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Arunnit Boonrod
• Detection
• Localization
• Characterization
GBM
Intraventricular astrocytoma
Meningioma
Chapter 11 Adult brain tumor, MRI of brain and spine 4th edition, Atlas
Anaplastic brainstem glioma
Brainstem astrocytoma
Chapter 11 Adult brain tumor, MRI of brain and spine 4th edition, Atlas
• Detection
• Characterization
• Intra or extra axial
tumor?
tumor =
tumor locates within
brain parenchyma
tumor =
tumor locates outside
the brain parenc...
• CSF cleft between brain and lesion
• Vessels interposed between brain and
lesion
• Cortex between brain and lesion
• Dur...
• Specific location
– Intra-axial  Lobes, cortical base, periventricular,
midline crossing
– Extra-axial  CPA, sellar/ p...
CSF cleft (yellow arrow).
Displaced subarachnoid vessels (blue arrow)
Gray matter between lesion (curved red arrow).
W...
• Detection
• Localization
• Border
– Well or ill define
– Localized or infiltrative
• Tumor tissue
– Calcification
– Hemorrhage
– Cystic
– Necrosis
...
• Detection
• Localization
• Characterization
• Extra-axial tumor
– Meningioma
– Schwannoma
– Epidermoid cyst
• Intra-axial tumor
– Primary brain tumor; glioma
– Second...
• 80% of extra-axial lesions = meningioma or a
schwannoma.
• 75% of intra-axial = metastasis or astrocytoma
Brain tumor-sy...
• Most common nonglial primary brain tumor
• 15-20% of primary brain tumor
• Peak incidence 40-60 years
• Female:Male = 2:...
CT
• 70-75% hyperdense
• 20-25% calcified
• 90% enhanced strongly
• 10-15% Cystic area
• 60% Peritumoral edema
• Hemorrhag...
• A. Sagittal T1w and B. FLAIR show
a large mass deviating the
cerebellum.
• C. T2w: homogeneous, low-
signal-intensity ma...
• 6-8 % of primary brain tumor
• Most common CPA mass (75-80%)
• Peak incidence 50-60 years
• Associated with NF-2
Chapter...
• Cystic, hemorrhage
• Less calcification
• Peritumoral arachnoid cyst.
• At CPA cistern
– Intracanalicular component,  w...
www.headneckbrainandspine.com
T1: usually iso-intense to CSF
T1 C+ :thin enhancement around the periphery may sometimes be seen
T2: usually iso-intense ...
– Meningioma
– Schwannoma
– Epidermoid
– Primary brain tumor; glioma
– Secondary or brain metastasis
• Most common intra-axial brain masses
– lymphoma (5%)
– demyelinating and inflammatory conditions (3%)
– infarcts (2%)
– ...
Mitosis
Microproliferative vss
Necrosis
Can’t see
MR perfusion (rCBV),
enhancement
MRS, DWI
Low grade
astrocytoma
Anaplastic
astrocytoma
Glioblastoma
(GBM)
• 40-70 yrs
• For intracranial metastasis; intraaxial metastasis is
the most common form.
– Lung, breast, melanoma, GI, RC...
• Focal lesion at GW junction with
• Extensive edema more than primary glioma or abscess.
• Essentially .
• Cortical metas...
• Three simple steps
– Detection
– Localization
– Characterization
• Sign of extra-axial location
between brain
and lesion
• Chapter 11 Adult brain tumor, MRI of brain and spine 4th edition,
Atlas
• Brain tumor-systematic approach, Radiology ass...
Basic approach to brain tumor
Basic approach to brain tumor
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Basic approach to brain tumor

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detection, localization, characterization

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Basic approach to brain tumor

  1. 1. Arunnit Boonrod
  2. 2. • Detection • Localization • Characterization
  3. 3. GBM Intraventricular astrocytoma Meningioma Chapter 11 Adult brain tumor, MRI of brain and spine 4th edition, Atlas
  4. 4. Anaplastic brainstem glioma Brainstem astrocytoma Chapter 11 Adult brain tumor, MRI of brain and spine 4th edition, Atlas
  5. 5. • Detection • Characterization
  6. 6. • Intra or extra axial tumor? tumor = tumor locates within brain parenchyma tumor = tumor locates outside the brain parenchyma, such as Skull, CSF cisterns and ventricles.
  7. 7. • CSF cleft between brain and lesion • Vessels interposed between brain and lesion • Cortex between brain and lesion • Dura (Meninges) between brain and lesion • Peripheral, broadly base along calvarium • Overlying bone change • Enhancement of adjacent meninges • Displaement of brain from the skull Chapter 11 Adult brain tumor, MRI of brain and spine 4th edition, Atlas
  8. 8. • Specific location – Intra-axial  Lobes, cortical base, periventricular, midline crossing – Extra-axial  CPA, sellar/ parasellar, intraventricular (specific ventricle), pineal region, skull base tumor, etc.
  9. 9. CSF cleft (yellow arrow). Displaced subarachnoid vessels (blue arrow) Gray matter between lesion (curved red arrow). Widen subarachnoid space 90% CPA mass = schwannoma Brain tumor-systematic approach, Radiology assistant
  10. 10. • Detection • Localization
  11. 11. • Border – Well or ill define – Localized or infiltrative • Tumor tissue – Calcification – Hemorrhage – Cystic – Necrosis – Cellularity – Enhancement pattern • Surrounding structures – Extension – Bone and dural change – Mass effect – Degree of perilesional brain edema
  12. 12. • Detection • Localization • Characterization
  13. 13. • Extra-axial tumor – Meningioma – Schwannoma – Epidermoid cyst • Intra-axial tumor – Primary brain tumor; glioma – Secondary or brain metastasis
  14. 14. • 80% of extra-axial lesions = meningioma or a schwannoma. • 75% of intra-axial = metastasis or astrocytoma Brain tumor-systematic approach, Radiology assistant
  15. 15. • Most common nonglial primary brain tumor • 15-20% of primary brain tumor • Peak incidence 40-60 years • Female:Male = 2:1-4:1 • Most common at parasagittal and convexity
  16. 16. CT • 70-75% hyperdense • 20-25% calcified • 90% enhanced strongly • 10-15% Cystic area • 60% Peritumoral edema • Hemorrhage rare • Bone change: Hyperostosis, erosion, pneumosinus dilatans MRI • Typically isointense signal to gray matter • > 95% enhanced strongly, commonly heterogeneous • CSF/ Vascular cleft • 60 % dural tail Chapter 14 meningioma and other nonglial neoplasms, Diagnostic neuroradiolgy, Anne Osborn.
  17. 17. • A. Sagittal T1w and B. FLAIR show a large mass deviating the cerebellum. • C. T2w: homogeneous, low- signal-intensity mass with widening of the CPA cistern and deviation of the brainstem, findings characteristic of an extraaxial mass. • D. After contrast, the mass enhances diffusely and shows the typical association of a dural tail of enhancement, a finding not seen with most other common cerebellopontine angle masses, such as acoustic schwannoma. Chapter 11 Adult brain tumor, MRI of brain and spine 4th edition, Atlas
  18. 18. • 6-8 % of primary brain tumor • Most common CPA mass (75-80%) • Peak incidence 50-60 years • Associated with NF-2 Chapter 15 Miscellaneous tumors, Diagnostic neuroradiolgy, Anne Osborn.
  19. 19. • Cystic, hemorrhage • Less calcification • Peritumoral arachnoid cyst. • At CPA cistern – Intracanalicular component,  widening of the porus acusticus  Trumpet sign – Extracanalicular extension into cerebellopontine angle "ice-cream-cone" appearance. Chapter 15 Miscellaneous tumors, Diagnostic neuroradiolgy, Anne Osborn.
  20. 20. www.headneckbrainandspine.com
  21. 21. T1: usually iso-intense to CSF T1 C+ :thin enhancement around the periphery may sometimes be seen T2: usually iso-intense to CSF (65%) FLAIR: often heterogeneous/dirty signal; higher than CSF Dirty CSF DWI: Restricted diffusion Chapter 15 Miscellaneous tumors, Diagnostic neuroradiolgy, Anne Osborn.
  22. 22. – Meningioma – Schwannoma – Epidermoid – Primary brain tumor; glioma – Secondary or brain metastasis
  23. 23. • Most common intra-axial brain masses – lymphoma (5%) – demyelinating and inflammatory conditions (3%) – infarcts (2%) – abscesses (1%) TilgnerJ, Herr M, Ostertag C, Volk B. Validation of intraoperative diagnoses using smear preparations from stereotactic brain biopsies: intraoperative versus final diagnosis—influence of clinical factors. Neurosurgery2005; 56(2): 257–263.
  24. 24. Mitosis Microproliferative vss Necrosis Can’t see MR perfusion (rCBV), enhancement MRS, DWI
  25. 25. Low grade astrocytoma Anaplastic astrocytoma Glioblastoma (GBM)
  26. 26. • 40-70 yrs • For intracranial metastasis; intraaxial metastasis is the most common form. – Lung, breast, melanoma, GI, RCC and unknown origin • Usually multiple, but 30-50% solitary (esp. melanoma, lung, breast) • Early deposit at gray-white junction (like other hematogeneous diseases)
  27. 27. • Focal lesion at GW junction with • Extensive edema more than primary glioma or abscess. • Essentially . • Cortical metastasis shows less edema  might be seen only on post contrast study. • Variable signals. • Variable types of enhancement. • Any patient with a primary cancer with intracranial enhancement in a non vascular distribution,
  28. 28. • Three simple steps – Detection – Localization – Characterization • Sign of extra-axial location between brain and lesion
  29. 29. • Chapter 11 Adult brain tumor, MRI of brain and spine 4th edition, Atlas • Brain tumor-systematic approach, Radiology assistant • Chapter 14 meningioma and other nonglial neoplasms, Diagnostic neuroradiolgy, Anne Osborn. • Chapter 15 Miscellaneous tumors, Diagnostic neuroradiolgy, Anne Osborn. • www.headneckbrainandspine.com • TilgnerJ, Herr M, Ostertag C, Volk B. Validation of intraoperative diagnoses using smear preparations from stereotactic brain biopsies: intraoperative versus final diagnosis—influence of clinical factors. Neurosurgery2005; 56(2): 257–263.

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