2 Course ECONR
Braintumors oder Tumorlike diseases
Braintumors oder Tumorlike diseases
Which tumor calcify spinal
ganglioglioma
DD spinal schwannoma - menigeoma
Menigingeoma konvex to dura
Hemangioblastoma
dorsal aspect of conus
mostly interemdullary
hypervascular
posterior spinal
VHL
Which tumors can do drop mets
Ependymoma
GBM
Medulloblastoma
Gangion of SCarpa
Gangion of N vestibularis where Schwannoma beginns
What does the surgeon want to know in schwannoma
growing
on which nerv
where is facial nerv
can i preserve the hearing (lower intens means very hard preserv hearing)
Why can be fluid in cochlea be lower in schwannoma
Schwannoma can bloc vasa vasorum und more protein come up
Can you have Schwannoma of the den N I
yes ther are filiae in the lamina cribriforame
Most selden nerv with schwannoma
N VI
What signal does have neuroma (chron defektt of nerv)
T1 hyperintesn
Tumor on Nerv without enhancement
Neurofibroma
Tumor on Nerv without enhancement
Neurofibroma
Hemangiom on which nerf at most?
Gangion geniculi N VII
Calcifing nerv DD
hämangioma
Menigeoma
DD more than 1 nerv enhancung along
Met
Lymphoma
Leukemia
leptomeniosis and more nerv enhancing think of
sarcoid
Spinal Ependymoma more tumor oder reativ cyst
Astrozytoma
Ep: reaktiv
Astro: tumor
Oedem in Menigeoma
Secretiv Menigeoma
Kongestion of veins
malignacy
pial infiltration
Wie lange dauert es bis ligamnetiertes /embolisitertes Menigneom rekrutiert wieder neue Gefässe
2 Tage
Wie lange muss NCH warten bis Menigeom weichmit Nekrosis
5-7 day
Normaler Proteingehalt Liquor
150-450 mg/l
Kommen GBM cerebellär häufig selten
selten
Wann haben Oligodentrogliome schlechte Prognose
loss of 1p or 19q
Bestimmt Anreicheurng Prognose von
Oligodentrogliomen?
Astrocytomen?
Oligo nein,
Astro ja
Nenne Neuronale und mixed neurogliale Tumoren
Gangliogliomas
Dysembryoplastic neuro-epithelial
tumors
Central Neurocytoma
Dysplastic cerebellar gangliocytoma
Desmoplastic Infantile astrocytoma
Charakteristika DNET
Young
pelotting calvarian
"hamartuos"
cortical dysplasia
cystic
Circumscribed Astrocytoma
Pilocytic Astrocytoma
Subependymal Gaint Cell Astrocytoma
Pleiomorphic Xanthoastrocytoma
Pilocytic astrocytoma Charakteristika
Most common glioma in children
Corresponds to WHO grade I
Most frequent locations are:
- Cerebellum: 85%
- Hypothalamic/third ventricular region
- Optice neve/chiasm
- Dorsal brain stem
*
Pilocytic astrocytoma: imaging characteristica
Cerebellar
large cyst with mural nodule
nodule enhances strongly
Midline tumours
solid mass
diffuse enhancement, possibly heterogeneous
small cysts possible
Subependymal giant cell
astrocytoma charactersic
Mostly associated with tuberous sclerosis
Other signs of tuberous sclerosis (cortical
tubers, subependymal calcifications)
present
Rounded, calcified and strongly enhancing
mass near the foramen of Monro
Frequently (acute) hydrocephalus
Pleiomorphic Xantho-Astrocytoma characteristic
Rare tumors of children and young adults
Cerebral hemispheres, mostly temporal
Can be malignant
Can present as:
- cyst with a mural nodule which is
attached to the leptomeninges
- solid mass
Enhancement is intense and represents
hypervascularity
GBM enstehungsarten
siehe Bild
Wichitgkeit Enhancement Astrozystom
Is considered essential:
For characterising a new lesion as
malignant
For diagnosing malignant
transformation of a previously benign,
non-enhancing lesion
Non-enhancing tumors are
considered grade II
Wieviele % der nicht anreichernden Tumoren sind Anaplastisch?
40% (obwohl eine nicht anreicherung für gewöhnlichs Grad II angebenen wird
Oligodendroglioma Characteristik
Slow-groing tumor with propensity to
involve the cortex
Very heterogeneous tumor making
histologic grading difficult
Mixed oligo-astrocytoma is frequent
Genetics are very important. Loss of 1p and
19 q dramatically changes (improves) the
prognosis of the patiënt
Oligodendroglioma: 1p
Oligodendroglioma imaging characteristics
Most important imaging hallmarks are:
Cortical location or extension
Streaky calcifications imaging characteristics
- are not mandatory
- can have a very misleading appaerence on MR
Patchy or more diffuse enhancement that
does not necessarily represents
malignant transformation!!
*
Ependymoma charactersitric
Infratentorial: mostly in children
fourth ventricle
calcification frequent
platicity: lateral extension through foramen of
Luschka
inhomogeneous enhancement
Adult Ependymoma
Is mostly supratentorial
If totally intraventricular: to be
differentiated from central neurocytoma,
meningioma, astrocytoma
If not totally intraventricular
(70 % in adults) : can be indistinguishable
from malignant astrocyoma
Calcification frequent
*
Choroid plexus papilloma
Arise from choroid plexus epithelium
Comprise benign papilloma (grade I)
and carcinomas (grade III)
Lateral ventricle: 80 % children
Can produce CSF with hydrocephalus
Choroid plexus papilloma: imaging
Cauliflower-like intraventricular mass
Calcification frequent
Marked enhancement
-
- 1 / 238
-
Lernkarten
PRIMARY CEREBRAL LYMPHOMA and Perfusion
PCL histopathologically demonstrate angiocentric growth with neoplastic cells forming multiple, thick layers around blood vessels.
Tumor cells are found in the perivascular spaces and within the vessel walls, but hypervascularity is not observed.
Differences in tumor vascularity between GBM and Lymphoma may provide discrimination between the lesions.
Lymphomas present relative decrease in rCBV contrary to hypervascular GBMs,
thus perfusion MRI can be useful in differentiating the two tumortypes.
CONCLUSIONS Perfusion TUmors
- DSC is the most commonly used method of MR perfusion
- Increased (>1.75) rCBV correlates with high grade tumor
- Heterogeneous perfusion correlates with high grade tumor
- Meningiomas also have increased rCBV but a hight leakage (T2* not hight after peak
- Lymphoma less vascular than high grade gliomas
- Metastasis pertitumoral rCBV not high
Advantage PRESS
less sensitive to motion and
diffusion
better for intermediate and
long echo-times
Advantage STEAM (Spectro)
less S/N
sensitive to the coupling effects from metabolites
best for short-echo times
better water-suppression
AB welchem Alter ha Spectroskopie
2 Jahre
standard metabolic ratios (Spectro)
NAA/Cr
NAA/Cho
Cho/
Cho/N
normal abnormal
NAA/Cr 2.0 <1.6
NAA/Cho 1.6 <1.2
Cho/Cr 1.2 >1.5
Cho/NAA 0.7 > 1.0
Lac in Spectroscopie when seen (Tumors)?
- inverted doublet at 1.3 – 1.4 ppm on TE 144 ms
• endpoint of anaerobic glycolysis
• it is most often seen in high grade gliomas and metastases (adults)
What does DWI measure
Magnitude of Water diffusion
ADC -> Einheit?
10-3 mm2/s
DTI
What does it measure?
magnitude and direction of Diffusion
shows microstrukture (anisotropie)
Tumor with high cellularitiy
(and high DWI resstrictrion)
Lymphoma
Neurglial tumors
What is Diffusionrestruction with exitotoxic glutamate induced oedema?
DAI
Hypoxic brain dmage
MS
Kreutzfeld jacob
shaken Baby
Hepatic encephalopath
Pontin myelinolysis
Wernicke
Anteile primitive GMB (primär) in %
95%
Sekundäre from Astro II-> IV
Which TUmorfaktor is correltated to CBV
Vascular endothelial growth factor
Does in Ologodenraglioma enhancem mean malignant transformation?
no!
50% of Oligo enhance at Grad II
PS: 40% of anaplastic Astro don't enhance
Gliomarten
Astrocytome
Oligodendrogliome
Ependymome
Plexuscarcinome
MTT Formel (with CBV CBF)
MTT = CBV / CBF
rCBV in lowgradtumor
in high grad Tumor?
>1.5
>1.75
EXTRA-INTRA CEREBRAL:
• EXTRA-INTRA AXIAL:
Difference?
EXTRA-INTRA CEREBRAL:
originating from CNS cells
• EXTRA-INTRA AXIAL:
localized out or into the CNS
Welche Echozeit für Lactt
mittlelere 144 ms
inverted
Welche peaks better in long echotime 288 ms
NAA, Chol , Krea
Which Metabolits besser echotime 35 ms
Lipid, glu/gln, acetat
PEAK
Acetat (Infektion v-ppm?)
NAA?
1.98 Acetate
2 NAA
Abzess spectro in 24h after treatment- else unctable
Anatomische Verbindung wernicke-> Brocca
Fasciculus arcuatus (AF)
Fractionierte Aisotropie DTI
Kann welche Werte annehmen?
0 bis 1
z.B.
Graue Substanz unorganisiert -> 0.1
Corpus callosum 1
periphere weisse Substanz 0.5-0.6
Deoxyhb para- oder diamegentic
paramagnetic
in suszept weighting signalsenkung
oxyhb steigerung -> BOLD-EFFEkt , da oyxhb zu deoxyhb gesteigert (Vasodilatation)
Wenn Läsion in T2 zentral dunkel und randständig ringförmig anreichert DD
Granulomatöse erkr wie TBC, Sarcoid, sonstiger infekt
Tracer PET für Recurrent Tumor in Astrozytoma or Oligodendroglioma (Proliferationsmarker)
18F-fluoro-3'-deoxy-3'-L: -fluorothymidine (18F-FLT) - Proliferationmarker, does not cross the BBB
or
18F-fluoro-dihydroxy-l-phenylalanine (F-DOPA) -> Oligodendroglioma Aminoacid crosses BBB -> better for recurrent Tumor
RANO Criteria tumour progression
• < 12 weeks after chemoradiotherapy
– new enhancement outside of the radiation field
• >12 weeks after chemoradiotherapy
– 25% increase of enhancing area
– New enhancement outside radiation field
– Significant increase of non-enahcing T2/FLAIR lesion on stable or increasing doses of corticosteroids
• Clinical deterioration not result of comorbidities
The “rule of the 90’s” in Kraniophayngeoma
• 90% have calcifications
• 90% are (at least partly) cystic
• 90% enhances
• >90% are suprasellar in location
Most realabe paramter for Tumor recuurence
rCBV > 1.75
Pseudo-progression (what is it?)
– transient increase in contrast enhancement
– in 20–30% of GBMs receiving radiation and temozolomide
– inflammatory reaction ; increased permeability of BBB
-> rCBV can resolve!!
Pseudo-response (what is it?)
– after anti-angiogenic treatment
– rapid decrease of enhancement but minimal effect on overall
survival
– VEGF inhibitors result in rapid normalization of the BBB
APT (Amino proton transvere) MRT
Turnover of Proteins in GBM
Unterscheidung Necrosis from Tumorrecuurence
Adenoma and Cephaleo-> think of
Apolexia Hypophysis -> life threatening
Differentiation Schwanomma and Meniegioma
Schwannoma gradually enhancement
Meneingeioma sudden enhancemnd
TRacer for Paraganglioma in PET
18-FDOPA
Mengieoma Spectroscopie spezifischer Marker
Alanin
Where is Chordoam arising off?
Spenooccipital synochondrosis
Notochordial rests
Is Chondrosarkoma of skullbase midline
no, most always off midline -(vs chordoma)
