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Showing posts with label Brain Tumors. Show all posts
Showing posts with label Brain Tumors. Show all posts
Monday, June 14, 2010
radiological summary
Magnetic resonance imaging plays a critical role in the diagnosis, management, and follow-up of adult supratentorial neoplasms. However, there is considerable overlap in the imaging findings of these lesions. New imaging methods, such as functional MR imaging, diffusion imaging, and spectroscopy may further improve diagnostic specificity and surgical management. Knowledge of the pathogenesis of these tumors, imaging characteristics, and available novel imaging tools will aid the radiologist in making meaningful contributions in the evaluation and treatment of these lesions.
Intraventricular metastases from lung carcinoma. Axial enhanced Tl-weighted images demonstrate an enhancing mass within the atrium and occipital horn of the right lateral ventricle. Note attachment to the pedicle of the choroid plexus (arrow). (Click to magnify figure)http://yassermetwally.wordpress.com/brain-tumors/adult-brain-tumors/
Metastatic breast carcinoma. A, Axial FLAIR images demonstrate a solitary mass with extensive surrounding edema in the left subinsular region. B, Axial and coronal enhanced Tl -weighted images show ring enhancement. Although the differential for a solitary mass lesion includes primary neoplasms and infectious etiologies, the peripheral location of this lesion, and the disproportionate amount of edema incited by the mass suggest metastatic disease. (Click to magnify figure)http://yassermetwally.wordpress.com/brain-tumors/adult-brain-tumors/
cystic type
Cystic meningioma. A, Axial postcontrast Tl -weighted image reveals a cystic mass lesion involving the left frontal lobe with peripheral enhancement, as well as enhancement around a trapped CSF intensity collection laterally (white arrow). B, Axial postcontrast Tl -weighted image near vertex of the head demonstrates the extra-axial nature of the mass with associated dural attachment (white arrow). (Click to magnify figure)http://yassermetwally.wordpress.com/brain-tumors/adult-brain-tumors/
non glial tumor
Meningioma in a 27-year-old woman who presented with new-onset seizure. A, Axial unenhanced CT image demonstrates a large hyperdense extra-axial mass in the left temporal region with associated central calcification (black arrow) and surrounding edema. B, Axial enhanced CT demonstrates intense homogeneous enhancement. Distinction of intra- versus extra-axial mass by CT can be difficult. C, Axial T2-weighted MR image clearly demonstrates a CSF cleft around the circumference of the tumor (arrowhead) indicating this to be an extra-axial mass. D, Sagittal postcontrast Tl -weighted image demonstrates a dural tail anteriorly and posteriorly along the tentorium (white arrows). (Click to magnify figure)
Lymphoma. A, Axial T2-weighted image shows relatively low signal intensity of the mass indicating high cellularity (black arrow) with surrounding edema high signal intensity B, Postcontrast Tl-weighted image demonstrates marked enhancement of the mass in the right centrum semiovale with surrounding edema. (Click to magnify figure)Secondary CNS lymphoma occurs from spread of systemic disease to the CNS (non- Hodgkin’s more common than Hodgkin’s). Secondary lymphomas typically involve the leptomeninges, and CSF with parenchymal involvement is much less common. MR imaging findings include leptomeningeal/dural enhancement and hydrocephalus.
http://yassermetwally.files.wordpress.com/2008/03/abt11.jpg
(WHO grade IV)
Primitive neuroectodermal tumor (PNET). A, Axial T2-weighted image demonstrates a large hemispheric heterogeneous signal mass with areas of cyst formation (white arrow). Note iso-intense signal of the mass on T2-weighted image reflecting high cellularity. B, Axial Tl -weighted image demonstrates presence of hemorrhage (arrowhead). C, Axial postcontrast Tl -weighted images shows heterogeneous enhancement pattern. (Click to magnify figure)(WHO grade 11)
Oligodendroglioma in an 81-year-old man. A, Axial CT image shows a calcified left frontal lobe mass (white arrowhead). B, Axial T2-weighted image demonstrates heterogeneous T2 signal reflecting the presence of calcifications and some surrounding edema. C, Postcontrast coronal Tl -weighted image shows mild enhancement (long white arrow). Statistically, a calcified mass is still more likely to represent low-grade astrocytoma. (Click to magnify figure)
http://yassermetwally.files.wordpress.com/2008/03/abt9.jpg
Gliomatosis cerebri in a 74-year-old woman. A, Axial T2-weighted, FLAIR, and enhanced Tl -weighted images demonstrate high signal intensity in the right temporal lobe involving white matter and cortex. The acute clinical presentation suggested infarct. B, Diffusion weighted image and TRACE apparent diffusion coefficient (ADC) map demonstrate increased water diffusion in the lesion (slightly higher values on ADC map, outlined by arrowheads), excluding acute infarction. Note that encephalitis may have a similar MR appearance and diffusion characteristics. (Click to magnify figure)
Gliomatosis cerebri. Coronal FLAIR images show diffuse infiltration of the left temporal lobe with gray and white matter involvement (arrowhead). Note the relative lack of mass effect for the degree of infiltration. The white matter infiltration extends across the corpus callosum (white arrow) and involves bilateral deep white matter tracts (double arrow). (Click to magnify figure)http://yassermetwally.wordpress.com/brain-tumors/adult-brain-tumors/
(WHO grade 111)
Anaplastic astrocytoma. Axial T2-weighted, FLAIR, and gradient echo images demonstrate a left frontal opercular mass with a minimal amount of edema. Appearance might suggest low-grade glioma; however, the presence of hemorrhage (white arrow) suggests higher grade. (Click to magnify figure)http://yassermetwally.wordpress.com/brain-tumors/adult-brain-tumors/
(WHO grade 111)
Anaplastic astrocytoma. Axial T2-weighted and enhanced Tl -weighted images demonstrate a large right temporal mass with prominent enhancement and extensive surrounding infiltration. Differential diagnosis includes lymphoma. (Click to magnify figure)http://yassermetwally.wordpress.com/brain-tumors/adult-brain-tumors/
(WHO grade 11)
World Health Organization (WHO)Grade II infiltrating astrocytoma(low grade). Axial T2-weighted, FLAIR, and enhanced Tl -weighted images. There is a high signal intensity mass in the left frontal lobe. No significant edema or enhancement is identified. (Click to magnify figure)Saturday, October 17, 2009
Brain Tumors
AstrocytomaThese tumors arise from star-shaped brain cells called astrocytes. Astrocytomas can arise anywhere in the brain, but in adults they usually arise in the largest part of the brain known as the cerebrum. In children, they develop in the cerebellum, brain stem, and cerebrum. Astrocytomas are graded from I to IV with the least aggressive designated grade I and the most aggressive, or rapidly growing, designated grade IV. Grades I and II astrocytomas are called low grade astrocytoma.Grade III astrocytomas are sometimes also called anaplastic astrocytomas and grade IV astrocytomas are usually referred to as glioblastoma multiforme or GBM.
Schwannoma
SchwannomaThis is a tumor that arises from the Schwann cell. These cells are present in nerves, including those that control balance and hearing. One common site of schwannoma growth is on the vestibular nerve, which carries signals from the inner ear to the brain stem. Tumors arising in this location are called acoustic neuroma (AN), although a more correct name is vestibular schwannoma (VS). These tumors occur most often in adults and produce progressive hearing loss in one ear. Some patients with a genetic condition called neurofibromatosis or NF have vestibular schwannomas on both sides (see picture). Patients with this genetic disorder may have schwannomas in other locations and can develop meningiomas as well.
Ependymoma
EpendymomaThis tumor arises from cells that line the ventricles, which are the fluid-filled spaces within the brain, or from the central canal of the spinal cord. They more commonly occur in children and young adults and can develop either in the ventricles or within the substance of the brain.
Glioblastoma multiformeGlioblastoma
Glioblastoma multiformeGlioblastoma
is the most common and one of the most aggressive primary brain tumors. It can arise from changes in the growth pattern of either a low grade astrocytoma or an anaplastic astrocytoma. Alternatively, GBM may arise de novo without any prior history of a lower grade primary brain tumor. Because of its aggressive nature, treatment of glioblastoma usually involves a combination of surgery, radiation therapy and chemotherapy.
Grade 3 astrocytoma
Brain stem glioma
Grade 3 astrocytoma
Brain stem gliomaThis type of tumor is usually an astrocytoma that is distinguished by the specific brain location in which it arises. Brain stem gliomas are most frequently diagnosed in young children and in middle-aged adults. They can produce serious neurologic symptoms due to their location in close proximity to critical brain structures. Treatment usually involves a combination of radiation therapy and chemotherapy. Surgical treatment is possible only rarely.
Craniopharyngioma
CraniopharyngiomatThis tumor (pictured left) grows at the base of the brain and arises from the band of tissue that connects the brain and the pituitary gland. Craniopharyngiomas occur in both adults and in children and generally consist of solid tumor tissue and a fluid-filled cyst. Treatment usually involves microneurosurgery; however, radiation therapy and gamma knife (radiosurgery) may be used in some cases as well.
Pituitary Adenoma
Craniopharyngioma
CraniopharyngiomatThis tumor (pictured left) grows at the base of the brain and arises from the band of tissue that connects the brain and the pituitary gland. Craniopharyngiomas occur in both adults and in children and generally consist of solid tumor tissue and a fluid-filled cyst. Treatment usually involves microneurosurgery; however, radiation therapy and gamma knife (radiosurgery) may be used in some cases as well.
Pituitary Adenoma
These are common tumors that arise from the pituitary gland located at the base of the brain. If they grow large enough, they can compress the optic nerves causing serious vision problems. Such tumors are called macroadenomas (pictured right) . Smaller tumors are known as microadenomas. Some pituitary tumors produce excessive amounts of hormones that can disrupt the bodyï¾’s metabolism. Pituitary tumors compress the normal pituitary gland and can adversely affect its function. Some pituitary tumors can be treated medically with drugs like bromocryptine and octreotide. Others must be treated surgically. For some patients, conventional radiation therapy and gamma knife (radiosurgery) can be used effectively as well.
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