0:00

Here's, here's a child with a, um,

0:04

they'll defined hypodensity in the

0:07

right cerebellar hemisphere.

0:10

See this on the coronal image looks fairly defined

0:14

when we get, when do it like this and see it.

0:16

On this coronal, there's a ovoid circumscribed,

0:21

um, T two hyperintense lesion.

0:24

In the right cerebellar hemisphere,

0:27

there's incomplete suppression of signal on flare imaging.

0:30

So this does not look like the cystic component

0:35

that we saw in that first case,

0:37

even though on T two it looks very bright,

0:39

almost like fluid.

0:41

But this is not a cystic component.

0:45

Um, this is solid just high water content.

0:48

This heterogeneous post contrast enhancement

0:54

and this facilitated diffusion,

0:56

the diffusivity is approximately 1650.

1:00

And this is a solid pilocytic astrocytoma

1:03

with no discernible cystic components.

1:05

So, um, textbooks

1:07

and some lectures often will suggest

1:09

that pilocytic astrocytoma will be a cyst with a nodule,

1:13

but they very often can be solid.

1:15

Um, if they're solid, they look like this

1:19

very high water content, uh, facilitated diffusion,

1:23

some heterogeneous enhancement that happens

1:25

on delayed imaging.

1:27

Now, trying to link what we're seeing in imaging to, um,

1:33

clinical is, you know, it's starting to make sense

1:36

that we're getting an insight into these lesions.

1:40

So again,

1:42

this patient had a solid pilocytic, astrocytoma,

1:47

intraoperative MRI demonstrate, uh,

1:50

achieved a gross total resection,

1:52

and at two year follow-up, there's no signs of recurrence.

1:55

So this is essentially a, a cure.

1:58

So that's, um, a great, um, a great outcome.

2:02

Obviously they undergo surveillance for at least five years

2:05

and then maybe a more prolonged,

2:07

uh, surveillance after that.

2:10

But, um, this child's essentially cured.

Case: Solid Pilocytic Astrocytoma With No Discernible Cyctic Component

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0:00

Here's, here's a child with a, um,

0:04

they'll defined hypodensity in the

0:07

right cerebellar hemisphere.

0:10

See this on the coronal image looks fairly defined

0:14

when we get, when do it like this and see it.

0:16

On this coronal, there's a ovoid circumscribed,

0:21

um, T two hyperintense lesion.

0:24

In the right cerebellar hemisphere,

0:27

there's incomplete suppression of signal on flare imaging.

0:30

So this does not look like the cystic component

0:35

that we saw in that first case,

0:37

even though on T two it looks very bright,

0:39

almost like fluid.

0:41

But this is not a cystic component.

0:45

Um, this is solid just high water content.

0:48

This heterogeneous post contrast enhancement

0:54

and this facilitated diffusion,

0:56

the diffusivity is approximately 1650.

1:00

And this is a solid pilocytic astrocytoma

1:03

with no discernible cystic components.

1:05

So, um, textbooks

1:07

and some lectures often will suggest

1:09

that pilocytic astrocytoma will be a cyst with a nodule,

1:13

but they very often can be solid.

1:15

Um, if they're solid, they look like this

1:19

very high water content, uh, facilitated diffusion,

1:23

some heterogeneous enhancement that happens

1:25

on delayed imaging.

1:27

Now, trying to link what we're seeing in imaging to, um,

1:33

clinical is, you know, it's starting to make sense

1:36

that we're getting an insight into these lesions.

1:40

So again,

1:42

this patient had a solid pilocytic, astrocytoma,

1:47

intraoperative MRI demonstrate, uh,

1:50

achieved a gross total resection,

1:52

and at two year follow-up, there's no signs of recurrence.

1:55

So this is essentially a, a cure.

1:58

So that's, um, a great, um, a great outcome.

2:02

Obviously they undergo surveillance for at least five years

2:05

and then maybe a more prolonged,

2:07

uh, surveillance after that.

2:10

But, um, this child's essentially cured.

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: Solid Pilocytic Astrocytoma With No Discernible Cyctic Component