By Joseph Heiserman
Self evaluate color assessment of Neuroimaging
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TEACHING PEARLS ➣ S-PNET is a rare neoplasm of young children that is generally well-circumscribed in the supratentorial brain but is otherwise heterogeneous in imaging characteristics. ➣ Prognosis is dismal and significantly worse than the closely-related medulloblastoma. REFERENCES Reddy AT (2001). Advances in biology and treatment of childhood brain tumours. Curr Neurol Neurosci Rep 1(2):137–43. Young-Poussaint T (2001). Magnetic resonance imaging of pediatric brain tumours: state of the art.
DIFFERENTIAL DIAGNOSIS Images 18C, D. 39 18: Answer 18 DIAGNOSIS Pineoblastoma. I MAGING FINDINGS Images 18A, B (sagittal T1, axial contrast-enhanced T1, respectively) demonstrate a T1 hypointense, homogeneously enhancing mass of the pineal gland (i,ii). There is compression of the aqueduct causing hydrocephalus with enlarged occipital and frontal horns. DIFFERENTIAL DIAGNOSIS The differential diagnosis of a pineal region mass includes: • Pineoblastoma (18A, B). • Pineocytoma. • Germinoma (see Question 38).
The differential diagnosis of a leptomeningeal and parechymal lesion in a immunocompromised patient includes: • Tuberculosis. • Lymphoma (28D, axial FLAIR). • Toxoplasmosis. • Abscess. • Cryptococcosis (atypical) (28E, axial FLAIR). Lymphoma (28D) shows strong enhancement and might be difficult to distinguish from TB. Involvement of the basal ganglia, periventricular WM, and ependymal surfaces would favour lymphoma. Toxoplasmosis would present as an enhancing lesion that would be expected to respond to anti-microbial therapy.