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
-
Cartes-fiches
Methotrexate in spine - imaging?
Enhancing anterior nerve rotts like guillan barré
WO hat Abszess dickerer -anreicherungung
gegen Cortex
What kann simulate in DWI Abszess
hämorrhagic Met
dense Meta (small cell lung ca)
DOess an Abzess has a high rCBV?
no
How differetia GMB to pyegenic abszess with swi
Abszess dual ring sign (homogeneous hypointens ring)
GBM no ring
Fungal Abszess Charakteristic
dark central
hemorrhagic (angiogenetic)
smal abszesses (ex Candida)
must not enhance, DWI must not be posti
Keypoint pyogenic Abszess
-Low signal intensity capsule on T2WI
• Peripheral enhancement & edema
NOT ALWAYS SMOOTH!!
• Bright on DWI, low ADC
HOMOGENEOUS
• Low rCBV
• Smooth, complete rim on SWI Dual rim sign
Fungal Infections Keypoint
• Central hypointensity on T2WI
• NO Enhancement is common (Immunocompromised)
• Hemorrhagic
• Cortical location
• Microabscesses
• Intracavitary projectionson DWI -> ---fungal cel
TBC charachtertic
elivedeted Diffusion
MRS: lipid and Lactate hight (no succinate, acetate)
Differetiate
caseating: T2 dark centre, ringenhancement
non caseating: T2 brigth, nodule enhancement
Was macht Glutamate cerebral
Macht durch öffnung der "Poren" zytotoxisches Oedem
entweder nicht mehr aufgenommen, vermehrt ausgeschütt (synapse verletzt), dysregulriert und vermehrt produziert
Fragen für maxillofaciale Tumoren
1 at birth
2 growing disporpotion to age
3 was there a regress oder progress in time
4 changes with infek
Maxillofacial
Typisch für venoöse mf
lymph mf
phelbolithen venös
fluid-fluidlevel lymphog
Angio negativ in al
capillaryy hämagioma
venous mf
wher is the juvenil angiofibrocoming from
f. sphenopalatinum
Retinoblastoma
Agressive Tumor off the enuroectodermal cells of retina (primitiv photoreceptors)
Leucocoria
Most common tumor ocular (1:15000)
Before 5 years
Bilateral or trilateral is defekt of RB-gene
Calcification 90%
Role of imaging RB
Optic nerve extension
Scleral breaktrough
Metastases
Ct features of RB
Calcification 90%
Mild enhancement
Dens vitrous
RB MRI
Hypointens T2w
Moderate enhancement
Moderate hyperintens in T1w
Ocular Melanoma
Arises of pigmented layer
50-70 years
retinal detachment with bleeding
t2 dark, t1 bright
Most common ocular Tumor in adults
DD Leukochoria
Retinoblastoma
Melanoma
PHPV
Posterior Catarakt
COats disease
Coloboma
Toxocara canis
PHPV
Persistent hyaloid artery and primary vitreous
No calcification (vs retinoblastoma)
Retinal detachment and bleeding
Coats disease
Vascular abnormtiy
5-8 years
exsudativ retinitis
no calcification vs Retinoblastoma
denser bulbus
how many with NF1 develops optic glioma ?
15%
Optic glioma is assoc with NF1
In 30-50%
Chronic inflamatory demyelinating polyneurophy (CIPD) in eye
Immune mediated neuropathjy
Slowing nerve conduction
Onion ring shell demyelinisation
Lacrimal gland tumor
Lymphatic 50% (lymphoma …)
Epithelial 50% (pleomophic adenoma …)
Diff capillary vs cavernous hämangioma
Cap : child , grow 1 jahr, then normally involutes
cavernous -> Ven : 18-72 years, enlarges
Optic glioma can involve optial tract?
yes
Opticochiasmal glioma possible
low grade WHO I
Conal lesions
Thyroid eyes disease (Grave disease)
Pseudotumor (DD lymphoma) - all structures
DAnger of Thyoid eye disease
Apical crowding of optic nerv
Pseudotumor
idiopatic infalmation
all structures of orbied
female
DD lymphom (can in pathology simuymphoma)
CIPD orbit
onion shell demyn uaf nerves (Guillain barre oderoie toth syndrom s
Empty orbit sign
NF1, sphenoid wing dys
pulsating exophthalmus (CSF pulses are weitergeleitet)
Invertical papilloma
lateral nasal wall
calcified
DD fibrouse dysplasia
NOF, but more agressiv
Ameloblastoma
Regio 36-8 46-8
Blastic
benigne
30-40 years
DEntogene zysten
radiculr cystic -> infektion
follikular zyste -> unrupteret tooth
keratocyste (Basalcell syndroma)
Nasale tumors
SCC
Sinnasal adeno-CA (ethmoidal)
adenoid cystic CA
undifferentiated sinonsal CA
Melanoma
Multiple myeloma
Esthesioneuroblastom 20 & 50 years
Nasal tumors in Children
Lymphoma
Chloroma
Rhabomyosarkoma
Indication of PET in suprahyoid cancer
Risko of nodal spread (T3 und T4)
overestimistas size
