Brain tumours Flashcards

1
Q

List the intraventricular brain tumors

A
  • Ependymoma (children, toothpaste lesion)
  • Pilocytic astrocytoma (children, large cystic lesion with central mural nodule)
  • Subependymoma (adults, usually in 4th and lateral ventricles), doesn’t enhance
  • Central neurocytoma (adults, lateral ventricles attached to septum pellucidum, heterogeneous mass with variable enhancement)
  • SEGA tumors (benign, young patients with TS, larger than 1 cm, calcification and marked contrast enhancement)
  • Choroid plexus tumors (papilloma, carcinoma)
  • Metastases
  • Meningioma
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2
Q

List primary brain tumours that diffusion restrict

A

1) GBM
2) Medulloblastoma
3) Lymphoma

DDx: Infarct, abscess, demyelination

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3
Q

Define pseudoprogression and pseudoresponse

A

Pseudoprogression - apparent increase in T2 signal in the first 3 months, usu due to radiation or chemo (caution unless clearly outside of XRT field)

Pseudoresponse - apparent decrease in enhancement, typically due to VEGF inhibitors which are anti-angiogenic and alter blood brain barrier; can occur as early as 24-48 hours- persistent findings for 4 weeks are needed to call response

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4
Q

MRS for glioblastoma

A

Decreased NAA, decreased Cr, decreased myoinosital

Increased choline, increased lactate

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5
Q

Most commonly tumours to bleed

A

GBM, mets - melanoma, thyroid, choriocarcinoma, RCC

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6
Q

Tumours that are hypointense on T2

A
  • Hypercellular tumours (medullo, lymphoma, germinoma, some GBMs)
  • Mucinous mets
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7
Q

Tumours that are hyperintense on T1

A

Mets - melanoma
Fatty tumours - dermoid/ teratoma
Hemorrhagic mets (RCC, thyroid, melanoma, chorio)

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8
Q

Ependymoma location in adults versus kids

A

Post fossa of children, spinal cord in adults
“Toothpaste” tumours
Adult spinal tumour can occur anywhere in intramedullary cord - main ddx is astrocytoma (younger patients), difficult to distinguish b/w these on imaging

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9
Q

What is Lhermitte-Duclos imaging appearance and associations

A

Dysplastic cerebellar gangliocytoma - WHO I
Part hamartoma, part neoplasm
Almost always associated with Cowden syndrome (multiple hamartomas, increased risk Ca)
Tiger-striped lesion cerebellum

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10
Q

ATRT imaging findings

A

Embryonal tumour - grade 4
Infants/younger patients
Can look like medulloblastoma, heterogeneous, enhancing, +/- edema
Post fossa solid tumour, but also occur supratentorial (ddx: medulloblastoma, embryonal tumours with multi-layerered rosettes i.e. ETMR)

Associated with malignant rhabdoid tumour of kidney

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11
Q

Hemangioblastoma imaging features

A

WHO Grade 1 - DDX cystic tumour post fossa
Occurs in cerebellum, medulla, or spinal cord
Ass with VHL (in 30% of cases)
Cystic mass, enhancing mural nodule
Prominent flow voids, +/- syrinx

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12
Q

PXA imaging features (pleomorphic xanthoastrocytoma)

A
WHO Grade II - astrocytoma variant
Rare tumour childhood and adolescents
Chronic epilepsy
Cyst with mural nodule in temporal lobe, dural thickening and enhancement
DDx ganglioglioma (more heterogeneous)
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13
Q

Ganglioglioma

A

Mass in temporal lobe
Similar appearance to PXA
Also in young patient with epilepsy
Won’t see dural thickening like in PXA

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14
Q

Imaging appearance of central neurocytoma

A

Lobulated mass with cystic foci and calcs attached to septum pellucidum, young adults, good prognosis

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15
Q

Chorioid plexus papilloma/carcinoma

A

Most common BT in babies**
Hyperintense on T2, enhancing, cauliflower-like
Can see in adults, usu in 4th ventricle

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16
Q

Classic location for SEGA

A

Enhancing mass, lateral ventricle near Foramen of Munro

17
Q

Subependymoma demographics and imaging features

A

Middle age and older adults
Often incidental
4th ventricle most common, or at foramen of munro lateral ventricle
Don’t enhance, so can easily be missed

18
Q

CNS lymphoma imaging features

A

Primary: Periventricular, enhancing mass, diffusion restriction, in BG and frontal lobes, can cross CC
Melt away with chemo/rads
Can be heterogenous if immunocompromised, with ring enhancing lesion most commonly seen in BG
DDx: toxoplasmosis (look at perfusion, or do thallium, or PET)

Secondary lymphoma typically involve meninges, may cause leptomeningeal carcinomatosis and dural masses

19
Q

3 most common primary tumours to met to brain

A

Lung, breast, melanoma

20
Q

Multiple meningiomas is associated with _____ or _____

A

NF2 or prior rads

21
Q

Most common tumours to met to dura

A

Breast (#1), lymphoma, small cell lung Ca, melanoma

22
Q

Key intracranial manifestations of VHL

A

Hemangioblastomas and endolymphatic sac tumours (along posterior petrous ridge)

23
Q

DDx CPA angle mass

A
Schwannoma (#1) 
Meningioma
Arachnoid cyst 
Epidermoid cyst 
Aneursym
Intra-axial neoplasm
24
Q

Differences between arachnoid cyst and epidermoid on imaging

A

Arachnoid - follows CSF on all sequences, FLAIR suppression

Epidermoid - diffusion restriction, does no suppress on FLAIR

25
DDx Suprasellar Mass
Most common: Children - craniopharyngioma, optic pathway glioma**(associated with NF1), germinoma Adults - pituitary macroadenoma extending into suprasellar space, meningioma, Rathke's cleft cyst, also craniopharyngioma (bimodal distribution) Other: epidermoid and dermoid cysts, aneurysm (do not miss diagnosis!), hypothalamic hamartoma (kids-tuber cinereum), mets (breast Ca), lymphoma, sarcoid and TB
26
Most common intracranial germ cell tumour
Germinoma | 80% pineal gland, 20% pituitary
27
Clinical and imaging findings in hypothalamic hamartoma
Occurs in children Gelastic seizures, precocious puberty Mass in tuber cinereum, non-enhancing, iso T1/T2
28
What is Parinaud syndrome?
Compression of tectal plate/rostral midbrain (usually from tumour in pineal region) Results in upward gaze paralysis, nystagmus
29
Imaging appearances of pineal germinoma
Avidly enhancing lesion, engulfs pineal glad, central calcification (engulfs) Ddx. teratoma Occurs in teenagers
30
Imaging appearances of pineoblastoma
Explosive calcification along margins, poorly defined mass, enhancing with diffusion restriction, obstructive hydro, mets and seeding look for associated retinoblastoma (trilateral retinoblastoma) - both on light sensing pathway