0:01

Not to gild the lily,

0:03

but I'd like to show a second example

0:06

of an IDH mutant tumor.

0:09

This one does not have that flare mismatched sign.

0:13

Here we have a tumor,

0:14

which is relatively homogeneous on the flare scan.

0:17

Some might argue that there is a slightly diminished area

0:21

of signal intensity here that's not quite as dramatic as we,

0:25

what we would call a flare mismatch sign.

0:27

At the same time, this was an IDH mutant tumor.

0:31

Here is the T two wade scan.

0:33

Important features of this tumor are that, um, you know,

0:37

goes out to the cortex.

0:40

It doesn't show very much mass effect,

0:42

and we don't have any tumor tissue.

0:45

Extending to the append surface of the ventricle extension

0:50

to the append surface of the ventricle is an important

0:52

feature because it often, again, means

0:54

that this cannot be surgically removed in its entirety

0:57

because they don't want to enter the ventricle.

1:00

It also predisposes for the possibility

1:02

of subarachnoid seeding whens on the

1:05

append of the ventricle.

1:07

And it also is prognostically a poor prognosis

1:11

because there's often incomplete surgical resection.

1:15

So in this case, the tumor, once again on the, uh,

1:19

post gadolinium enhanced images, we see

1:21

that there is no evidence of significant enhancement.

1:25

Another important feature

1:26

that you should include in your reports is the presence

1:31

of blood vessels that cross the tumor.

1:35

So here we have our anterior cerebral artery branches

1:38

and we notice that there are some blood vessels

1:41

that are on the surface of the tumor,

1:43

but these generally are going to veins

1:46

and draining to the superior sagittal sinus, so no arteries

1:50

that are in the tumor itself.

1:53

And that, again, is a useful negative for the neurosurgeons

1:57

that they don't have to worry about an are arterial issue

2:01

during the resection of the tumor.

2:04

Remember that if they take that artery during the resection

2:06

of the tumor, there is that small possibility

2:08

that they may have a peripheral infarction

2:11

of the distal portion of that blood vessel,

2:15

which may be a surgical complication

2:18

looking at this grade two tumor.

2:20

We also note that the a DC map does not show areas

2:24

of dark signal intensity and

2:25

therefore compatible with a lower grade tumor.

2:29

So a hypoperfused tumor, again compatible

2:32

with the grade two astrocytoma.