0:00

Alright, let's shift now from some of the adult

0:05

gliomas where we separated things into astrocytomas

0:10

and the groden gliomas.

0:13

And now let's look at some of the pediatric tumors

0:16

that we described with regard to some of the mutations.

0:21

So this is a patient who has an H three

0:25

K 27 M mutation and

0:27

therefore is one of those diffuse midline gliomas.

0:31

And this is a typical appearance of them in which you see

0:35

that on the sagittal T one Wade scan, you have a mass

0:40

that is either in the third ventricle or the thalamus,

0:44

but in any case, it's in the midline.

0:46

Here's our pons and medulla.

0:47

You notice that the cerebellar tonsils are being pushed

0:50

downward here to the frame

0:52

and magnum on post gadolinium hand scans.

0:55

This lesion is again growing

1:00

into the third ventricle,

1:02

but probably expanding out into the thalamus.

1:06

We have areas here of enhancement, which I would expect

1:09

would not be part

1:10

of the third ventricle and more superiorly.

1:12

You can see the third ventricle is a little bit displaced

1:16

to the right side by this paramedian left-sided component.

1:21

On the T two eight scan, we have a little bit

1:24

of a motion blur, but what we readily

1:28

identify is the presence of trans penal CSF flow

1:33

or interstitial edema suggesting acute hydrocephalus

1:36

because of the obstruction at the third ventricle

1:40

and aqueduct, uh, you notice

1:42

that this tumor has a intimate association

1:46

with the internal cerebral veins.

1:47

Coming back to the vein of galin, an important point

1:50

for the surgeons, again, do not want to

1:54

occlude these vessels or cauterize these vessels

1:57

because of the potential for a venous infarction.

2:01

On this case, we have the A DC map

2:03

and there are two different boxes

2:04

that have been measured here.

2:06

One with a mean of 715, the other with a mean

2:08

of 775 indicating that this is likely a higher grade tumor.

2:14

Remember that the H three K 27 M

2:17

and the H 3G 34 M tumors are both

2:22

grade four high grade

2:25

gliomas occurring in the pediatric population.

2:28

So I think this is a pretty nice example of

2:33

the imaging features of what one would expect

2:36

with these midline pediatric gliomas.

Case: H3K27M Midline Glioma, Grade 4

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0:00

Alright, let's shift now from some of the adult

0:05

gliomas where we separated things into astrocytomas

0:10

and the groden gliomas.

0:13

And now let's look at some of the pediatric tumors

0:16

that we described with regard to some of the mutations.

0:21

So this is a patient who has an H three

0:25

K 27 M mutation and

0:27

therefore is one of those diffuse midline gliomas.

0:31

And this is a typical appearance of them in which you see

0:35

that on the sagittal T one Wade scan, you have a mass

0:40

that is either in the third ventricle or the thalamus,

0:44

but in any case, it's in the midline.

0:46

Here's our pons and medulla.

0:47

You notice that the cerebellar tonsils are being pushed

0:50

downward here to the frame

0:52

and magnum on post gadolinium hand scans.

0:55

This lesion is again growing

1:00

into the third ventricle,

1:02

but probably expanding out into the thalamus.

1:06

We have areas here of enhancement, which I would expect

1:09

would not be part

1:10

of the third ventricle and more superiorly.

1:12

You can see the third ventricle is a little bit displaced

1:16

to the right side by this paramedian left-sided component.

1:21

On the T two eight scan, we have a little bit

1:24

of a motion blur, but what we readily

1:28

identify is the presence of trans penal CSF flow

1:33

or interstitial edema suggesting acute hydrocephalus

1:36

because of the obstruction at the third ventricle

1:40

and aqueduct, uh, you notice

1:42

that this tumor has a intimate association

1:46

with the internal cerebral veins.

1:47

Coming back to the vein of galin, an important point

1:50

for the surgeons, again, do not want to

1:54

occlude these vessels or cauterize these vessels

1:57

because of the potential for a venous infarction.

2:01

On this case, we have the A DC map

2:03

and there are two different boxes

2:04

that have been measured here.

2:06

One with a mean of 715, the other with a mean

2:08

of 775 indicating that this is likely a higher grade tumor.

2:14

Remember that the H three K 27 M

2:17

and the H 3G 34 M tumors are both

2:22

grade four high grade

2:25

gliomas occurring in the pediatric population.

2:28

So I think this is a pretty nice example of

2:33

the imaging features of what one would expect

2:36

with these midline pediatric gliomas.

Report

Faculty

David M Yousem, MD, MBA

Professor of Radiology, Vice Chairman and Associate Dean

Johns Hopkins University

Lesson

Introduction

Lesson

Meningiomas

Lesson

Non-glial Tumors

Lesson

2021 WHO CNS Tumor Classification

Lesson

Gliomas

Lesson

Pediatric Brain Tumor Cases

Case: H3K27M Midline Glioma, Grade 4