Upload
dr-muhammad-bin-zulfiqar
View
889
Download
1
Embed Size (px)
Citation preview
MRI Case DiscussionMacroadenoma, Neurogenic Spinal Tumors and
Spinal Ependymoma
Muhammad Bin Zulfiqar PGR IV SIMS/SHL Alnoor Diagnostic / New Radiology Department
Case 1
• H/O headache, forgetfulness, visual abnormalities.
• Known case of hypothyroidism.
• Snowman sign
Imaging Findings
• There is 3.4 x 3.3 x 2.8 cm sized sellar / suprasellar / right parasellar mass
• Showing intense enhancement on postgadolinium images.
• Mass is encasing intracavernosal part of both ICA.• Right parasellar mass is causing splaying of
interpeduncular cistern at midbrain level and• Compressing upon adjacent temporal lobe as well.
The mass is also compressing upon optic chiasma
Differentials
• Pituitary Macroadenoma• Meningioma• Craniopharyngioma• Chordoma / Chondrosarcoma• Pituitary Mets
Our Diagnosis
• Pituitary Macrodenoma
Pituitary Macroadenoma
• Tumor > 10 mm.• 25-60 years.• Extension– Sellar– Suprasellar– Parasellar
Classification of Pituitary Tumors
• ANATOMICAL SIZEMicroadenoma(<10 mm)Macroadenoma(>10 mm)
Classification of Pituitary Tumors
ACCORDING TO CLINICAL SYMPTOMSFunctionalNon functional
Classification of Pituitary Tumors
ACCORDING TO EXTENT OF EXPANSION OR EROSION OF SELLA
Grade 0: Intrapituitary microadenoma with normal sellar appearance
Grade I: Normal-sized sella with asymmetric floorGrade II: Enlarged sella with an intact floorGrade III: Localized erosion of sellar floorGrade IV: Diffuse destruction of floor
Classification of Pituitary Tumors
ACCORDING TO SUPRASELLAR EXTENSION
Type A: Tumor bulges into the chiasmatic cisternType B: Tumor reaches the floor of the 3rd ventricleType C: Tumor is more voluminous with extension
into the 3rd ventricle up to the foramen of MonroType D: Tumor extends into temporal or frontal
fossa
Case 2
• 23 years old lady with h/o of severe back pain radiating to right leg.
Imaging Findings
• There is 16 x 1.6 cm sized intradural extramedullary mass extending from T-11 down to L4-5 vertebra.
• Causing right posterolateral displacement• Compression upon lower thoracic cord /
conus medullaris. • Shows intense enhancement on
postgadolinium images.
Differentials
• Ependymoma• Astrocytoma• Dermoid • Infarct• Hematoma• Meningioma• Metastasis• Subdural empyema
Our Diagnosis
• Ependymoma
Spinal Tumors
• Extradural• Intradural extramedullary• Intramedullary
Case 3
• 35 years old lady with h/o backache, both lower limb weakness, and urinary incontinence.
• Dumbbell Sign
Imaging Findings• There is 7.2 x 5.3 cm size heterogeneous intensity right
paravertebral mass at T3-4 level showing intraspinal / intradural extension.
• Causing left anterior lateral displacement• Compression upon thoracic cord. • The described mass is causing significant expansion of right exiting
neural foramina • Shows heterogeneous enhancement on post gad images with
multiple areas of necrosis. • The mass is also involving the right paraspinal muscles• Marrow abnormality is seen in T3-4 level with sparing of
intervertebral discs.
Differentials
• Neurofibroma• Neuroblastoma• Ganglioneuroma• Meningioma• Schwannoma
Our Diagnosis
• Neurogenic tumor most probabally Malignant Peripheral Nerve Sheath Tumor with differential of Schwannoma.
Malignant Peripheral Nerve Sheath Tumors
• Malignant peripheral nerve sheath tumours (MPNSTs) are forms of peripheral nerve sheath tumours and comprise of malignant forms of neurofibromas andschwannomas.
• They can either arise de-novo or de-differentiate from an existing neurofibroma or schwannoma.
Imaging Features
• The larger the lesion, the more likely for it to be malignant
• Irregular borders (although most MPNSTs can have well defined margins)
• Rapid growth on interval imaging
Imaging Features
• T1: usually isointense to muscle heterogeneous signal on T1 (if present) may useful in differentiating from a neurofibroma 3
• T2: can have low signal due to high collagen content or high signal due to necrosis
• Heterogeneous contrast enhancement.
Schwannomas
• Schwannomas are benign tumours of Schwann cell origin
• Most common tumour of peripheral nerves.• Peak age is 5-6th decade.• Most commonly solitary• If Multiple---NF2
General Imaging Features
• Cystic and fatty degeneration are common • The larger a schwannoma is, the more likely it
is to show heterogeneity • Hemorrhage occurs in 5% of cases • calcification is rare• peripheral arachnoid cysts may be associated• peritumoural odema may be seen
MRI Features
• T1: isointense or hypointense• T2: hyperintense• T1 C+ (Gd): intense enhancement
THANK YOU