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
-
Flashcards
Wieviele prozent wkeit bei Optic pathwy Glioma ass zu NF 1
75%
NF1 general
Chromosom 17
1:3500
most Phakomatosis
Autososam dominant
Neurofibrom, -> low risk of maiign transformation
scoliososis
scalooping verebral body
arachnoidal zysts
NF1 imaging
Tumors (optic glioma)
UBO (no mass, Basalganglia, no enhancement)
spenoid dysplasia (emty orbit sign)
Macrocephalia (50%) - lager Corpus callosum)
NF2 general
Central disiease
Chrormosom 22
Intracranial Tumors -> MISME)
Spinal tumors (ependymomamas, Schwannoma, menigeomas)
tuberous sklerosis (Migration error)
Trias
Naevus (brigth spot on skinn)
Mental retradation
seizure
only in 1/3 of patient complet
Imaging TRuberous sclerosis
Mirgation Error
Hamartoma (Tuber)
Subependymal nodulas with enhancment (does not mean they are malignant-9
Subemepdymal Giantcell Astrozytome (>1.5 cm)
Associtata Tuberous sklerose
Renal (Angiomyolipoma)
Pulmonalre (LAM)
Vascular (Anuerysma)
Sturge weber intracranial (Venous anomaly)
Abscend cortical veins
Collateral venous drainage
-> chronic ischimia -> atrophia, calcifiaktion
Zusammenfassung Phakomatosuis
s bild
wieviele Hämangioblasomte sind zystic?
66%
33% are solid
Woher kommen peritumorale Zysten um Hemangioblastoma
Degenration von Oedem Tumoe/nodule
Which phakomatosis does not have cutanous expression
Von Hippel Lindau
Tumoraen assozieirt VHL?
Hämagioblastoma
RCC
Pankreas
• EXTRA-INTRA CEREBRAL:
• EXTRA-INTRA AXIAL:
• EXTRA-INTRA CEREBRAL:
originating from CNS cells
• EXTRA-INTRA AXIAL:
localized out or into the CNS
Häufige Tumoren des jungen Kindes (Gliome)
Astro I pilocytic -> NF I?
Hypothalamic Glioma -> NF1
Optic Glioma -> (NF1)
Gionat cell Astro -> Tuberous sklerosis
Gliomatosis cerebrir
RARE: GBM
Ependymoma (supratent rare, more infratentrotentitl)
Oligo rare
Neuronale Tumoren des Kindes
Wann kommen diese vor
Adult
DNET
Desmopl. infantil Gangioglioma
Was für Substabteb haben PNET in Spectro
Taurin
Atypical teratoid rhaboid tumor
ATRT
rare
posterior fossa lesions in childs
• cerebellar astrocytoma:37.1%
• medulloblastoma:34.6%
• brainstem glioma:11.4%
• ependymoma:7.0%
• others:9.9%
Anreicherungen von peritumoralen Zysts in pilocyt Astro und hämangiobladst - bedeuting
intratumorale Zyste -> Entfernen
Nicht enhancing -> cyst from oedema -< kann belassen werden
Differentioan pilocytic astro vs. hämabioblastoma
Astro pilozytic rCBV < 1.5
Hämangioblstoma >>> 7-10
Wievilee Ependymoma entstehen im 4. ventrikel
60%
Diffusioen
Ependumoma
pilo Astro
Medollo
Less Astro
middle Ependymoma
high Medullo
Wie kann man Leakage im Dynamic suszeptibility contrast (DSC) verhindern
1/2 KM Menge vor der Persfusion spritzen
Oder Mache DCE vor DSC
Wie lange kann Peudoprogression andauern
3 Monate
DD zu GBM
Gliosarcoma
Rosai-Dorfmann Disease?
Granulomatöse Erkrankung in Far East, selten in Europe
Bilateral Lymphnodes with pain
Diffuse Metas leptomenigeal
lung, breast, melanoma, lymphom, leukemia
How many lesions are not metas in patients with known cancer
11%
Metas tha can bleed
Melanoma
Thyroid
Renalcell
bronchus
Methothextrae in Brain
can cause both PRES and acute encephalopathy
Acute encephalopathy
develops later
resolves more slowly
characteristic are pyramidal signs
- hemiparesis
- paraparesis
- choreoathetoid movements
hypertension unusual
PRES
6-24 hours after therapy
resolves more rapidly
clinical symptoms
- altered mental status
- blurred vision
hypertension
Wann tritt Pseudoprogression auf
GBM und chemoradioy with temozol
When can radiotion necrosis start after Therapie
2-6 Month till 5-10 years
Imaging pattern in rnecrosis
rCBV normal
"swiss cheese pattn
soap bubble
MT,T CBV, CBF in radioation necr,
in Tumor?
Tumor: MTTT low, CBV, CBF high
Radiation: MTT high, CBV, CBF low
Primary CNS Lymphoma (PCNSL) Characteristik
• Rare variant of non Hodgkin lymphoma
• Immunocompetent and immunodeficient
patients
• 10 15% Epstein Barr virus (EBV)
• 40 60% solitary lesions
• 5% lymphomatosis cerebri disseminated
HIV an Lymphoima -> Type?
non hodgkin b-zellymphoma
possible not enhancment or partial enhancem
How to differentiate lymphoma & Toxoin HIV Pat
Thalium SPECT
PET
postitiv in Lymphoma
What is angiocentric lymphoma
Lymphoma in small vessels -> linear enhancement
poor prognosis
CNS Leukemia Typen (z.B ALL)
Carcinomatous meningitis: meningeal disease
Carcinomatous encephalitis: intravascular aggregates
Granulocytic sarcoma: tumor masses (Chloroma)
