glioblastoma multiforme
• Radiation necrosis
•
63. • Above image shows glioblastoma multiforme
(GBM). The enhancement indicates that this is a high-
grade tumor, but only parts of it enhance. Notice that
there is also a cystic component with ring
enhancement. The tumor cells probably extend beyond
the area of edema as seen on the FLAIR image.
This is because gliomas grow infiltratively into normal
brain - initially without any MR changes.
64. • Above images show a tumor located in the right hemisphere.
Although is a large tumor, the mass-effect is limited. This
indicates that there is marked infiltrative growth, a
characteristic typical for gliomas. Notice the heterogeneity
on both T2WI and FLAIR. There is patchy enhancement. All
these findings are typical for a GBM. Virtually no other tumor
behaves in this way.
67. Contrast Enhancement
• Above patient is diagnosed case
Neurofibromatosis II. After the administration of
contrast the two meningiomas and the
schwannoma are easily seen.
68. Contrast Enhancement
• Leptomeningeal metastases are usually not seen
without the administration of intravenous contrast.
The case demonstrates the abnormal enhancement
along the brainstem, along the folia of the cerebellum
(yellow arrow) and along the fifth intracranial nerve
(blue arrow) in a patient with leptomeningeal
metastases.
70. • Above image shows a midline tumor arising from the
clivus. This is the typical presentation of a chordoma.
The differential diagnosis would include a metastasis
and a chondrosarcoma.
71. • Above another skull base tumor located off midline. This is a typical
presentation for a chondrosarcoma. The differential diagnosis
would include a metastasis and a paraganglioma. Chondrosarcomas
can be located in the midline and chordomas are sometimes
located off midline but those cases are exceptional.
72. • On the left an example of a Skull Base
Paraganglioma.
73. • Above images show an enhancing mass anterior
to the skull base and also in the region of the
right cavernous sinus.
In the bone window setting there is sclerosis of
the skull base, particularly in the region of the
clivus.
Continue
74. • On the left enhanced sagittal and coronal T1WI. The most striking
finding is the black clivus due to the sclerosis. A normal clivus is
bright on T1WI as a result of the fatty bone marrow. There is an
enhancing mass anterior to the clivus.
• On the coronal images we see the enhancement extending through
the foramen ovale to the right of the cavernous sinus.
The diagnosis is a nasopharyngeal squamous cell carcinoma with
intracranial extension.
• The differential diagnosis would include: skull base metastasis,
lymphoma, chronic infection and even a meningioma - although
this would be an unusual way for a meningioma to spread.
76. • On the left are images of a mass in the
suprasellar cistern. On the NECT we can see that
it contains calcium. On the T1WI there is a
hyperintense area that shows no enhancement
(i.e. cystic). There are other components that
show enhancement. The tumor is complicated by
a hydrocephalus. These findings are very specific
for a craniopharyngeoma.
77. • Above a NECT and enhanced CT-images Show
a contrast enhancing midline lesion above
pituitary fossa
78. • Notice the normal inferiorly displaced
pituitary gland. This means it is not a
macroadenoma. The diagnosis is again a
craniopharyngioma.
The differential diagnosis would include an
astrocytoma and a meningioma.
80. • The images show an unusual cystic mass with
enhancing septations. There is also some
enhancement within the internal acoustic canal.
Based on the images the most likely diagnosis
would be a cystic schwannoma, but this
happened to be an uncommon, cystic
presentation of a meningioma.
84. • Above images show tumor located in the pineal region.
The tumor contains calcifications. There is
homogeneous enhancement, which is common for a
tumor in the pineal region.
Based on the age of the patient, the location and the
tumor characteristics, this is most likely a germinoma.
86. • On the left a tumor located in the 3rd ventricle.
The tumor contains calcifications.
The diagnosis is a giant cell astrocytoma.
87. 4th ventricle
• In children tumors in the 4th ventricle are very
common.
Astrocytomas are the most common followed by
medulloblastomas (or PNET-MB), ependymomas
and brainstem gliomas with a dorsal exophytic
component.
• In adults tumors in the 4th ventricle are
uncommon. Metastases are most frequently
seen, followed by hemangioblastomas, choroid
plexus papillomas and dermoid and epidermoid
cysts.
88. • Many non-
tumorous lesions
can mimic a brain
tumor.
Abscesses can
mimic metastases.
Multiple sclerosis
can present with a
mass-like lesion
with enhancement,
also known as
tumefactive
multiple sclerosis..
In the parasellar
region one should
always consider
the possibility of a
aneurysm.
91. • Sometimes it can be very difficult to differentiate between intra/extra
axial mass lesions and imaging in multiple planes may be necessary.
• Above tumor apparently look like falcine meningioma, but on careful
inspection we can appreciate gray matter on the anteromedial and
posteromedial side of the lesion (red arrow). This indicates that the
lesion is intra-axial.
• If the lesion was extra-axial the gray matter should have been pushed
away.
• Histopathology proved this mass lesion to be a melanoma metastasis.
The most common tumors in adults are listed in the table on the left.Note that metastases are by far the most common. It is important to realize that 50% of metastases are solitary.Particularly in the posterior fossa, metastases should be in the top 3 of the differential diagnostic list.Hemangioblastoma is an uncommon tumor, but it is the most common primary intra-axial tumor in the adult.Supratentorially, metastases are also the most common tumors, followed by gliomas.
Bony changes are seen in bone tumors like chordomas, chondrosarcomas and metastases. They can also be secondary, as is seen in meningiomas and other tumors.
These cortically based tumors have to be differentiated from non-tumorous lesions like cerebritis, herpes simplex encephalitis, infarction and post-ictal changes.
The reason for this is that tumor cells blend with the normal brain parenchyma where the blood brain barrier is still intact. Tumor cells can be found beyond the enhancing margins of the tumor and beyond any MR signal alteration - even beyond the area of edema.
It is not possible to resect such a lesion, since the infiltrating tumors cells are within the normal-appearing brain tissue.
Common skull base tumors are listed in the table on the left. These tumors either arise from extracranial structures like the sinuses (sinonasal carcinoma), or from the skull base itself (chordoma, chondrosarcoma, fibrous dysplasia).Chordoma is usually located in the midline, while chondrasarcoma usually arises off the midline.
This lesion surely has the appearance of a meningioma: these tumors can be hypointense on T2 due to a fibrocollageneous matrix or calcifications and frequently produce reactive edema in the adjacent white matter of the brain.