0:00

So here's another patient

0:02

with a left cerebral pontine angle mass.

0:05

In ENC case, there's, there's vascular

0:08

and cranial nerve encasement.

0:09

That's relevant because schwannomas, um,

0:13

and don't,

0:14

schwannomas don't typically encase vessels like this.

0:18

Meningiomas don't typically encase it like this.

0:21

They will displace them.

0:22

Again, there's always exceptions,

0:24

but typically speaking, you know, we're, we're thinking

0:27

of something that's encasing

0:29

and not just purely pushing on those neurovascular

0:33

structures has intermediate characteristics.

0:35

On T two 80 imaging, there's no significant enhancement

0:42

and there's intermediate to facilitated diffusivity.

0:45

The quantitative diffusion characteristics were 1225.

0:51

So this mass, this is an appendamoma,

0:54

and the imaging features are suggestive of, uh,

0:57

posterior fossa, appendamoma type B.

1:01

But, um, now just be aware

1:03

that non enhancing tumors will often have non enhancing

1:07

metastatic deposits.

1:08

They can be extremely challenging to identify.

1:11

So if you see that one, um, technique

1:16

to consider is post contrast flare imaging.

1:20

Now, the, um, diffusion can actually help

1:26

identify them sometimes, especially

1:27

for non enhancing me neuroblastoma, like the group four.

1:31

But for appendamoma, where the diffusion may not be

1:34

as clear cut in identifying the metastatic deposits,

1:37

post contrast flare imaging, T two flare imaging, uh,

1:41

can be helpful in finding leptin metastatic disease.

Case: Posterior Fossa Ependymoma Type B

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0:00

So here's another patient

0:02

with a left cerebral pontine angle mass.

0:05

In ENC case, there's, there's vascular

0:08

and cranial nerve encasement.

0:09

That's relevant because schwannomas, um,

0:13

and don't,

0:14

schwannomas don't typically encase vessels like this.

0:18

Meningiomas don't typically encase it like this.

0:21

They will displace them.

0:22

Again, there's always exceptions,

0:24

but typically speaking, you know, we're, we're thinking

0:27

of something that's encasing

0:29

and not just purely pushing on those neurovascular

0:33

structures has intermediate characteristics.

0:35

On T two 80 imaging, there's no significant enhancement

0:42

and there's intermediate to facilitated diffusivity.

0:45

The quantitative diffusion characteristics were 1225.

0:51

So this mass, this is an appendamoma,

0:54

and the imaging features are suggestive of, uh,

0:57

posterior fossa, appendamoma type B.

1:01

But, um, now just be aware

1:03

that non enhancing tumors will often have non enhancing

1:07

metastatic deposits.

1:08

They can be extremely challenging to identify.

1:11

So if you see that one, um, technique

1:16

to consider is post contrast flare imaging.

1:20

Now, the, um, diffusion can actually help

1:26

identify them sometimes, especially

1:27

for non enhancing me neuroblastoma, like the group four.

1:31

But for appendamoma, where the diffusion may not be

1:34

as clear cut in identifying the metastatic deposits,

1:37

post contrast flare imaging, T two flare imaging, uh,

1:41

can be helpful in finding leptin metastatic disease.

Report

Faculty

Asim F Choudhri, MD

Chief, Pediatric Neuroradiology

Le Bonheur Children's Hospital

Lesson

Introduction

Lesson

Meningiomas

Lesson

Non-glial Tumors

Lesson

2021 WHO CNS Tumor Classification

Lesson

Gliomas

Lesson

Pediatric Brain Tumor Cases

Case: Posterior Fossa Ependymoma Type B