This document summarizes key MRI features of common pediatric posterior fossa and suprasellar tumors. It discusses pilocytic astrocytoma, medulloblastoma, atypical teratoid-rhabdoid tumor, ependymoma, brainstem glioma, hemangioblastoma, craniopharyngioma, and hypothalamic hamartoma. For each tumor type, it describes typical location, imaging appearance on various MRI sequences, distinguishing imaging characteristics, and differential diagnosis considerations.
Intraventricular mass (Radiology) of a child {A CASE}Dr.Santosh Atreya
An intraventricular mass was found in a 5-year-old child. The main differential diagnoses included choroid plexus carcinoma, central neurocytoma, primitive neuroectodermal tumor, and atypical teratoid rhabdoid tumor. Imaging findings like location in the ventricle, enhancement pattern, and presence of calcification or cysts can help narrow the diagnosis, as the masses have overlapping characteristics. An accurate diagnosis is important to guide surgical planning and determine appropriate post-operative treatment.
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.
This document discusses various types of embryonal brain tumors that occur in children. It begins by providing background on the incidence of childhood cancers and CNS tumors specifically. It then lists and describes the main embryonal brain tumor types seen in children, including medulloblastoma, atypical teratoid/rhabdoid tumor, embryonal tumor with multilayered rosettes, pineoblastoma, and pituitary blastoma. For each tumor type, it discusses characteristics such as age of onset, location, histopathological features, molecular markers, treatment approaches, and prognosis. It emphasizes the importance of molecular classification in determining treatment strategies and clinical outcomes for these tumors.
1) The document discusses several types of neoplasms that can arise intraventricularly, including medulloblastoma, ependymoma, subependymoma, and choroid plexus tumors.
2) Medulloblastoma most commonly presents in the roof of the fourth ventricle in children, while ependymoma can occur in any age and location.
3) Imaging plays an important role in the diagnosis and characterization of intraventricular masses, with MRI providing the best visualization of location and extent of disease.
I LOVE NEUROSURGERY INITIATIVE: INTRACRANIAL TUMORS.pptwalid maani
This document discusses intracranial tumors, including:
- Their incidence rates, with primary brain tumors occurring in 6 per 100,000 people and metastatic tumors in 30 per 100,000 people.
- Common tumor types like astrocytomas, oligodendrogliomas, ependymomas, medulloblastomas, meningiomas, and pituitary tumors.
- Risk factors, clinical presentation, investigations including CT, MRI, PET and angiography, pathology classification, and management approaches like surgery, radiation and chemotherapy.
This document provides information about various types of brain tumors, including their epidemiology, signs and symptoms, diagnosis, and treatment. It discusses tumors such as glioblastoma, meningioma, schwannoma, oligodendroglioma, hemangioblastoma, and pituitary adenoma. Some key points are: glioblastoma is the most common and malignant glial tumor; meningioma arises from the meninges and is usually benign; and pituitary adenomas can be non-functioning or hormone producing. Diagnosis involves imaging, biopsy, and neurological exam. Treatment depends on the tumor type but may include surgery, radiation, chemotherapy, and supportive care.
Intraventricular mass (Radiology) of a child {A CASE}Dr.Santosh Atreya
An intraventricular mass was found in a 5-year-old child. The main differential diagnoses included choroid plexus carcinoma, central neurocytoma, primitive neuroectodermal tumor, and atypical teratoid rhabdoid tumor. Imaging findings like location in the ventricle, enhancement pattern, and presence of calcification or cysts can help narrow the diagnosis, as the masses have overlapping characteristics. An accurate diagnosis is important to guide surgical planning and determine appropriate post-operative treatment.
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.
This document discusses various types of embryonal brain tumors that occur in children. It begins by providing background on the incidence of childhood cancers and CNS tumors specifically. It then lists and describes the main embryonal brain tumor types seen in children, including medulloblastoma, atypical teratoid/rhabdoid tumor, embryonal tumor with multilayered rosettes, pineoblastoma, and pituitary blastoma. For each tumor type, it discusses characteristics such as age of onset, location, histopathological features, molecular markers, treatment approaches, and prognosis. It emphasizes the importance of molecular classification in determining treatment strategies and clinical outcomes for these tumors.
1) The document discusses several types of neoplasms that can arise intraventricularly, including medulloblastoma, ependymoma, subependymoma, and choroid plexus tumors.
2) Medulloblastoma most commonly presents in the roof of the fourth ventricle in children, while ependymoma can occur in any age and location.
3) Imaging plays an important role in the diagnosis and characterization of intraventricular masses, with MRI providing the best visualization of location and extent of disease.
I LOVE NEUROSURGERY INITIATIVE: INTRACRANIAL TUMORS.pptwalid maani
This document discusses intracranial tumors, including:
- Their incidence rates, with primary brain tumors occurring in 6 per 100,000 people and metastatic tumors in 30 per 100,000 people.
- Common tumor types like astrocytomas, oligodendrogliomas, ependymomas, medulloblastomas, meningiomas, and pituitary tumors.
- Risk factors, clinical presentation, investigations including CT, MRI, PET and angiography, pathology classification, and management approaches like surgery, radiation and chemotherapy.
This document provides information about various types of brain tumors, including their epidemiology, signs and symptoms, diagnosis, and treatment. It discusses tumors such as glioblastoma, meningioma, schwannoma, oligodendroglioma, hemangioblastoma, and pituitary adenoma. Some key points are: glioblastoma is the most common and malignant glial tumor; meningioma arises from the meninges and is usually benign; and pituitary adenomas can be non-functioning or hormone producing. Diagnosis involves imaging, biopsy, and neurological exam. Treatment depends on the tumor type but may include surgery, radiation, chemotherapy, and supportive care.
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.
This document discusses embryonal brain tumors in children. Some key points:
- Embryonal tumors account for a large fraction of pediatric brain tumors and have a tendency to disseminate through cerebrospinal fluid.
- Major embryonal tumor types include medulloblastoma, CNS primitive neuroectodermal tumor, and atypical teratoid/rhabdoid tumor.
- Medulloblastoma is the most common malignant primary brain tumor in children. It can be classified based on histology and molecular markers into subgroups like WNT, SHH, Group 3 and Group 4 that have different clinical behaviors and prognoses.
- Treatment involves surgery, chemotherapy and radiation therapy
Unusual non epithelial tumors of head and neckDrAyush Garg
This document provides information on several unusual non-epithelial tumors of the head and neck region. It discusses glomus tumors, hemangiopericytomas, chordomas, lethal midline granuloma, chloroma, and radiation therapy techniques for treating some of these tumors. Key information includes the classification, epidemiology, pathology, clinical presentation, diagnostic workup, management including surgery and radiation therapy, and radiation therapy techniques for glomus tumors, hemangiopericytomas, chordomas, and lethal midline granuloma.
Dr. Sharmin Nahar and Dr. Olivia Akhter are presenting a seminar on pediatric hematology and oncology at BSMMU. They discuss the case of a 2-year-old girl admitted with headaches, vomiting, and seizures for the past month as well as left-sided weakness. Imaging shows a mass in the 4th ventricle causing hydrocephalus, possibly an ependymoma or medulloblastoma. They then provide an introduction to brain tumors in children, discussing types, incidence, risk factors, classification, and clinical features. Treatment options for brain tumors including surgery, radiation, and chemotherapy are also summarized.
PINEAL REGION TUMORS DIAGNOSIS & SURGICAL APPROACHES.pptxMedhatMoustafa3
Anatomy and related vascular structures of pineal region.pathological classification and incidence. Clinical Presentations and different diagnostics modalities. Different surgical approaches for pineal region
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.
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.
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.
1. World Health Organization (WHO) grade 1 and 2 gliomas account for 60% of pediatric supratentorial tumors, with pilocytic astrocytomas being the most common, making up 1/3 of pediatric gliomas. Pilocytic astrocytomas have an excellent prognosis with 95% 10-year survival.
2. Diffuse astrocytomas are less common low-grade tumors in children. High-grade gliomas including anaplastic gliomas and glioblastomas are rare in children but have a poor prognosis, though survival is better than in adults.
3. Subependymal giant cell tumors are slow-growing tumors seen in children with tuberous s
This document discusses precocious puberty, which is defined as the development of secondary sex characteristics before age 8 in girls and 9 in boys. There are two types: central precocious puberty caused by early activation of the hypothalamic-pituitary axis, and peripheral precocious puberty caused by elevated sex steroid levels independent of gonadotropins. Imaging depends on gender and lab results, and may include MRI of the brain in boys with central precocious puberty or ovarian/testicular ultrasound in peripheral precocious puberty cases. Common causes discussed include hypothalamic hamartomas, ovarian cysts, Leydig cell tumors, and congenital adrenal hyperplasia.
This document discusses precocious puberty and summarizes key points about central precocious puberty (CPP) and peripheral precocious puberty (PPP). CPP is caused by early activation of the hypothalamic-pituitary axis, while PPP is caused by elevated sex steroid levels independent of gonadotropin secretion. Imaging depends on gender and lab results, including MRI of the CNS for boys with CPP and pelvic ultrasound for girls. Common causes of CPP include hypothalamic hamartoma and hypothalamic-chiasmatic astrocytoma. Adrenal cortical neoplasms are a potential cause of PPP in girls presenting as virilization.
This document discusses the differential diagnosis and imaging characteristics of pediatric posterior fossa tumors. It outlines several common tumor types including pilocytic astrocytoma, brainstem glioma, medulloblastoma, ependymoma, and hemangioblastoma. For each tumor, the document describes clinical presentation, typical imaging appearance on MRI and CT, as well as radiologic features like enhancement and cystic components. Pilocytic astrocytomas often appear as a cyst with an enhancing mural nodule, while medulloblastomas present as midline masses in the roof of the fourth ventricle. The document provides an overview of posterior fossa pediatric tumors to aid in differential diagnosis and evaluation.
This document discusses the management of meningiomas. It covers the classification, diagnosis and treatment of grades I, II and III meningiomas. For grade I meningiomas, observation or surgery is typically recommended. Adjuvant radiation may be used after subtotal resection. For grade II meningiomas, maximal safe resection followed by radiation is usually recommended. For grade III meningiomas, maximal resection combined with high-dose radiation or chemoradiation is the standard approach due to their aggressive nature.
1) Brain metastases are a common consequence of systemic cancer that spreads via hematogenous spread, most often originating from the lung, breast, skin (melanoma), kidney, or colon.
2) Treatment options include surgical resection to reduce symptoms from mass effect, whole brain radiation therapy to control multiple metastases, and stereotactic radiosurgery for limited metastases.
3) Patient prognosis depends on factors like age, functional status, extent of primary cancer, and number/size of brain metastases, with standardized grading systems used to assess survival outcomes.
The document discusses several types of tumors that can occur in the head and neck region of children. Lymphoma, rhabdomyosarcoma, medullary carcinoma of the thyroid, and neuroblastoma are some of the tumors mentioned. For lymphoma, the most common presentation is cervical lymphadenopathy, while rhabdomyosarcoma often presents with pain and swelling in locations like the orbit or paranasal sinuses. Diagnosis involves biopsy along with imaging and lab tests. Treatment depends on the specific tumor but may involve chemotherapy, radiation, and surgery. All childhood cancer cases should be referred to a specialist center.
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.
This document discusses craniopharyngioma, a benign brain tumor that typically arises in the sellar/suprasellar region. There are two pathological types - adamantinomatous (seen in children) and papillary (seen in adults). Adamantinomatous tumors are often large with prominent cysts, calcification, and vivid enhancement on imaging. Papillary tumors tend to be more solid with fewer small cysts and less calcification. Treatment involves surgical resection with radiotherapy for incomplete resections, and adamantinomatous tumors have a higher recurrence rate than papillary tumors.
The document provides information about brain metastasis including:
- Brain metastasis are cancer cells that have spread to the brain from primary tumors elsewhere in the body. Lung cancer, breast cancer, melanoma, and renal cancer are common sources.
- Symptoms depend on the location of metastases and can include headaches, nausea, focal weakness, seizures, and alterations in consciousness. Diagnosis is typically made through MRI or CT imaging.
- Treatment involves steroids, anticonvulsants, surgery to remove solitary metastases, stereotactic radiosurgery for a small number of lesions, whole brain radiation, and occasionally chemotherapy. The prognosis is generally poor with a median survival of 4-5 months.
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.
This document provides information on various types of brain tumors classified by their cell of origin and grade. It discusses oligodendrogliomas, anaplastic oligodendrogliomas, and their typical imaging and clinical presentation. It also covers ependymomas, subependymomas, choroid plexus tumors, and other neuroepithelial tumors such as astroblastomas. Finally, it summarizes neuronal and glioneuronal tumors like gangliogliomas which are a common cause of tumor-related temporal lobe epilepsy.
The document provides a list of radiological signs and anatomical structures including: spotters for azygous lobe, Chilaiditi syndrome, ectrodactyly-lobster claw hand deformity, mini brain sign for plasmocytoma, and paint brush sign for medullary sponge kidney. It also lists Onodi cell and identifies anatomical structures including the seminal vesicle, mesorectal fat, coracoid process, anterior glenoid labrum, infraspinatus, middle glenohumeral ligament, and deltoid. Additionally, it mentions air embolism.
This document provides information about hysterosalpingography (HSG) and fistulogram procedures. It describes:
- HSG is used to evaluate the uterine cavity and fallopian tubes by injecting radio-opaque dye through the cervix. It can detect abnormalities in the shape of the uterus and fallopian tube blockages.
- A fistulogram uses injected contrast dye to visualize and determine the route and extent of abnormal passages like fistulas or sinuses.
- Both procedures require informed consent and have risks like discomfort, infection or allergic reaction to the contrast dye. Precautions are taken to perform them aseptically and accurately map any abnormalities found.
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.
This document discusses embryonal brain tumors in children. Some key points:
- Embryonal tumors account for a large fraction of pediatric brain tumors and have a tendency to disseminate through cerebrospinal fluid.
- Major embryonal tumor types include medulloblastoma, CNS primitive neuroectodermal tumor, and atypical teratoid/rhabdoid tumor.
- Medulloblastoma is the most common malignant primary brain tumor in children. It can be classified based on histology and molecular markers into subgroups like WNT, SHH, Group 3 and Group 4 that have different clinical behaviors and prognoses.
- Treatment involves surgery, chemotherapy and radiation therapy
Unusual non epithelial tumors of head and neckDrAyush Garg
This document provides information on several unusual non-epithelial tumors of the head and neck region. It discusses glomus tumors, hemangiopericytomas, chordomas, lethal midline granuloma, chloroma, and radiation therapy techniques for treating some of these tumors. Key information includes the classification, epidemiology, pathology, clinical presentation, diagnostic workup, management including surgery and radiation therapy, and radiation therapy techniques for glomus tumors, hemangiopericytomas, chordomas, and lethal midline granuloma.
Dr. Sharmin Nahar and Dr. Olivia Akhter are presenting a seminar on pediatric hematology and oncology at BSMMU. They discuss the case of a 2-year-old girl admitted with headaches, vomiting, and seizures for the past month as well as left-sided weakness. Imaging shows a mass in the 4th ventricle causing hydrocephalus, possibly an ependymoma or medulloblastoma. They then provide an introduction to brain tumors in children, discussing types, incidence, risk factors, classification, and clinical features. Treatment options for brain tumors including surgery, radiation, and chemotherapy are also summarized.
PINEAL REGION TUMORS DIAGNOSIS & SURGICAL APPROACHES.pptxMedhatMoustafa3
Anatomy and related vascular structures of pineal region.pathological classification and incidence. Clinical Presentations and different diagnostics modalities. Different surgical approaches for pineal region
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.
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.
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.
1. World Health Organization (WHO) grade 1 and 2 gliomas account for 60% of pediatric supratentorial tumors, with pilocytic astrocytomas being the most common, making up 1/3 of pediatric gliomas. Pilocytic astrocytomas have an excellent prognosis with 95% 10-year survival.
2. Diffuse astrocytomas are less common low-grade tumors in children. High-grade gliomas including anaplastic gliomas and glioblastomas are rare in children but have a poor prognosis, though survival is better than in adults.
3. Subependymal giant cell tumors are slow-growing tumors seen in children with tuberous s
This document discusses precocious puberty, which is defined as the development of secondary sex characteristics before age 8 in girls and 9 in boys. There are two types: central precocious puberty caused by early activation of the hypothalamic-pituitary axis, and peripheral precocious puberty caused by elevated sex steroid levels independent of gonadotropins. Imaging depends on gender and lab results, and may include MRI of the brain in boys with central precocious puberty or ovarian/testicular ultrasound in peripheral precocious puberty cases. Common causes discussed include hypothalamic hamartomas, ovarian cysts, Leydig cell tumors, and congenital adrenal hyperplasia.
This document discusses precocious puberty and summarizes key points about central precocious puberty (CPP) and peripheral precocious puberty (PPP). CPP is caused by early activation of the hypothalamic-pituitary axis, while PPP is caused by elevated sex steroid levels independent of gonadotropin secretion. Imaging depends on gender and lab results, including MRI of the CNS for boys with CPP and pelvic ultrasound for girls. Common causes of CPP include hypothalamic hamartoma and hypothalamic-chiasmatic astrocytoma. Adrenal cortical neoplasms are a potential cause of PPP in girls presenting as virilization.
This document discusses the differential diagnosis and imaging characteristics of pediatric posterior fossa tumors. It outlines several common tumor types including pilocytic astrocytoma, brainstem glioma, medulloblastoma, ependymoma, and hemangioblastoma. For each tumor, the document describes clinical presentation, typical imaging appearance on MRI and CT, as well as radiologic features like enhancement and cystic components. Pilocytic astrocytomas often appear as a cyst with an enhancing mural nodule, while medulloblastomas present as midline masses in the roof of the fourth ventricle. The document provides an overview of posterior fossa pediatric tumors to aid in differential diagnosis and evaluation.
This document discusses the management of meningiomas. It covers the classification, diagnosis and treatment of grades I, II and III meningiomas. For grade I meningiomas, observation or surgery is typically recommended. Adjuvant radiation may be used after subtotal resection. For grade II meningiomas, maximal safe resection followed by radiation is usually recommended. For grade III meningiomas, maximal resection combined with high-dose radiation or chemoradiation is the standard approach due to their aggressive nature.
1) Brain metastases are a common consequence of systemic cancer that spreads via hematogenous spread, most often originating from the lung, breast, skin (melanoma), kidney, or colon.
2) Treatment options include surgical resection to reduce symptoms from mass effect, whole brain radiation therapy to control multiple metastases, and stereotactic radiosurgery for limited metastases.
3) Patient prognosis depends on factors like age, functional status, extent of primary cancer, and number/size of brain metastases, with standardized grading systems used to assess survival outcomes.
The document discusses several types of tumors that can occur in the head and neck region of children. Lymphoma, rhabdomyosarcoma, medullary carcinoma of the thyroid, and neuroblastoma are some of the tumors mentioned. For lymphoma, the most common presentation is cervical lymphadenopathy, while rhabdomyosarcoma often presents with pain and swelling in locations like the orbit or paranasal sinuses. Diagnosis involves biopsy along with imaging and lab tests. Treatment depends on the specific tumor but may involve chemotherapy, radiation, and surgery. All childhood cancer cases should be referred to a specialist center.
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.
This document discusses craniopharyngioma, a benign brain tumor that typically arises in the sellar/suprasellar region. There are two pathological types - adamantinomatous (seen in children) and papillary (seen in adults). Adamantinomatous tumors are often large with prominent cysts, calcification, and vivid enhancement on imaging. Papillary tumors tend to be more solid with fewer small cysts and less calcification. Treatment involves surgical resection with radiotherapy for incomplete resections, and adamantinomatous tumors have a higher recurrence rate than papillary tumors.
The document provides information about brain metastasis including:
- Brain metastasis are cancer cells that have spread to the brain from primary tumors elsewhere in the body. Lung cancer, breast cancer, melanoma, and renal cancer are common sources.
- Symptoms depend on the location of metastases and can include headaches, nausea, focal weakness, seizures, and alterations in consciousness. Diagnosis is typically made through MRI or CT imaging.
- Treatment involves steroids, anticonvulsants, surgery to remove solitary metastases, stereotactic radiosurgery for a small number of lesions, whole brain radiation, and occasionally chemotherapy. The prognosis is generally poor with a median survival of 4-5 months.
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.
This document provides information on various types of brain tumors classified by their cell of origin and grade. It discusses oligodendrogliomas, anaplastic oligodendrogliomas, and their typical imaging and clinical presentation. It also covers ependymomas, subependymomas, choroid plexus tumors, and other neuroepithelial tumors such as astroblastomas. Finally, it summarizes neuronal and glioneuronal tumors like gangliogliomas which are a common cause of tumor-related temporal lobe epilepsy.
The document provides a list of radiological signs and anatomical structures including: spotters for azygous lobe, Chilaiditi syndrome, ectrodactyly-lobster claw hand deformity, mini brain sign for plasmocytoma, and paint brush sign for medullary sponge kidney. It also lists Onodi cell and identifies anatomical structures including the seminal vesicle, mesorectal fat, coracoid process, anterior glenoid labrum, infraspinatus, middle glenohumeral ligament, and deltoid. Additionally, it mentions air embolism.
This document provides information about hysterosalpingography (HSG) and fistulogram procedures. It describes:
- HSG is used to evaluate the uterine cavity and fallopian tubes by injecting radio-opaque dye through the cervix. It can detect abnormalities in the shape of the uterus and fallopian tube blockages.
- A fistulogram uses injected contrast dye to visualize and determine the route and extent of abnormal passages like fistulas or sinuses.
- Both procedures require informed consent and have risks like discomfort, infection or allergic reaction to the contrast dye. Precautions are taken to perform them aseptically and accurately map any abnormalities found.
The document discusses the Pre-Conception and Prenatal Diagnostic Techniques (Prohibition of Sex Selection) Act, 1994 (PCPNDT Act). It provides an overview of key aspects of the act including definitions, registration requirements, prohibitions, and penalties. The act aims to regulate prenatal diagnostic techniques and prevent their misuse for sex determination and female feticide. Clinics must register and follow guidelines on maintaining records and obtaining consent. Sex determination is prohibited except for certain medical reasons. Violations can lead to imprisonment, fines, and suspension of medical licenses.
A PACS (picture archiving and communication system) is a digital system that replaces conventional radiology film. It allows images to be acquired, stored, transmitted, and displayed digitally. Key benefits include images always being available anywhere, simultaneous viewing by multiple users, and organized storage and retrieval of patient images. While expensive to implement, a PACS improves efficiency and can pay for itself within 5 years through cost savings.
1. The document reviews normal embryonic development in the first trimester as seen on ultrasound imaging. Key milestones include visualization of the gestational sac at 5 weeks, yolk sac at 5.5 weeks, and fetal pole and heart motion at 6 weeks.
2. Abnormal appearances of the gestational sac and yolk sac are described, many of which are associated with poor pregnancy outcomes. These include irregular shapes, thin decidual reactions, large or small sizes.
3. Ultrasound can also determine chorionicity and amnionicity in multiple gestations, identifying whether the placentas and amniotic sacs are shared between embryos. This provides information about risks for complications.
This document provides an overview of arterial anatomy in the brain and imaging of strokes. It discusses the anterior and posterior circulations, variants and anomalies like aberrant internal carotid arteries and persistent stapedial arteries. It also covers the circle of Willis and acute cerebral ischemia/infarction, including pathophysiology, CT findings like ASPECTS scoring, CTA, perfusion CT, and MRI findings in the hyperacute, subacute and chronic stages. Specific topics like watershed infarcts and artery of Percheron infarction are also mentioned.
IVP is used to examine the urinary tract by injecting contrast media intravenously and taking x-ray images. It is used to evaluate diseases of the kidneys, ureters, and bladder as well as detect abnormalities, injuries, and calculi. The procedure involves injecting contrast media into a vein while serial x-ray images are taken over 35 minutes to visualize the functioning of the kidneys and flow of contrast through the urinary tract. Precautions are taken for patients with iodine sensitivity, pregnancy, or risk of adverse reactions to contrast.
This document discusses traumatic diaphragmatic rupture detected using CT imaging. It presents two case studies of young male patients who experienced blunt trauma in road traffic accidents and presented with breathlessness and abdominal pain. CT scans revealed ruptures of the left diaphragm with herniation of the stomach in both cases. The document reviews that diaphragmatic injuries occur in 0.8-8% of blunt abdominal trauma cases but are often initially undiagnosed. Multi-detector CT is considered the best way to diagnose diaphragmatic injuries. It concludes that CT plays a key role in evaluating diaphragmatic injuries after trauma.
PLANNING OF X-RAY, CT ROOMS AND QUALITY ASSURANCE.pptxSrinath Chowdary
Dr. Vimala presented on planning X-ray and CT rooms and quality assurance in diagnostic radiology. She discussed proper planning of radiology rooms and quality control measures to ensure safety and accurate diagnosis. The presentation was moderated by Dr. Ramakanth and focused on best practices in diagnostic imaging facilities.
The document summarizes the key components and functioning of fluoroscopic imaging equipment, specifically x-ray image intensifiers. It describes:
1) The four basic elements of an image intensifier - input phosphor, photocathode, electrostatic focusing lens, and output phosphor. X-ray photons are converted to light photons which eject electrons that are focused to the output phosphor.
2) Key materials used - the input phosphor is cesium iodide which converts x-rays to light efficiently. The output phosphor is zinc sulfide which produces a brighter image.
3) Benefits of image intensifiers over earlier fluoroscopy include a brighter image from electron multiplication and the ability to view images
The document discusses primary CNS lymphoma, noting that it refers to lymphoma isolated to the craniospinal axis without primary tumors elsewhere. It can occur in both immunocompetent and immunocompromised patients, with HIV/AIDS being a major risk factor. Presenting symptoms and imaging findings may vary depending on immune status and tumor location, but classic presentations include solitary enhancing masses on MRI, often in deep brain regions. Early diagnosis is important for effective treatment.
Primary central nervous system (CNS) lymphoma refers to isolated involvement of the brain or spinal cord without tumors elsewhere. It was once rare but is now more common, especially in immunocompromised patients like those with HIV. On imaging, primary CNS lymphoma typically appears as a solitary, enhancing mass in the brain in immunocompetent patients but can present atypically in HIV patients as multiple deep brain lesions with necrosis and irregular enhancement. Imaging plays a key role in the diagnosis and treatment of primary CNS lymphoma.
This document discusses scatter radiation and methods to reduce it in radiography. It defines scatter radiation as photons that are deflected from their original path during imaging. Scatter radiation degrades image quality by adding unwanted density. The document explores how increasing field size, patient thickness, and kVp can increase scatter and describes various methods to reduce it, including filters, grids, collimation, and beam centering devices. It provides details on different types of filters, grids, and how moving grids can help eliminate visibility of grid lines while increasing patient dose.
This document discusses various types of radiation detectors. It begins by explaining the need for detectors to measure ionizing radiation since our senses cannot detect it. The key detection methods discussed are ionization, luminescence, photographic effect, thermoluminescence, chemical effect, and biological effect. Specific detector types covered in detail include gas-filled detectors like ionization chambers and Geiger counters, scintillation detectors, semiconductor detectors, and dosimeters. The document provides information on how each type of detector works and its applications.
Primary Effects of CNS Trauma
The document summarizes various primary injuries that can occur to the central nervous system following traumatic brain injury. It describes direct injuries such as scalp lacerations, skull fractures, and epidural or subdural hematomas caused by blows to the head. It also discusses indirect injuries such as diffuse axonal injury caused by rapid acceleration/deceleration forces. Specific types of injuries are defined, including cortical contusions, subarachnoid hemorrhage, and deep brain injuries to structures like the brainstem and ventricles. Diagnostic imaging findings for the various injuries on CT and MRI are also summarized.
The document summarizes the key components and functions of an x-ray generator. It discusses how transformers are used to change voltage levels for the filament circuit and high voltage circuit. The filament circuit uses a step-down transformer to provide low voltage for heating the x-ray tube filament. The high voltage circuit uses an autotransformer and step-up transformer to provide high voltage of 40,000-150,000 volts for electron acceleration. Rectification is also discussed, which converts the alternating current output of the high voltage transformer to direct current required by the x-ray tube.
1) The document discusses the components and functioning of an x-ray tube, including the cathode, thermionic emission, space charge effect, focussing cup, anode, and grid control.
2) It describes how increasing the voltage across the x-ray tube increases the kinetic energy of electrons, producing x-rays via bremsstrahlung and characteristic radiation processes.
3) Rotating and stationary anodes are discussed as ways to dissipate heat generated during x-ray production and allow higher power outputs from the tube.
1. There are several radiological signs that can help determine if a retroperitoneal mass originates from an adjacent organ, including the beak sign, phantom organ sign, and embedded organ sign.
2. Primary retroperitoneal sarcomas are the most common retroperitoneal masses in adults. The most common subtypes are liposarcoma, leiomyosarcoma, and malignant fibrous histiocytoma.
3. Lymphoma is also a common retroperitoneal malignancy that typically presents as bilateral confluent lymphadenopathy along the superior mesenteric vessels, known as the "sandwich sign".
This document discusses various methods of craniometry used to diagnose craniovertebral junction (CVJ) anomalies through multimodality radiological assessment. It describes several important cranial landmarks and reference lines used to evaluate the CVJ, including Chamberlain's line, McRae's line, McGregor's line, and Wackenheim's line. It then classifies common congenital CVJ anomalies such as atlanto-occipital assimilation, platybasia, basilar invagination, occipital condyle hypoplasia, atlas anomalies, axis anomalies, and discusses associated conditions like Chiari malformation.
This document discusses different types of bone fractures and how they appear on x-rays. It outlines key factors for interpreting x-rays such as whether the fracture is complete or incomplete, comminuted, caused by stress or trauma. Stress fractures occur from repetitive lower magnitude stress rather than acute trauma. Fracture orientation provides clues, with oblique fractures resulting from direct blows, transverse from diseases, and spiral from torsion and compression forces.
LGBTQ+ Adults: Unique Opportunities and Inclusive Approaches to CareVITASAuthor
This webinar helps clinicians understand the unique healthcare needs of the LGBTQ+ community, primarily in relation to end-of-life care. Topics include social and cultural background and challenges, healthcare disparities, advanced care planning, and strategies for reaching the community and improving quality of care.
Can Allopathy and Homeopathy Be Used Together in India.pdfDharma Homoeopathy
This article explores the potential for combining allopathy and homeopathy in India, examining the benefits, challenges, and the emerging field of integrative medicine.
2024 HIPAA Compliance Training Guide to the Compliance OfficersConference Panel
Join us for a comprehensive 90-minute lesson designed specifically for Compliance Officers and Practice/Business Managers. This 2024 HIPAA Training session will guide you through the critical steps needed to ensure your practice is fully prepared for upcoming audits. Key updates and significant changes under the Omnibus Rule will be covered, along with the latest applicable updates for 2024.
Key Areas Covered:
Texting and Email Communication: Understand the compliance requirements for electronic communication.
Encryption Standards: Learn what is necessary and what is overhyped.
Medical Messaging and Voice Data: Ensure secure handling of sensitive information.
IT Risk Factors: Identify and mitigate risks related to your IT infrastructure.
Why Attend:
Expert Instructor: Brian Tuttle, with over 20 years in Health IT and Compliance Consulting, brings invaluable experience and knowledge, including insights from over 1000 risk assessments and direct dealings with Office of Civil Rights HIPAA auditors.
Actionable Insights: Receive practical advice on preparing for audits and avoiding common mistakes.
Clarity on Compliance: Clear up misconceptions and understand the reality of HIPAA regulations.
Ensure your compliance strategy is up-to-date and effective. Enroll now and be prepared for the 2024 HIPAA audits.
Enroll Now to secure your spot in this crucial training session and ensure your HIPAA compliance is robust and audit-ready.
https://conferencepanel.com/conference/hipaa-training-for-the-compliance-officer-2024-updates
Can coffee help me lose weight? Yes, 25,422 users in the USA use it for that ...nirahealhty
The South Beach Coffee Java Diet is a variation of the popular South Beach Diet, which was developed by cardiologist Dr. Arthur Agatston. The original South Beach Diet focuses on consuming lean proteins, healthy fats, and low-glycemic index carbohydrates. The South Beach Coffee Java Diet adds the element of coffee, specifically caffeine, to enhance weight loss and improve energy levels.
At Apollo Hospital, Lucknow, U.P., we provide specialized care for children experiencing dehydration and other symptoms. We also offer NICU & PICU Ambulance Facility Services. Consult our expert today for the best pediatric emergency care.
For More Details:
Map: https://cutt.ly/BwCeflYo
Name: Apollo Hospital
Address: Singar Nagar, LDA Colony, Lucknow, Uttar Pradesh 226012
Phone: 08429021957
Opening Hours: 24X7
Michigan HealthTech Market Map 2024. Includes 7 categories: Policy Makers, Academic Innovation Centers, Digital Health Providers, Healthcare Providers, Payers / Insurance, Device Companies, Life Science Companies, Innovation Accelerators. Developed by the Michigan-Israel Business Accelerator
The best massage spa Ajman is Chandrima Spa Ajman, which was founded in 2023 and is exclusively for men 24 hours a day. As of right now, our parent firm has been providing massage services to over 50,000+ clients in Ajman for the past 10 years. It has about 8+ branches. This demonstrates that Chandrima Spa Ajman is among the most reasonably priced spas in Ajman and the ideal place to unwind and rejuvenate. We provide a wide range of Spa massage treatments, including Indian, Pakistani, Kerala, Malayali, and body-to-body massages. Numerous massage techniques are available, including deep tissue, Swedish, Thai, Russian, and hot stone massages. Our massage therapists produce genuinely unique treatments that generate a revitalized sense of inner serenely by fusing modern techniques, the cleanest natural substances, and traditional holistic therapists.
We are one of the top Massage Spa Ajman Our highly skilled, experienced, and certified massage therapists from different corners of the world are committed to serving you with a soothing and relaxing experience. Luxuriate yourself at our spas in Sharjah and Ajman, which are indeed enriched with an ambiance of relaxation and tranquility. We could confidently claim that we are one of the most affordable Spa Ajman and Sharjah as well, where you can book the massage session of your choice for just 99 AED at any time as we are open 24 hours a day, 7 days a week.
Visit : https://massagespaajman.com/
Call : 052 987 1315
Let's Talk About It: Breast Cancer (What is Mindset and Does it Really Matter?)bkling
Your mindset is the way you make sense of the world around you. This lens influences the way you think, the way you feel, and how you might behave in certain situations. Let's talk about mindset myths that can get us into trouble and ways to cultivate a mindset to support your cancer survivorship in authentic ways. Let’s Talk About It!
International Cancer Survivors Day is celebrated during June, placing the spotlight not only on cancer survivors, but also their caregivers.
CANSA has compiled a list of tips and guidelines of support:
https://cansa.org.za/who-cares-for-cancer-patients-caregivers/
Bringing AI into a Mid-Sized Company: A structured Approach
CNS2.pptx
1. Conventional and Advanced
MRI Features of Pediatric
Intracranial Tumors: Posterior
Fossa and Suprasellar Tumors
MODERATOR:DR.BHAGYALAKSHMI M.D
PRESENTOR:N.LAKSHMI CHAITANYA
3. Pilocytic Astrocytoma
• Cerebellar astrocytomas account for 30% of all posterior fossa
tumors in children, with the most common histologic subtype
being JPA.
• The majority of JPAs, 60%, arise from the cerebellum.
• Five percent of patients with neurofibromatosis type 1 (NF1) will
develop a cerebellar JPA, although the most common location for
pilocytic astrocytoma in NF1 patients is the optic nerve or optic
chiasm.
4. • The classic imaging appearance of a JPA, is of a large cyst with
a solid mural nodule within one of the cerebellar hemispheres.
• less commonly, JPA may present on imaging as a predominantly
solid mass with little to no cyst like component.
• On MRI, the cystic portion is hypointense relative to gray matter
on T1-weighted images and hyperintense relative to gray matter
on T2-weighted images.
• JPA is a low-grade neoplasm (GRADE-1)
5. • Enhancement patterns may vary, but JPA most commonly (46%)
appears as a cyst with an enhancing wall and an intensely
enhancing mural nodule.
• Diffusion-weighted imaging (DWI) of JPAs shows no restricted
diffusion, which is consistent with the characteristics of a low-
grade tumor.
• MR spectroscopy (MRS) performed on the solid portion of
pilocytic astrocytomas shows elevated choline-to–N-acetyl
aspartate (NAA) ratios and elevated lactate levels, which is an
aggressive metabolite pattern.
6. • The elevated lactate levels in JPAs do not reflect necrosis, which
is rare in pilocytic astrocytomas and, rather, reflect
aberrant glucose utilization.
• DTI has been shown to be a useful adjunct in differentiating
thalamopeduncular pilocytic astrocytomas from infiltrating tumors
in the posterior fossa because pilocytic astrocytomas displace
corticospinal tracts, whereas other tumors may encase them or
disrupt them.
• JPAs may mimic hemangioblastomas.
7.
8.
9. Medulloblastoma
• Medulloblastoma accounts for 35–40% of all posterior fossa
tumors in children with peak occurrence at approximately 4
years old.
• Classic medulloblastoma typically arises from the roof of the
fourth ventricle and is midline in location in 75–90% of cases.
• Desmoplastic medulloblastoma is a rare histologic variant that
typically occurs off midline in the cerebellar hemisphere.
10. • Classic medulloblastoma is a highly cellular, densely packed
tumor, which is reflected on imaging; it appears hyperdense
relative to brain on CT (89% of cases) and shows restricted
diffusion on DWI.
• Apparent diffusion coefficient (ADC) values are significantly lower
in medulloblastoma.
• This feature of medulloblastoma allows differentiation from JPA,
ependymoma, and brainstem glioma.
• Medulloblastoma is a high-grade tumor, so it can be
differentiated from low-grade posterior fossa tumors on the basis
of its increased rCBV on perfusion MRI.
11. • T2-weighted imaging shows heterogeneous signal: The solid
components appear hypointense relative to gray matter because
of the highly cellular nature of the tumor and the cystic
components, which are seen in 59% of cases, appear
hyperintense.
• Calcifications can be found in up to 20% of cases and
hemorrhage is rare.
• Enhancement may be variable in degree, ranging from diffuse
homogeneous enhancement to very little patchy enhancement.
12. • Medulloblastomas generally have the characteristic
spectrographic signature for a neuroectodermal tumor with high
taurine, depleted NAA, and prominent choline and lipid peaks.
• Because treatment of patients with medulloblastoma involves
craniospinal radiation, DTI and DWI are potentially useful in early
detection and monitoring of radiation-induced white matter injury
through the measure of fractional anisotropy (FA) and ADC
values.
13. • At diagnosis, 14–43% of patients with medulloblastoma are
reported to have microscopic or nodular seeding of the
subarachnoid space; therefore, at the time of diagnosis, an MRI
examination of the entire spine should be performed to determine
if there is leptomeningeal dissemination.
14.
15. Atypical Teratoid-Rhabdoid Tumor
• ATRT constitutes 1–2% of pediatric brain tumors and has a
predilection for infants; it most commonly occurs in children
younger than 3 years old.
• Within the CNS, ATRT most commonly occurs infratentorial and
off midline, 38–65%; however, in 4–8% of the cases, tumors are
present at multiple CNS sites at the time of diagnosis.
• ATRT mimics medulloblastoma radiologically and histologically
and has been misdiagnosed in the past.
16. • ATRTs can now be differentiated from medulloblastomas using
specific immunohistochemical markers and by detecting certain
gene mutations or deletions, such as the lack of INI1 expression
on immunohistochemical stains.
• Conventional MRI shows heterogeneous signal intensity on T1-
and T2-weighted pulse sequences because the mass commonly
contains cysts, hemorrhage, and calcifications.
• Eccentrically located cysts may favor the diagnosis of ATRT
over primitive neuroectodermal tumor and medulloblastoma.
17. • A highly aggressive appearance of a tumor with skull invasion
may favor ATRT over other cystic masses such as JPA or
desmoplastic infantile ganglioglioma.
• The enhancement pattern of ATRTs is most commonly
heterogeneous and is rarely homogeneous, reflecting the
complex histopathology of this tumor.
• Restricted diffusion is typical.
• MRS shows an aggressive metabolite pattern with elevated
choline, decreased or absent NAA, and prominent lipid and
lactate peaks.
18. • Distinguishing between an ATRT and a medulloblastoma is
important because the prognosis associated with ATRT is worse
than that associated with medulloblastoma.
• A younger patient age, intratumoral hemorrhage, and
cerebellopontine angle involvement favor a preoperative
diagnosis of ATRT over medulloblastoma.
19.
20. Ependymoma
• Ependymoma is the third most common posterior fossa tumor in
children.
• Incidence peaks in patients 0–4 years old.
• Approximately 70% of intracranial ependymomas are infratentorial and
arise from ependymal cells lining the floor of the fourth ventricle and
foramen of Luschka.
• Neurofibromatosis type 2 (NF2) is the only known genetic disorder
associated with a predisposition for ependymomas; however, NF2
patients typically develop the intramedullary spinal type of
ependymoma.
21. • Histologically, ependymomas tend to have a high proportion of
intracellular myxoid accumulation and cyst formation.
• These features are reflected on conventional MRI as high signal
intensity relative to uninvolved gray matter on T2-weighted and
FLAIR pulse sequences.
• Areas of low signal intensity relative to gray matter on T2-
weighted images and FLAIR images may represent calcifications
or hemorrhage.
22. • Sagittal images may be the key to the diagnosis in some cases
because sagittal images can be used to identify the point
of origin as the floor of the fourth ventricle, as seen in
ependymoma, versus the roof, as seen in medulloblastoma.
• Calcification is a common feature seen in 50% of ependymoma
cases and contrast enhancement is heterogeneous.
• Although not pathognomonic, the plastic nature of ependymoma
results in the classic presentation of a fourth ventricle mass
extending through the foramen of Luschka (15%) or foramen of
Magendie (60%).
23. • Some ependymomas may show restricted diffusion.
• Perfusion MRI patterns for ependymomas are variable and are likely
related to the histologic subtype. However, in general, perfusion MRI
of ependymomas shows markedly elevated cerebral blood volume
(CBV) and poor return to baseline CBV, which is attributable to the
fenestrated blood vessels observed microscopically.
• MRS generally shows depleted NAA and elevated choline and lactate
levels, but the primary application of MRS in the setting of
ependymoma is to evaluate for tumor recurrence versus posttreatment
change.
24.
25. Brainstem Glioma
• Brainstem gliomas comprise approximately 10–20% of all
intracranial tumors in children and 75% of brainstem gliomas
occur in patients younger than 10 years.
• Brain stem gliomas are not designated as a specific pathologic
category in the WHO classification of CNS tumors and are
classified by location rather than histology.
• They are classified broadly as diffuse intrinsic gliomas or as
nondiffuse brainstem tumors.
26. • The diffuse intrinsic tumor type is the most common, with
an approximate frequency of 75–85%.
• NF1 patients with brainstem gliomas have a more favorable
prognosis than non-NF1 patients.
• On MRI, diffuse pontine gliomas characteristically expand the
pons and are usually hypointense relative to gray matter on T1-
weighted images and hyperintense relative to gray matter on T2-
weighted and FLAIR images.
• Most diffuse brainstem gliomas do not enhance; however if they
do enhance,enhancement is very little and heterogeneous.
27. • Most diffuse gliomas do not show restricted diffusion and ADC
values are characteristically higher than in medulloblastomas.
• Most diffuse brainstem gliomas are histologically low grade, but a
subset rapidly evolves into highgrade neoplasms; on advanced
imaging techniques, high-grade neoplasms are suggested
by focal areas of restricted diffusion and increased rCBV.
• These findings likely correspond to areas of anaplasia.
28. • Moreover, MRS shows utility in establishing a brainstem glioma’s
baseline metabolic profile so subsequent metabolic changes on
serial MRS can be used as markers for disease progression.
• Malignant degeneration is suggested by increased lipids and
reduced NAA-to-choline, creatine-to-choline, and myoinositol-to-
choline ratios.
• Importantly, identifying increased choline concentrations on
serial MRS may precede clinical worsening by up to 5 months.
29. • Diffuse intrinsic brainstem gliomas had higher mean
concentrations of citrate than ependymomas, medulloblastomas,
and JPAs.
• With respect to brainstem gliomas, DTI plays an essential role in
diagnosis and surgical planning.
• Demyelinating diseases may mimic diffuse intrinsic brainstem
gliomas clinically and on conventional imaging
techniques; however, tractography clearly distinguishes between
the two because brainstem gliomas deflect white matter tracts
whereas demyelinating diseases result in truncated fibers.
30. • Tractography allows visualization of spatial relations between
tumor and adjacent fiber tracts; in operable brainstem glioma
tumor types, tractography provides important presurgical
information because preservation of white matter tracts
correlates with better neurologic and functional outcomes after
surgery.
• Diffuse intrinsic gliomas are nonoperative. The standard
treatment is fractionated external beam radiotherapy, with
chemotherapy reserved for cases of tumor progression
despite radiotherapy.
31. • The diffuse intrinsic type has the worst prognosis of all brainstem
gliomas, with median survival rarely exceeding 9 months.
• Focal midbrain tumors have a more indolent course and a more
favorable prognosis.
32.
33. Hemangioblastoma
• Hemangioblastomas account for 1–3% of all intracranial
neoplasms, and most occur in middle-aged adults.
• In children younger than 18 years old, these tumors are
extremely rare, with an incidence of less than 1 per 1 million.
• One of the most common manifestations of von Hippel–Lindau
(VHL) syndrome is multiple CNS hemangioblastomas, with
the most common site of presentation being in the cerebellum.
34. • Patients with cerebellar hemangioblastomas typically present
with headache, vertigo, ataxia, and ninth cranial nerve palsy; in
some cases, polycythemia has been noted given that up to 40%
have been reported to secrete erythropoietin.
• Hemangioblastomas are highly vascular tumors and may present
as a mural nodule within a large cyst cavity (45%) or a purely
solid tumor (45%).
• Typical hemangioblastomas are hypo- to isointense relative to
gray matter on T1 and hyperintense relative to gray matter on T2
with enhancement of the mural nodule.
35. • The cyst wall most commonly does not enhance unless lined by
neoplasm.
• Large feeding and draining vessels in the periphery and within
the solid component appear as tubular flow voids on T2-weighted
imaging.
• Hemangioblastomas mimic pilocytic astrocytomas
and pleomorphic xanthoastrocytomas in their imaging
appearance, but because of their intrinsic high vascularity,
hemangioblastomas have the highest rCBV thus, perfusion
MRI may be a useful diagnostic adjunct.
38. Craniopharyngioma
• Craniopharyngiomas are benign tumors that arise from
squamous epithelium.
• They represent 50% of suprasellar tumors in children; most
cases are diagnosed in children who are 4–5 years old, with a
second incidence peak during the fourth to fifth decades.
• Craniopharyngiomas can arise in the sellar region, suprasellar
region, or both.
39. • Because of the location of this tumor, patients commonly present
clinically with visual disturbance, due to compression of the optic
chiasm; endocrinologic disorders, from involvement of the
hypothalamus and pituitary; or headache and hydrocephalus.
• Nearly 90% of craniopharyngiomas are suprasellar, are cystic
with calcifications, and have nodular or rim enhancement on CT.
• CT is particularly helpful in the identification of these lesions
because of its high sensitivity for calcification.
40. • On MRI, the cystic component may be hypo- or hyperintense
relative to gray matter on T1 because of the liquid cholesterol
component, methemoglobin, or proteinaceous fluid.
• The solid component may be iso- or hypointense on T1-weighted
images and iso- or hyperintense relative to gray matter on T2-
weighted images.
• Calcifications usually appear as low signal on T2-weighted
imaging.
41. • The signal characteristics of craniopharyngiomas on DWI and
FLAIR imaging may vary depending on the viscosity of the fluid.
• If there is a high degree of viscosity, the tumor may appear
hyperintense on FLAIR imaging and isointense on DWI with a
slightly lower ADC than CSF.
• MRS may help differentiate craniopharyngiomas from other
suprasellar masses by depicting prominent peaks of lipids and
cholesterol.
• The differential diagnosis includes hypothalamic glioma, Rathke
cleft cyst, and germ cell tumors.
42. • Optic DTI may help in the preoperative evaluation and treatment
of craniopharyngiomas because DTI has been proven useful
in differentiating the optic nerves from chiasmatic or suprasellar
tumors.
• Normal white matter tracts are usually associated with high FA
values, which will allow depiction of the tracts by fiber-tracking
software.
• On the contrary, abnormal white matter tracts with low FA
values may not be seen on tractograph.
43.
44. Hypothalamic Hamartoma
• Hypothalamic hamartomas are not true neoplasms.
• They are considered developmental malformations from mature
ganglionic tissue that involve the tuber cinereum.
• Clinically patients with hypothalamic hamartoma can present with
gelastic seizures, precocious puberty, and developmental delay.
• On CT, hypothalamic hamartoma appears as a homogeneous
isodense suprasellar mass.
45. • MRI, hypothalamic hamartoma can be identified by the presence
of a small, well-defined pedunculated or sessile mass.
• It is isointense relative to gray matter on T1-weighted images and
is iso- to slightly hyperintense relative to gray matter on T2-
weighted imaging, FLAIR imaging, and DWI without
enhancement or calcification.
• MRS has shown increased myoinositol levels with decreased or
normal NAA levels.
• The differential diagnosis includes germinoma and hypothalamic
glioma.
46.
47. Hypothalamic and Chiasmatic Gliomas
• Hypothalamic and chiasmatic gliomas represent 10–15% of
pediatric supratentorial tumors, 20–50% of which are associated
with NF1.
• Histologically, they are mostly pilocytic astrocytomas and low-
grade astrocytomas and the distinction between chiasmatic origin
and hypothalamic origin may be difficult.
48. • Hypothalamic and chiasmatic gliomas appear hypointense
relative to gray matter on T1and hyperintense relative to gray
matter on FLAIR and T2 with homogeneous enhancement.
• The MRS spectral pattern is similar to those of other
astrocytomas with a dominant choline peak.
• Optic DTI is helpful for planning surgery of these tumors, as with
craniopharyngiomas, by differentiating glioma from the optic
nerve.
• The differential diagnosis includes germ cell tumors, Langerhans
cell histiocytosis, and inflammatory conditions.
49. • Hypothalamic and chiasmatic gliomas may be differentiated from
germ cell tumors by the usual hyperintense signal on T2-
weighted images compared with the hypointense signal of
germ cell tumors
50. Conclusion
• Imaging in pediatric CNS tumors is an essential component in
the care of these patients and has evolved greatly over the past
decade.We are becoming better at making a preoperative
diagnosis of the tumor type, detecting recurrence, and guiding
surgical management to avoid injury to vital brain structures.
This pattern is paradoxical because it does not reflect the quiescent clinical behavior of the tumor
some small tectal gliomas can be followed often with serial MRI and alleviation of hydrocephalus as needed with shunt placement or third ventriculostomy