0:00

Here's the patient with a brainstem,

0:02

expansile brainstem mass, uh, striations corresponding

0:05

to those, uh, transverse pontic cerebellar

0:07

fibers that we talked about.

0:09

Um, the diffusion weighted image shows nothing specific

0:13

of interest, but there's a fo some focal areas

0:15

of hypo intensity appearance on the a DC maps.

0:19

Now, some, uh, some, uh,

0:21

other advanced imaging was used multi voxel spectroscopy

0:24

and perfusion imaging.

0:26

Um, this multi vxl spectroscopy slightly higher level than

0:30

the, um, A DCI showed you, showed a hotspot area,

0:35

uh, in the, um, choline to NAA ratio right here.

0:39

The problem is that right here

0:43

and right here in those areas right next to it are

0:46

where the descending fibers

0:47

of the cortex spinal tract are so biopsying.

0:49

This hotspot area actually would, um,

0:53

not be very easy to do without risking, um,

0:57

uh, motor injury.

0:58

So the other area was, was targeted

1:02

based on the a DC maps.

1:05

So this is the diffuse midline gliomas, A-D-I-P-G pattern.

1:08

Um, you know, those areas are suggestive of higher grade,

1:13

both on the spectroscopy and the a DC maps

1:16

and the needle biopsy confirmed the diagnosis.

Case: Diffuse Midline Glioma With a DIPG Pattern

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0:00

Here's the patient with a brainstem,

0:02

expansile brainstem mass, uh, striations corresponding

0:05

to those, uh, transverse pontic cerebellar

0:07

fibers that we talked about.

0:09

Um, the diffusion weighted image shows nothing specific

0:13

of interest, but there's a fo some focal areas

0:15

of hypo intensity appearance on the a DC maps.

0:19

Now, some, uh, some, uh,

0:21

other advanced imaging was used multi voxel spectroscopy

0:24

and perfusion imaging.

0:26

Um, this multi vxl spectroscopy slightly higher level than

0:30

the, um, A DCI showed you, showed a hotspot area,

0:35

uh, in the, um, choline to NAA ratio right here.

0:39

The problem is that right here

0:43

and right here in those areas right next to it are

0:46

where the descending fibers

0:47

of the cortex spinal tract are so biopsying.

0:49

This hotspot area actually would, um,

0:53

not be very easy to do without risking, um,

0:57

uh, motor injury.

0:58

So the other area was, was targeted

1:02

based on the a DC maps.

1:05

So this is the diffuse midline gliomas, A-D-I-P-G pattern.

1:08

Um, you know, those areas are suggestive of higher grade,

1:13

both on the spectroscopy and the a DC maps

1:16

and the needle biopsy confirmed the diagnosis.

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: Diffuse Midline Glioma With a DIPG Pattern