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
Anterior tonillar pillar
Posterior tonillar pillar
anterior: palatoglossus muskl beyond -> Leitlinie zu Zunge
posterior: palatopharyngeal muscle -> Leitlinie zu pharynx
IN perineural spread of adenoid zystic - how many asymtocic
40%
Wieviele Lymphknoten mets are less then 1 cm
50%
prophlactic neck dissektion oder radiatio
ADC of pathologisc LN
<1.0 x 10-3 mm2/s ADC
High risk criteria of HN tumor with distant met-> distant met with PET
High risk patients:
• ≥ 4 lymph nodes metastases
• Bilateral lymph node metastases
• Lymph node metastases ≥ 6 cm
• Zone IV lymph node metastases
• Recurrent squamous cell carcinoma
• Second primary tumor
Larynx
T2->T3
T3-> T4
infiltration paralaryngeal space
going over cartilage
Synovial sarkoma
comming vom pluripotent mesenchymal cells
adolescens
Parathyroid imaging
very enhancing
look at the upper mediastinum!
Vocal cord paralysis
medialisizing vocal cord
bigger sinus piriformis
Carotisspacetumors
glomus
Schwannoma
Lymphnode under Sternocleido berührt jugulare vene
Level IIA
not touching Level IIB
Differential
Vascular malformatiormation
Vasculr tumor
MF: At birth
Tumor: growth
AVM
late hit in formation
early on
Triggering:; Trauma , infektion
AVM growth -> more cells?
No - more shunt (dilation)
Iigation embolisation ist not acurate for defintiv treatment of AVM, only for presurgical treatment
right
3 Types of CAMS
otic
veretbal
porencephalic
Metameric AVM
CAMS
Cerebral Arterio metameric syndr
Venous MF
Growth under Venous compressioValssalva
Phelbolithis
may growth over time
no shunt
painfull
Cerebo venous metameric MF
Sturge Weber
Lymphatic MF
T2 hyperintiensno
enhancement no
fluid fluid level
septated
Hemangioma
capiullary hämangioma
Endovaskular treatment only in exception
Wann treten paraganliome vermehrt auf?
chronic lung diseease
Criterira of maligne paraganglioma
only mets LK
Imaging of paragangioma
multiplicity!!
Classification Paraganglioma jugular
FISH (z.B. FISH C erosion of the jugugular foramen)
lokation paragangiolma
carotid
vagal
tympanicum
jugular
Carotic paraganglioma clastion
Shamblin
Location vagal/ caroticum paraganglioma
vagal : betwenn jug vein und the ACI& ACE
caroticum: betweenn ACE & ACI -> lyric sign
Spectro in ischäme
NAA down
Lactat high
Krea down
In wievilen % is Angiographie in vasculitis normal?
40%
Goldstandard für Dg primäre Vasculits
Menigeral Biopsie
Nerve of Glomus tympanicum
Jacobs nerv (glossopharyngeal branch)
Nerv of glomus jugulare
Arnold nerv (vagus branch)
Secretion of paraganglioma
Catecholamines, selden 5-10%
NUK Diagn PGL
Octreotid-SPECT
18- FDOPA PET
Most frequent intramedullary tumor
Ependymoma is the most frequent intramedullary tumor, followed by astrocytoma.
third most frequent intramedullary tumor
Hemangioblastoma is the third most frequent intramedullary tumor.
peak incidence for spinal astrocytomas
peak incidence for spinal astrocytomas is in the third and fourth decade and
the average age at presentation is 30 years
The peak incidence for spinal ependymomas
The peak incidence for spinal ependymomas is in the fourth and fifth decade and
the median age at presentation is 35 years
Localisation Spinal paraganglioma
Spinal paraganglioma are usually found in the conus medullaris, cauda
equina or filum terminale
