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96 Cards in this Set

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Multiple enhancing lesion – DDx
1. Metastases
2. Infection (septic emboli)
3. Lymphoma
4. MS/ADEM
5. Multicentric GBM
6. Subacute infarct
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
Empty Sella
1. Most common cause
2. Other causes
1. defect in diaphragma sella with CSF pulsations
2. Sequela of Sheehan’s syndrome
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.
Cystic Pituitary Masses
1. Cystic adenoma
2. Craniopharyngioma
3. Rathke’s pouch cyst
Hemosiderin Deposition in Pitutary – Dx?
1. Haemochromatosis
2. Hemosiderosis
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
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
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
Cavernous Sinus/Parasellar Masses
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)
Tumors of Skull
1. EG
2. Multiple myeloma
3. mets
4. Hemangioma
5. Epidermoid
What are the mixed glial/neuronal tumors?
1. central neurocytoma
2. dysemroplastic neuroepithelial tumor (DNET)
3. Ganglioglioma, ganglioneuroma
Cerebral Glioma – DDx
1. Lymphoma
2. Metastasis
3. Hematoma
4. Abscess
5. Tumefactive MS
6. Enhancing Infarct
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
Parapineal Tumors/Mass Lesions
1. Meningioma from tectal plate
2. Tectal, posterior IIIrd ventricle gliomas
3. Developmental cysts (epidermod, dermoid, arachnoid cysts)
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
What are the two characteristic findings of hemangioblastomas?
1. cyst and enhancing mural nodule
2. serpiginous T2-flow voids
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
Posterior fossa mass – child – DDx
1. Brainstem glioma
2. JPA
3. Medulloblastoma/ATRT
4. Ependymoma
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
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
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
1. Hemangioblastoma
2. CPP/CPC
3. Glomus Jugulare
4. Meningioma
5. GBM
6. Malignant Ependymoma
7. Pituitary adenoma
Cerebral Masses with Hemorrahge – DDx
1. Infarct
2. Hemorrhagic Metastasis
3. GBM
4. Germinoma
5. Teratoma
6. Thrombosed aneurysm
7. Thrombosed AVM
8. Cavernous Angioma
9. Dural Sinus Thrombosis
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
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
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
Small Ring-Enhancing Lesions – DDx
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
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