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Neuroradiology > Intraaxial masses - supratentorial > Flashcards

Intraaxial masses - supratentorial Flashcards

1
Q

What tumors are hyperintense on T1?

A

Melanoma
hemorrhagic mets (RCC, Thyroid, Choriocarcinoma, Melanoma)
Dermoid, teratoma

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2
Q

What are the 4 main types of glial cell?

A

Astrocytome - support, healing
Oligodendrocyte - maintain myelin
Ependymal cells - circulates CSF
Choroid plexus - makes CSF

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3
Q

What age range to suspect low grade astrocytoma?

What is the MRI appearance? CT?

Key feature?

A

20-40

T2 hyperintense/ FLAIR hyperintense, rarely surrounding edema
20% calcify on CT

NO ENHANCEMENT!

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4
Q

Supratentorial parenchymal location, Nonenhancing mass, bright on T2/FLAIR, calcs on CT

20-40yo

A

Low grade astrocytoma

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5
Q

What are the MRS and perfusion differences in low grade vs anaplastic astrocytoma?

A

Low grade: no increase in rCBV, elevated myoinositol and choline, low NAA, no lipids/lactate

Anaplastic: Elevated rCBV, LOW myoinositol and NAA, high choline, no lipids

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6
Q

Supratentorial parenchymal inhomogenous mass with EDEMA, can have enhancement

40-50 yo

A

Anaplastic astrocytoma

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7
Q

What is the imaging of anaplastic astrocytoma?

A

Varies, can range from T2/FLAIR thickening of cortex to focal enhancing lesion mimicking GBM

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8
Q

White matter mass with nodular rim enhancement and surrounding T2/FLAIR signal, restrict diffusion

elderly male

A

GBM

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9
Q

Who gets GBM? What is the imaging on MRI?

Where does it spread?

A

> 50 (65-75), Males 3:2

Heterogeneously enhancing mass within cerebral WM with surrounding edema

INVADES white matter tracts, through CSF, and transependymally

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10
Q

What are the spectrum of astrocytoma?

A

Low grade astrocytoma, anaplastic astrocytoma, GBM

Also JPA in post fossa of kids

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11
Q

What is gliomatosis cerebri?

A

Diffuse infiltrating astrocytoma that invades 2 or more cerebral lobes

First involves white matter with widening of tracts then extends diffusely

Criteria for dx is at least 2 lobes plus extracortical involvement such as BG, CC, brainstem, cerebellum

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12
Q

What is the imaging of gliomatosis cerebri?

A

Diffue T2/FLAIR signal throughout involved brain

Shows mass effect but DOESNT enhance

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13
Q

Differential for diffuse T2/FLAIR signal throughout multiple cerebral lobes?

A

Gliomatosis cerebri
Lymphoma
PML
AIDS encephalopathy

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14
Q

What is a key feature of gliomatosis cerebri?

A

DOESNT enhance

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15
Q

Who gets oligodendroglioma? What is the usual symptom?

A

40-50 male with seizures

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16
Q

Where do oligodendroglioma present?

What are the variants?

What is the imaging features?

A

Subcortical white matter in FRONTOTEMPORAL regions (also temporal and occipital and CC)

Pure
Oligoastrocytoma - mixture with astrocytoma, can degenerate into GBM
Anaplastic oligodendroglioma - indistinguishable from GBM

CALCIFY!!!! most common calcifying intracranial tumor

Scalloping of inner table

MR: T2 Bright, enhances 50%, doesnt restrict diffusion

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17
Q

What is a key feature between GBM and high grade oligodendroglioma?

A

Oligodendroglioma DOESNT restrict diffusion, will calcify

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18
Q

Where do supratentorial ependymomas occur? Who gets them? What is the imaging appearance/DDx?

A

SUPRATENTORIALLY: frontoparietal regions, adjacent to ventricles or within ventricles

Older adults

Oligodendroglioma/Astrocytoma - indistinguishable

Partially calcified/cystic mass adjacent to ventricles with enhancement

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19
Q

Where is the most common location for subependymoma? Where is the second most common?

Who gets them? What are the imaging characteristics?

A

MC: 4th ventricle, usually enhance
Frontal horn lateral ventricles adjacent to septum pellucidum, dont enhance

40-50yo

Calcifications, can present with hemorrhage, T2/FLAIR bright

20
Q

Nonenhancing mass with/without calcification with hemorrhagic propensity

A

Subependymoma

21
Q

What is the age/presentation for ganglioglioma?

Where are they located?

What is the classic appearance?

A

male,

22
Q

Temporal lobe cyst and enhancing mural nodule with calcification

A

Ganglioglioma

23
Q

What are the 4 tumors with a cystic appearance and enhancing nodule?

A

JPA
Hemangioblastoma
PXA
Ganglioglioma

24
Q

What tumors cause scalloping of calvarium?

A

Ganglioglioma

Oligodendroglioma

25
Q

Bubbly mass attached to septum pellucidum in frontal horn of lateral ventricle with calcification and moderate-marked enhancement

What is the unique MR appearance?

A

Central neurocytoma

Susceptibilty artifact

26
Q

Who gets central neurocytoma

A

young adults

27
Q

What are the intraventricular tumors?

A

Central neurocytoma, choroid plexus, meningioma, SEGA, subependymoma

28
Q

What are the 3 types of metastatic disease to the head?

A

Bone/epidural
Dural/leptomeningeal
Parenchymal

29
Q

What are the common mets to bone/epidural?

A

breast, prostate, lung, kidney, myeloma

30
Q

What are the common mets to dural/leptomeningeal?

A

breast, small cell carcinoma, melanoma, lymphoma, leukemia

31
Q

What are the common mets to the parenchyma?

A

Lung, breast, melanoma (skin), kidney, GI

“Lots of Bad Stuff Kill Glia”

32
Q

What mets are hyperintense on T1?

A

Melanoma, kidneys, lungs, choriocarcinoma, bowel

33
Q

What are the common types of lymphoma in the brain?

A

Nonhodgkins and B cell

34
Q

What is the imaging appearance of primary CNS lymphoma?

What are the key imaging features?

A

Deep grey/white matter lesions that are hyperdense on noncontrast CT, little mass effect or edema, PROMINENT ENHANCEMENT

PERIVENTRICULAR location and HIGH CELLULARITY (restricted diffusion, hyperdense on CT, hypo on T2), avidly enhance

35
Q

Homogenously enhancing periventricular lesion, dark on T1

A

Primary CNS lymphoma

36
Q

What is the main difference between immunocompetent and immunocompromised CNS lymphoma?

A

competent: avid enhancement
compromised: ring enhancement with central necrosis

37
Q

What is the typical appearance of immunocompromised CNS lymphoma (AIDS)?

A

periventricular ring enhancing lesions

38
Q

What is the appearance of secondary lymphoma in the CNS?

A

Leptomeningeal carcinomatosis/enhancement

39
Q

AVIDly enhancing tumor in

A

Choroid plexus papilloma

40
Q

What is the key feature between central neurocytoma and choroid plexus papilloma?

A

CPP avidly enhances

41
Q

What is the associated syndrome with CPP?

A

VHL

42
Q

Who is the patient with PXA?

Where is the most common location?

A

Rare tumor of childhood and adolescents, history of chronic epilepsy

Temporal lobe

43
Q

Supratentorial cystic cortical mass with enhancing mural nodule in the temporal lobe?

A

JXA

44
Q

What is the main differentiating feature between JXA and ganglioglioma?

A

JXA has dural thickening

45
Q

Give a tumor for the following posterior fossa mass in a child

Hyperattenuating CT, restricted diffusion
Cystic mass with enhancing mural nodule
Intraventricular mass, pushes through ventricle
Cystic mass with enhancing mural nodule with flow voids
Hyperattenuating CT, restricted diffusion,

A

Medulloblastoma

JPA

Ependymoma

Hemangioblastoma

ATRT

46
Q

Give a tumor for the following posterior fossa mass in an adult

Hx of malignancy, enhancing mass with edema
Cystic mass with enhancing mural nodule with flow voids
Minimal or little enhancement
Young adult and lateral location

A

Metastasis

Hemangioblastoma

Brain stem astrocytoma

Medulloblastoma

Neuroradiology (15 decks)

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