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96 Cards in this Set
- Front
- Back
Multiple enhancing lesion – DDx
|
1. Metastases
2. Infection (septic emboli) 3. Lymphoma 4. MS/ADEM 5. Multicentric GBM 6. Subacute infarct |
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Hemorrhagic Mets – DDx
|
MRCT
1. Melanoma 2. RCC 3. Choriocarcinoma 4. Thyroid |
|
Pineal Region tumors – DDx
|
1. Pineal Cell tumors – pineoblastoma, pineocytoma
2. Germ Cell Tumors – Germinoma, Teratoma 3. Epidermoid 4. Metastasis 5. Lipoma 6. Glial Tumor (Tectal Glioma) 7. Aneurysm of VOG |
|
Sellar/Parasellar Masses DDx
|
1. Pituitary Macroadenoma
2. Rathke’s cleft cyst 3. Craniopharyngioma 4. Lymphoma 5. lymphocytic/sarcoid hypophysitis/EG hypophysitis 6. Hematoma 7. Meningioma 8. arachnoid cyst 9. Germinoma/teratoma 10. epidermoid 11. Aneurysm 12. Mets 13. Hypothalamic Glioma, Optic Nerve Glioma 14. Abscess |
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Empty Sella
1. Most common cause 2. Other causes |
1. defect in diaphragma sella with CSF pulsations
2. Sequela of Sheehan’s syndrome |
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Lymphocytic Hypophysitis
1. When/why does it occur? 2. Imaging findings? 3. Clinical presentation |
1. Typically, post-partum period (Autoimmune reaction to involuting pituitary). Can occur in males however.
2. Typically enhancement of anterior pituitary and stalk, diaphragma sella, sometimes posterior pit. 3. headache, visual loss, amenorrhea, and failure of lactation, Diabetes insipidus. |
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Cystic Pituitary Masses
|
1. Cystic adenoma
2. Craniopharyngioma 3. Rathke’s pouch cyst |
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Hemosiderin Deposition in Pitutary – Dx?
|
1. Haemochromatosis
2. Hemosiderosis |
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Causes of Diabetes Insipidus – DDx
|
1. Traumatic – transection or postsurgical
2. Inflammatory a. Sarcoid hypophysitis b. EG c. Lymphocytic hypophysitis d. Abscess 3. Neoplastic e. Craniopharyngioma f. Macroadenoma g. Rathke’s cleft h. Germinoma i. Hypothalamic Glioma j. Lymphoma, Leukemic infiltration |
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Hamartoma of Tuber Cinereum
1. Location 2. Sx 3. How to distinguish from Germinoma, glioma? |
1. sessile or pedunculated mass b/w infundibuluma and mammilary bodies. Very slow growth
2. precocious puberty, gelastic sz 3. non-enhancing |
|
Lymphoma in Parasellar Region
1. Where is its preferred sites? |
1. Hypothalamic region
2. cavernous sinus |
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Parasellar/hypothalamic/hypophyseal Germinoma
1. Typical Age 2. Typical Sex 3. Typical sx 4. Typical imaging features 5. Pattern of spread (2) |
1. Under 30 (peak in 2nd decade related to puberty)
2. Male:Female equal in suprasellar region (7:1 male in pineal region) 3. Endocrine dysfunction DI, panhypopituitarism 4. enhancing mass, sellar & suprasellar, relatively T2-hypointense due to cellularity 5. Infiltrative & Subarachnoid seeding |
|
Lesions that undergo Subarachnoid Seeding
|
1. PNET’s (medulloblastoma, pineoblastoma)
2. ependymoma 3. GBM 4. juvenile pilocytic astrocytoma 5. Germinoma |
|
Infundibular Masses – DDx
1. Pediatric – common 2. Pediatric – uncommon 3. Adult – common 4. Adult - uncommon |
1. Pediatric – common
a. EG b. Germinoma c. Meningitis 2. Pediatric – uncommon d. Lymphoma e. Glioma 3. Adult – common f. Sarcoidosis g. Germinoma h. Mets 4. Adult – uncommon i. Lymphoma j. Glioma k. Choristoma |
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Cavernous Sinus/Parasellar Masses
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1. meningioma
2. Schwannoma (5 >> 3, 4, 6) 3. Skull Base tumors (mets, chordoma, chondrosarcoma, chondroma, plasmacytoma, NP/sinus Ca invasion) |
|
Skull Base Tumors – Ddx
|
1. Chordoma - #1 primary of clivus
2. Mets – (breast, lung, prostate) 3. Chondroma/chondrosarcoma 4. Plasmacytoma 5. Giant Cell Tumor |
|
Chordoma
1. most common location in clivus? 2. tissue origin? 3. Growth pattern 4. Where does it usually extend? 5. Imaging features 6. Alternate intracranial locations 7. Skull base mimic? |
1. spheno-occipital synchondrosis
2. notochordal elements 3. Slow, eroding bone by direct extension 4. sellar/parasellar, pontine cistern, sphenoid sinus, middle cranial fossa 5. lobulated T2-hyperintense and variably enhancing (minimal, mottled or homogeneous) tumoral calcifications, bony sequestra better shown on CT, 6. Petrous apex, parasellar region, prepontine cistern (notochordal elements) 7. Schwannoma going through skull base foramen (T2-hyperintense, enhancing) |
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Tumors of Skull
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1. EG
2. Multiple myeloma 3. mets 4. Hemangioma 5. Epidermoid |
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What are the mixed glial/neuronal tumors?
|
1. central neurocytoma
2. dysemroplastic neuroepithelial tumor (DNET) 3. Ganglioglioma, ganglioneuroma |
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Cerebral Glioma – DDx
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1. Lymphoma
2. Metastasis 3. Hematoma 4. Abscess 5. Tumefactive MS 6. Enhancing Infarct |
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Intraventricular Tumors
|
1. CPP/CPC
2. Meningioma 3. Central Neurocytoma 4. Subependymoma 5. Ependymoma 6. Exophytic glioma from hypothalamic, thalamic, pineal region 7. Medulloblastoma 8. Giant Cell Astrocytoma (SEGA) 9. Epidermoid Tumor 10. (Colloid Cyst, Choroid plexus Cyst) 11. Neuroepithelial Cyst 12. Ectopic pinealoma |
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Parapineal Tumors/Mass Lesions
|
1. Meningioma from tectal plate
2. Tectal, posterior IIIrd ventricle gliomas 3. Developmental cysts (epidermod, dermoid, arachnoid cysts) |
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Posterior Fossa Mass – Adult - DDx
|
1. Metastasis
2. Infarct 3. Hemangioblastoma 4. Glial Neoplasm (Astrocytoma, ependymoma) 5. Lymphoma 6. Medulloblastoma 7. Abscess 8. Skull base Tumor 9. Arachnoid Cyst 10. Meningioma 11. Schwannoma 12. Epidermoid 13. Extra-axial collection |
|
Most common primary adult cerebellar tumor?
Peak age of occurrence? |
Hemangioblastoma
1. 30 yo |
|
VHL
1. What % of hemangioblastomas are part of VHL? 2. What others disorders part of VHL? |
1. 10%
2. VHL disorders a. Hemangioblastomas b. Renal Cell Ca, renal cysts c. Islet cell tumors d. Endolymphatic Sac tumors e. Pheochromocytomas f. Pancreatic cystadenoma g. Epididymal cysts h. Liver cysts i. Retinal angioma |
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What are the two characteristic findings of hemangioblastomas?
|
1. cyst and enhancing mural nodule
2. serpiginous T2-flow voids |
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Acoustic Schwannoma
1. Which division of CNVIII do they usually arise from? 2. if found in adolescent, think ___ ? |
1. Superior division vestibular nerve
2. NFII |
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Posterior fossa mass – child – DDx
|
1. Brainstem glioma
2. JPA 3. Medulloblastoma/ATRT 4. Ependymoma |
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Lateral Ventricular Tumors – DDx
|
1. Meningioma
2. CPP/CPC 3. Choroid Plexus Cysts 4. Ependymoma 5. Subependymoma 6. Astrocytoma 7. Lymphoma 8. Metastases (to choroid Plexus) 9. Pineoblastoma 10. Central Neurocytoma 11. Giant Cell Astrocytoma |
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Masses Near the foramina of Monro – DDX
|
1. SEGA
2. Central Neurocytoma 3. Subependymoma 4. Astroctyoma 5. Craniopharyngioma 6. Colloid Cyst 7. Choroid Plexus Papilloma |
|
Masses Involving the Third Ventricle – DDX
|
1. Central Neurocytoma
2. Colloid Cyst 3. Aneurysm 4. Subependymoma 5. SEGA 6. Astrocytoma 7. Choroid Plexus Papilloma 8. Hypothalamic Hamartoma 9. Lipoma 10. Germinoma 11. Pineoblastoma 12. Teratoma 13. Metastasis 14. Primary CNS lymphoma |
|
Masses Involving the IVth Ventricle
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1. Ependymoma
2. JPA 3. Hemangioblastoma 4. Medulloblastoma/ATRT 5. Metastasis 6. Infarct 7. Brainstem glioma 8. Pontine Hemorrhage 9. Epidermoid Cyst 10. Cavernous Angioma 11. Cystercircosis |
|
Tumors with Prominent Vascularity – DDx
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1. Hemangioblastoma
2. CPP/CPC 3. Glomus Jugulare 4. Meningioma 5. GBM 6. Malignant Ependymoma 7. Pituitary adenoma |
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Cerebral Masses with Hemorrahge – DDx
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1. Infarct
2. Hemorrhagic Metastasis 3. GBM 4. Germinoma 5. Teratoma 6. Thrombosed aneurysm 7. Thrombosed AVM 8. Cavernous Angioma 9. Dural Sinus Thrombosis |
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Heterogeneous Cerebral Masses – DDx
|
1. Metastasis
2. Meningioma 3. GBM 4. Ependymoma 5. Pineoblastoma 6. Teratoma 7. Germinoma 8. Dermoid 9. Cavernous Malformation 10. Thrombosed Aneurysm/AVM 11. Oligodendroglioma 12. Hemorrhagic Infarct |
|
Cystic/Necrotic Supratentorial Masses – DDx
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1. Ependymoma
2. Cystic Astrocytoma 3. GBM 4. Oligodendroglioma 5. Colloid Cyst 6. Teratoma 7. Lymphoma (Immunocompromised) 8. Abscess 9. Arachnoid Cyst 10. Epidermoid/Dermoid 11. Meningioma 12. Pleiomorphic Astroctyoma 13. Ganglioglioma |
|
Cystic Masses Involving the Temporal Lobe – DDX
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1. Ganglioglioma/Gangliocytoma
2. Cystic Astrocytoma 3. Cystercircosis 4. GBM 5. Pleiomorphic xanthoastrocytoma 6. Desmoplastic Ganglioglioma 7. Dermoid Cyst 8. Epidermoid Cyst 9. Trapped Temporal Horn 10. Arachnoid Cyst 11. Choroid Fissure Cyst |
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Small Ring-Enhancing Lesions – DDx
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1. Toxoplasmosis
2. Lymphoma (Immunocompromised) 3. Abscess 4. Gangliocytoma 5. Astroctyoma 6. GBM 7. MS plaques 8. Mets 9. Resolving Hematoma 10. Cystercircosis 11. TB 12. Histoplasmosis |
|
Pineal Region Masses – DDx
|
1. Pineoblastoma
2. Pineocytoma 3. Germinoma 4. Teratoma 5. Epidermoid 6. VOG Aneurysm 7. Meningioma 8. Thalamaic Astroctyoma 9. Mets 10. Pineal Cyst 11. Lipoma 12. Arachnoid Cyst |
|
Parasellar Masses – DDx
|
1. Suprasellar extension of Macroadenoma,
2. Schwannoma 3. Aneurysm 4. Teratoma, Germinoma 5. Craniopharyngioma 6. Hypothalamic Glioma 7. Metastases 8. Optic Glioma 9. Opthalmico-hypothalamic JPA 10. Lymphoma 11. EG 12. Meningioma 13. Skull Base masses – chondrosarcoma, chordoma 14. Tolosa-Hunt Syndrome |
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Homogeneous Suprasellar Masses
|
1. Macroadenoma
2. Schwannoma 3. Hypothalamic Glioma 4. Meningioma 5. Optic Glioma 6. Lymphoma 7. EG 8. Pituitary hyperplasia 9. Ectopic Neurohypophysis 10. Cranipharyngioma 11. Rathke’s cleft cyst 12. Hypothalamic hamartoma 13. Lipoma |
|
Heterogeneous Suprasellar Masses – DDx
|
1. Pituitary Adenoma
2. Germinoma 3. Dermoid Cyst 4. Hypothalamic Glioma 5. Craniopharyngioma 6. Teratoma 7. Aneurysm |
|
Brainstem Masses – DDx
|
1. Pontine/Brainstem Glioma
2. Cavernous Malformation 3. Aneurysm 4. Infarct 5. MS plaque 6. Brainstem JPA 7. Pontine hemorrhage 8. Met 9. Central Pontine Myelinolysis 10. Leigh Disease 11. NF |
|
Solid Cerebellar Masses – DDx
|
1. PICA Infarct
2. Met 3. Hemangioblastoma 4. Medulloblastoma 5. Hematoma 6. Astroctyoma 7. Lhermitte-Duclos 8. Primary CNS Lymphoma 9. Dural AVM |
|
CPA Masses – DDx
|
1. Schwannoma
2. Aneurysm 3. Arachnoid Cyst 4. Meningioma 5. Met 6. Exophytic Brainstem glioma 7. Epidermoid 8. Ependymoma 9. Glomus Jugulare 10. Chordoma |
|
Petrous Apex Mass – DDx
|
1. Chondrosarcoma
2. Cholesterol Cyst 3. Gradenigo’s Syndrome 4. Cholesteotoma 5. Meningioma 6. Mucocele 7. Metastasis 8. Trigeminal Schwannoma 9. Hypoglassal Schwannoma 10. Glomus Jugulare 11. Petrous Epidermoid Cyst 12. Cisternal Epidermoid Cyst 13. Chordoma |
|
Temporal Lobe Edema – DDx
|
1. HSV
|
|
Multiple Cystic or “Punched-Out” Lesions – Ddx
|
1. Mets
2. Septic emboli 3. MS 4. ADEM 5. Lyme 6. Vasculitis 7. VR-spaces/Sublenticular Cysts 8. Cysticercosis 9. Canavan’s Disease 10. Histoplasmosis 11. Hurler’s Disease 12. Cystic Encephalomalacia |
|
Multiple Enahncing Cerebral Nodules
|
1. Mets
2. Subacute embolic infarcts 3. Septic Emboli 4. multifocal GBM 5. MS/ADEM 6. Sarcoid 7. Lymphoma 8. Aspergillosis 9. Bacterial Encephalitis 10. TB 11. Lyme Diseas 12. Borderzone infarcts |
|
Masses at Cranio-Cervical Junction – DDx
|
1. Skull base lesions – mets, meningioma, glomus jugulare, chondrosarcoma, chondroma, chordoma
2. Atlanto-axial joint hypertrophy/RA pannus 3. Hemangioblastoma 4. CPP 5. Ependymoma 6. Chiari – I malformation 7. Astroctyoma 8. Fibrous Pseudotumor 9. Schwannoma |
|
What are the tumors of embryonal remnants?
|
1. Craniopharyngioma
2. Colloid cyst 3. Teratoid tumors a. Epidermoid b. Dermoid c. Teratoma |
|
What are the incidences of common tumors in Pediatric age group
|
1. Astrocytoma – 50%
2. Medulloblastoma – 15% 3. Ependymoma – 10% 4. Craniopharyngioma – 6% 5. CPP 2% |
|
Incidences of pediatric posterior fossas tumors
|
1. JPA – 33%
2. Medulloblastoma 25-30% 3. Ependymoma – 6-14% 4. Brainstem glioma – 20% |
|
CNS tumors presenting at birth
|
1. Hypothalamic astrocytoma
2. CPP/CPC 3. Teratoma 4. PNET 5. Medulloblastoma 6. Ependymoma |
|
Pediatric Infratentorial/posterior fossa tumors
|
BE MACHO
1. Brainstem Glioma 2. Ependymoma 3. Medulloblastoma 4. AVM 5. Cystic Astrocytoma 6. Hemangioblastoma 7. Other |
|
Supratentorial Midline Tumors - PEDS
|
1. Optic glioma/hypothalamic Glioma (39%)
2. Craniopharyngioma (20%) 3. Astrocytoma – 9% 4. Pituitary Adenoma 5. Pineoblastoma – 9% 6. Germinoma – 6% 7. Lipoma – 6% 8. Teratoma – 3.5% 9. Pituiary adenoma 3.5% 10. Meningioma 2% 11. CPP 2% |
|
Supratenotrial Intraventricular Tumors – Peds
|
1. Lateral Ventricle
a. CPP b. SEGA c. Hemangioma in Struge-Weber syndrome 2. 3rd Ventricle d. Astroctyoma e. CPP f. Meningioma |
|
Extra-axial Tumor – DDx
|
MABEL
1. Meningioma 2. Arachnoid Cyst 3. Bony Lesion 4. Epidermoid 5. Leukemic/lymphomatous infiltration |
|
Multifocal CNS Tumors
|
1. Mets from Primary CNS Tumor
a. Commisural pathways b. CSF c. Satellite mets 2. Multicentric CNS tumor d. Multicentric glioma e. Concurrent tumors of different histology (coincidental) 3. Multicentric menigniomas (3%) without NF 4. Multicentric parimary CNS lymphoma |
|
Multifocal CNS Tumors
|
. Phakomatoses
f. NF – meningiomatosis, bilateral acoustics, bilateral optic nerve gloma, cerebral glioma, CPPs, multiple spine tumors, AVMs g. TS – subependymal tubers, intraventicular gliomas (SEGA), ependymomas h. VHL – hemangioblastomas, retinal angiomatosis, congenital cysts of pancrease, liver, benign renal tumjors, cardiac rhabdomyomas |
|
Intra vs. Extra-axial tumors re:
1. Subarachnoid space 2. displacement of cortex 3. feeding arteries |
1. Intra – narrows, extra – widens
2. intra – towards bone, extra – away 3. Intra – pial , Extra – dural |
|
CNS Tumors metastasizing Outside CNS
|
MEGO
1. Medulloblastoma 2. Ependymoma 3. GBM 4. Oligodendroglioma |
|
Calcified Intracranial Mass
|
Ca+Come
1. Craniopharyngioma 2. Astrocytoma, Anerusm 3. CPP 4. Oligodendroglioma 5. Meningioma 6. Ependymoma |
|
Avascular Mass of Brain
|
TEACH
1. Tumor: astrocytoma, met, oligodendroglioma 2. Edema 3. Abscess 4. Cyst, contusion 5. Hematoma, Herpes |
|
Intraventricular Tumor – DDX – in desc order
|
1. Ependymoma – 20%
2. Astrocytoma 3. Colloid Cyst 4. Meningioma 5. CPP 6. Epidermoid/dermoid 7. Craniopharyngioma 8. Medulloblastoma 9. Cysticercosis 10. Arachnoid cyst 11. Subependymoma 12. AVM 13. Teratoma 14. Metastasis |
|
Ivth Ventricle Tumor
|
1. CPP
2. Ependymoma/Glioma 3. Hemangioblastoma 4. Vermian Metastasis 5. AVM 6. Epidermoid tumor (rare) 7. Inflammatory Mass 8. Cyst |
|
IIIrd Ventricle Tumor
|
1. colloid cyst
2. SEGA 3. Glioma 4. Aneurysm 5. Craniopharyngioma 6. Ependymoma 7. Meningioma 8. CPP 9. Central Neurocytoma |
|
Jugular Foramen Mass
|
1. Glomus Jugular
2. Glomus Vagale 3. Meningioma 4. Schwannoma 5. Metastasis |
|
Dumbbell Mass Spanning Petrous Apex
|
1. Large trigeminal schwannoma
2. Meningioma 3. Epidermoid Cyst |
|
Posterior Fossa Tumor in Adult
|
1. Extra-axial tumor
a. Vestibular Schwannoma b. Arachnoid Cyst c. Meningioma d. Epidermoid e. CPP f. Chordoma 2. Intra-axial g. Mets (lung, breast) h. Hemangioblastoma i. Lymphoma j. Lipoma |
|
Cystic Mass in Cerebellar Hemisphere
|
1. Hemangioblastoma
2. Cerebellar astroctyoma 3. Metastasis 4. Lateral medulloblastoma (cerebellar sarcoma, desmoplastic) 5. CPP with lateral extension |
|
CPA Tumor
|
1. Vestibular Schwannoma
2. Meningioma 3. Epidermoid Inclusion Cyst 4. Arachnoid cyst 5. Anerusym of basilar/vertebral, PICA, dolicoectasia 6. CPP 7. Ependymoma 8. Trigeminal Neuroma 9. Glomus jugulare 10. Chordoma 11. Exophytic brainstem glioma (diffuse fibrillary) 12. Mets |
|
CPA Tumor
|
Ever Grave CerebelloPontine Angle Masses
1. Epidermoid 2. Glomus Jugulare 3. Chondroma, Chordoma, Cholesteotoma 4. Pituitary Tumor, Pontine Glioma (exophytic) 5. Acoustic and Trigeminal neuroma, Aneurysm, Arachnoid cyst 6. Meningioma, Mets |
|
Low-Attenuation Extra-axial Lesion
|
1. Epidermoid
2. Arachnoid Cyst 3. Vestibular schwannoma |
|
Lesion Expanding Cavernous sinus
|
1. Tumor
a. Trigeminal Schwannoma b. Pituitary adenoma c. Parasellar Meningioma d. Parasellar metastasis e. Invasion by tumor of skull base 2. Vessel f. ICA Aneurysm g. CCF 3. Tolosa-Hunt Syndrome – granulomatous pseudotumor invasion of cavernous sinus |
|
Sellar Destruction
|
1. Pituitary Adenoma
2. Suprasellar Tumor 3. Carcinoma of sphenoid/posterior ethmoid sinus (usually a/w nasopharyngeal mass) 4. Nasopharyngeal CA a. SCC b. Lymphoepithelioma (non-keratining form of SCC) – sclerosis of adjacent bone 5. Mets to sphenoid (breast, kidney, thyroid, colon, prostate, lung, esophagus) 6. Primary tumor of sphenoid bone (rare) – osteogenic sarcoma, giant cell tumor, plasmacytoma 7. Chordoma 8. Mucocele of sphenoid sinus (rare) 9. Enlarged 3rd Vent – aqueductal stenosis from infratentorial mass, maldevelopment |
|
Enlarged Sella
|
1. Tumor
a. Pituitary Adenoma b. Craniopharyngioma c. Meningioma (hyperostosis) d. Optic-glioma – J-shaped sella 2. Pituitary Hyperplasia e. Hypothyroidism f. Hypogonadism g. Nelson syndrome (subsequent to adrenalectomy) 3. CSF-space h. Enlarged 3rd ventricle i. Hydrocephalous j. Empty sella 4. Vessel k. Aneurysm l. Ecstatic ICA |
|
Enlarged Sella
|
CHAMPS
1. Craniopharyngioma 2. Hydrocephalus (empty sella) 3. AVM, Aneurysm 4. Meningioma 5. Pituitary adenoma 6. Sarcoid, TB |
|
J-shaped Sella
|
CONMAN
1. Chronic Hydrocephalus 2. Optic glioma, osteogenesis imperfecta 3. NF 4. Mucopolysaccharidosis 5. Achondroplasia 6. Normal Variant |
|
Parasellar Mass
|
SATCHMOLE
1. Sella Neoplasm with supresellar extension, Sarcoidosis, Schwannoma (trigeminal, III, IV) 2. Aneurysm, ecstatic carotid, CCF, Arachnoid cyst 3. Teratoma – Dysgerminoma, epidermoid, dermoid 4. Craniopharyngioma, Chordoma 5. Hypothalamic glioma, histiocytoma, hamartoma 6. Metastatic Disease, Meningioma, Mucocele 7. Optic Nerve glioma, neuroma 8. Lymphoma 9. E – EG |
|
Intrasellar Mass
|
1. Pituitary adenoma/carincoma - #1
2. Craniopharyngioma - #2 3. Meningioma – from surface of diaphragm, tuberculum sellae 4. Chordoma 5. Metastasis: lung, breast, prostate, kidney, GI tract, nasopharyngeal spread 6. Intracavernous ICA aneurysm: bilateral in 25% 7. Pituitary abscess – rapidly expanding mass a/w meningitis 8. Empty sella 9. Rathke cleft cyst: commonly at junction of anterior and posterior pit 10. Granular cell tumor = myeloblastoma (benign tumor of posterior pit) 11. Granuloma: sarcoidosis, giant cell granuloma, TB, syphilis, EG 12. Lymphoid adenohypophysitis 13. Pituitary hyperplasia e.g. Nelson syndrome |
|
Hypointense Lesion of Sella
|
1. Empty sella
2. Pituitary stone (pituilith) – sequela of autonecrosis of pit adenoma 3. Intrasella aneurysm 4. persistent trigeminal artery 5. Calcified meningioma 6. Pituitary hemochromatosis (anterior lobe only) |
|
Suprasellar Mass
|
1. Meningioma
2. Craniopharyngioma 3. Chiasmal/optic nerve glioma DDX chiasmal neuritis 4. hypothalamic glioma 5. hamartoma of tuber cinereum 6. infindibular tumor – mets, glioma, lymphoma, leukemia, histiocytosis, sarcoidosis, TB 7. Germinoma – ectopic pineoloma, frequently subarachnoid spread 8. Epidermoid/dermoid – cystic lesions with fat/ca++, no enhancement 9. Arachnoid cyst – most common in infancy, endocrine dysfunction, visual impairment, hydrocephalus (common) 10. Enlarged 3rd Vwentricle extending into pituitary fossa 11. Suprasellar aneurysm – rim calcification and eccentric position |
|
Infundibular disease
|
1. Neoplasm
a. Mets b. glioma c. Lymphoma d. Leukemia 2. Inflammatory disease e. Sarcoid f. EG g. TB |
|
Suprasellar Mass with Low attenuation
|
1. Craniopharyngioma
2. Dermoid/epidermoid 3. Arachnoid Cyst 4. Lipoma 5. Simple pituitary cyst 6. Glioma of hypothalamus |
|
Suprasellar Mass with mixed attenuation – Peds
|
1. hypothalamic-chiasmatic glioma
2. Craniopharyngioma 3. Hamartoma of tuber cinereum 4. Histiocytosis |
|
Suprasellar Mass with mixed attenuation
|
1. Suprasellar extension of pituitary adenoma
2. craniopharyngioma 3. epidermoid cyst 4. thrombosed aneurysm 5. low-grade hypothalamic/optic glioma 6. Inflammatory lesion: sarcoidosis, TB, sphenoid mucocele |
|
Suprasellar Mass with Calcification
|
1. Curvilinear
a. Giant Carotid Aneurysm b. Craniopharyangioma 2. Granular c. Craniopharyngioma d. Meningioma e. Granuloma f. Dermoid Cyst/Teratoma g. Optic/hypothalamic glioma (rare) |
|
Enhancing Supra- and intrasellar Mass
|
1. Pituitary Macroadenoma
2. Meningioma 3. Germinoma 4. Hypothalamic Glioma 5. Craniopharyngioma |
|
Perisellar Vascular Lesion
|
1. Aneurysm – giant aneurysm > 2.5 cm
2. AVM 3. Ectatic cavernous ICA 4. CCF |
|
Pineal Region Lesion Differential
|
1. Primary Tumors
a. Pineal Epithelial i. Pineablastoma ii. Pineocytoma b. Germ Cell Tumor i. Germinoma (40-50%) ii. Teratoma (15%), teratocarcinoma iii. CHESTES (Chorio, Embryonal, Seminoma/germinoma, Teratoma, Endodermal sinus) c. Other Cell Origin i. Retinoblastoma (trilateral Rb) ii. Astrocytoma iii. Ependymoma iv. Meningioma v. Hemangiopericytoma d. Cysts i. Pineal Cyst ii. Malignant teratoma iii. AVM/ VOG aneurysm iv. Arachnoid Cyst v. Inclusion cyst (dermoid/epidermoid) 2. Secondary Tumor e. Mets |
|
Pinea Region – DDx Considerations
1. If female – 2. If hypodense matrix 3. If distinct tumor margins 4. If calcification 5. If CSF seeding 6. If intense enhancement |
1. likely not Germ cell tumor
2. likely NOT pineal cell tumor 3. probably pineocytoma/teratoma/germinoma 4. likely NOT teratocarcinoma, mets, germinoma 5. NOT teratoma 6. likely NOT teratoma |
|
Intensely Enhancing Mass in Pineal Region
|
1. Germinoma
2. Pinceocytoma/blastoma 3. Pineal teratocarcinoma 4. Glioma of brainstem/thalamus 5. Subsplenial Meningioma 6. VOG aneurysm |
|
MASS IN CLIVUS
|
1. Chordoma - bone destruction
2. Meningioma - hyperostosis 3. Local invasion - nasopharyngeal cancer - pituitary tumor 4. Metastasis 5. Chondrosarcoma (more often paramedian) COMMENT: A basilar artery aneurysm may appear to arise from the clivus - look for pulsationartifact in the phase encoding direction |
|
Does primary CNS lymphoma respond to steroids?
|
1. Yes – may obscure diagnosis
|
|
Supratentorial cystic neoplasm
|
ganglioglioma,
pleomorphic xanthroastrocytoma, extraventricular ependymoma and pilocytic astrocytoma |