Cervical cord hemangioblastoma

Cervical cord hemangioblastoma, in a patient with von Hippel Lindau syndrome. A small enhancing intramedullary lesion is noted at C4, with mild accompanying vasogenic edema. 75% of spinal cord hemangioblastomas are sporadic, 25% occur in association with von Hippel Lindau syndrome. Spinal cord hemangioblastomas most commonly occur posteriorly within the cord, as in this patient. […] [...]

Chondrosarcoma of the cervical spine

The left lamina of C2 is involved by a focal mass lesion, which is slightly expansile in nature. A somewhat characteristic feature of the histologic diagnosis, reflecting hyaline cartilage, is the marked hyperintensity on the T2-weighted scan. There is moderate enhancement post-contrast, which as with the other findings (with the exception of the appearance on […] [...]

Ivory vertebra, metastatic prostate carcinoma

The ivory vertebra describes a dense sclerotic vertebral body on plain film or CT, with the correlate on MR being very low signal intensity on both T1- and T2-weighted sequences. L2 and S2 are involved in this fashion in the presented case, with additional metastatic lesions noted posteriorly in L1 and L3, together with mild […] [...]

Meningioma (WHO grade I, meningotheliomatous in type), cervical spine

A large, homogeneously enhancing, intradural extramedullary mass lesion is noted anteriorly within the thecal sac at the C2 level. There is prominent deformity and compression of the cord, long standing in nature, without evidence of edema or gliosis. Note the characteristic flat margin of the lesion along the dura. Part of the on-line supplement to […] [...]

Anaplastic astrocytoma (WHO grade III), CT and MR

A focal, mildly hyperdense, lesion is noted on CT in the right centrum semiovale, with restricted diffusion and no abnormal contrast enhancement. rCBV is mildly elevated. The hyperdensity on CT is unusual, with the diffusion restriction (confirmed on the ADC map, not shown) correctly suggesting a higher-grade lesion, with the lesion appearing on other scans […] [...]

Anaplastic ependymoma (WHO grade III), in an 18 month old infant

There is a large enhancing extra-axial mass lying within the 4th ventricle and extending into the foramen of Luschka on the left. Heterogeneity of the lesion with cystic and necrotic areas is characteristic, along with the previously described findings. Most patients are one to five years in age, and present – as this child – […] [...]

B cell lymphoma

A hyperintense periventricular mass lesion with accompanying vasogenic edema is noted in the right occipital lobe. The mass is hyperintense on DWI, with disruption of the blood-brain barrier (enhancement) demonstrated post-contrast. The mass had restricted diffusion (reflected by the high SI on DWI), which is compatible with primary CNS lymphoma, a diagnosis confirmed at surgery. […] [...]

Brain metastases, melanoma

Pre- and post-contrast axial T1-weighted scans are illustrated. Pre-contrast, several small lesions in the frontal lobes, in particular on the left, demonstrate hyperintensity. Numerous small nodular enhancing lesions are noted post-contrast, all at the gray-white matter junction. Hemorrhagic metastases are seen in up to 15% of brain metastases. A mnemonic for the primary tumors that […] [...]

Calvarial metastasis from breast carcinoma, with hyperostosis frontalis interna

A large lytic skull lesion is noted on CT, along with benign thickening along the inner table of the frontal bone (an incidental finding). MR depicts well the soft tissue mass within the skull, which is slightly expansile and easily distinguished pre-contrast from the adjacent fatty marrow, with enhancement post-contrast. Part of the on-line supplement […] [...]

Pancoast tumor

An apical soft tissue mass is present, with invasion of the adjacent vertebral body (visualized by the lucent defect therein). (Case provided courtesy of Reto Sutter, MD, Leitender Arzt, Radiologie, Uniklinik Balgrist, Zürich) Part of the on-line supplement to Neuroradiology – The Essentials with MR and CT (© 2015) [...]

Cerebellar hemangioblastoma

Cerebellar hemangioblastoma on MR, von Hippel Lindau syndrome. Well seen on axial T2- and sagittal post-contrast T1-weighted scans is a cystic cerebellar lesion with an enhancing mural nodule. This lesion is also illustrated on CT in an accompanying figure. A solid enhancing nodule (along the periphery of the cyst) would be the most characteristic imaging […] [...]

Cerebellar hemangioblastoma on CT

Cerebellar hemangioblastoma on CT, von Hippel Lindau syndrome. Post-contrast scans in all three orthogonal planes reveal a cystic cerebellar lesion, with an enhancing mural nodule, the most common imaging presentation for a hemangioblastoma. Part of the on-line supplement to Neuroradiology – The Essentials with MR and CT (© 2015) [...]

Convexity meningioma

Axial, sagittal, and coronal images reveal a round extra-axial lesion, with a broad base along the dura of the convexity, and a small associated dural tail. Additional typical findings for the diagnosis include relative isointensity to brain on the T1-weighted scan, slight hyperintensity on T2-weighted scans, and homogeneous contrast enhancement. Part of the on-line supplement […] [...]

Convexity meningioma with invasion of the superior sagittal sinus and the calvarium,CT

An enhancing lesion is identified along and to the left of the falx posteriorly, with occlusion of the superior sagittal sinus (diagnosed by the lack of enhancement). A portion of the sinus and adjacent draining cortical veins are identified along the anterior margin of the lesion. The calvarium is focally involved, with expansion, osteolysis and […] [...]

Convexity meningioma with invasion of the superior sagittal sinus and the calvarium,MR

In an accompanying figure, the CT findings in this case are presented. An extra-axial mass lesion is noted, adjacent to and to the left of the falx. The superior sagittal sinus is occluded. Meningiomas with restricted diffusion (hyperintensity on DWI), as in this example, tend to be malignant or highly atypical. The sagittal post-contrast exam […] [...]

Falx meningioma, with interval growth

The first post-contrast coronal T1-weighted scan was obtained six years prior to the second exam, with coronal FLAIR and post-contrast T1-weighted scans illustrated from the second exam. There has been interval growth of the lesion, substantial when viewed from a volume perspective. The lesion was electively removed, prior to possible involvement of the superior sagittal […] [...]

Ganglioglioma (cystic)

Presenting with seizure,a small intra-axial mass lesion is noted in the posterior temporal lobe in this young adult male. There is a small amount of associated vasogenic edema. Post contrast, the enhancement is predominantly rim-like in character, with likely both a solid (posteriorly) and a cystic component to the lesion. Part of the on-line supplement […] [...]

Schwannoma (WHO grade I)

A lobulated uniformly enhancing mass lesion is noted with the bulk of the mass paraspinal in location, extending into the foramen at the T4-5 level on the right, with epidural extent and mild displacement of the cord to the left. The intervertebral foramen is enlarged. The well-circumscribed nature of the lesion, and location, favor the […] [...]

Ganglioglioma (solid)

A relatively well defined intraaxial mass lesion is noted in the right temporal lobe, with low- and high signal intensity respectively on T1- and T2-weighted scans, and prominent enhancement. There is only mild accompanying vasogenic edema. Location in the temporal lobe is characteristic for this diagnosis, as was the patient’s age (13 years), with this […] [...]

Glioblastoma, right parietal in location

A relatively well-defined enhancing mass lesion is seen, with prominent accompanying vasogenic edema. Despite the absence of gross central necrosis, the abnormal high signal intensity on FLAIR extends within the splenium of the corpus callosum, and extended (on images not presented) to the left as well. This finding is consistent with infiltration of the corpus […] [...]

Hemangioblastoma (WHO grade I)

A cerebellar mass lesion is seen on the axial T2-weighted scan, with mild accompanying vasogenic edema. A distinctive additional finding is the many prominent associated vascular structures (flow voids). TOF MRA performed with contrast administration reveals a highly vascular lesion, with prominent early enhancement, and tortuous feeding vessels both anteriorly and posteriorly. There is prominent […] [...]

Macroadenoma of the pituitary gland, with intra-operative MR

Coronal and sagittal T1-weighted post-contrast scans are presented in a patient with a small macroadenoma, both prior to surgery (upper row) and intraoperatively (lower row). Note that the adenoma enhances less than the normal pituitary, and is located inferiorly within the sella. There is cavernous sinus invasion on the right. On the intra-operative scan, near […] [...]

Juvenile angiofibroma, in a 16-year-old male

A large, intensely enhancing, mass lesion is seen within the left nasal cavity posteriorly which extends to fill the sphenoid sinus. There is bone destruction and remodeling on CT. The blood supply was predominantly from the external carotid artery, specifically from branches of the internal maxillary artery and ascending pharyngeal artery. On DSA there is […] [...]

Metastatic melanoma

A large left frontal metastasis, with prominent enhancement and surrounding vasogenic edema is noted on pre- and post-contrast T1-weighted scans. There are small areas of hemorrhage (methemoglobin) and cystic change (with low signal intensity) therein. The 4 mm coronal post-contrast T1-weighted image raises the question of a small pinpoint cerebellar metastasis on the left. Reformatting […] [...]

Multiple cerebellar hemangioblastomas

Multiple cerebellar hemangioblastomas on MR, perfusion imaging (ASL). Two small nodular enhancing lesions, with mild accompanying vasogenic edema, are noted within the cerebellum in this patient with von Hippel Lindau syndrome. Arterial spin labeling (ASL) is an alternative technique to first pass perfusion MR, the latter acquired during bolus gadolinium chelate administration typically using echoplanar […] [...]

Multiple cerebellar hemangioblastomas on MR, von Hippel Lindau syndrome

Multiple cerebellar hemangioblastomas on MR, von Hippel Lindau syndrome. The highly vascular nature of hemangioblastomas is illustrated on this axial thick MIP from a contrast enhanced, 3D gradient echo, short TE, short TR T1-weighted scan. Part of the on-line supplement to Neuroradiology – The Essentials with MR and CT (© 2015) [...]

Olfactory groove meningioma

A large, midline, extraaxial lesion is noted within the low frontal region, with homogeneous enhancement on post-contrast coronal and axial images. On the former, the lesion is noted to extend inferiorly to the region of the left olfactory bulb. Part of the on-line supplement to Neuroradiology – The Essentials with MR and CT (© 2015) [...]

Oligodendroglioma, WHO grade II

A mass lesion is noted on the right, in the posterior frontal lobe, somewhat peripherally located and expansile in nature. The lesion is hyperintense on T2-weighted scans, and fairly homogeneous in nature. There was no abnormal contrast enhancement (image not shown). In neoplastic disease, choline is increased and NAA decreased, relative to normal brain, a […] [...]

Pilocytic astrocytoma

A large, relatively well-circumscribed, mass lesion is seen involving the right cerebellum in this 3-year old child. There is marked compression of the fourth ventricle and midbrain, with midline shift. There is a large solid enhancing component medially, with a cystic component laterally and enhancement as well of the cyst wall. Note that the cystic […] [...]

Pineal parenchymal tumor (WHO grade III)

An enhancing mass is noted with its epicenter in the region of the pineal gland. The ventricular system is enlarged, due to compression of the cerebral aqueduct. Hemorrhage is common with pineal parenchymal tumors, and is visualized in the current case (specifically hemosiderin, with low signal intensity) on the T2 FSE and DWI scans, but […] [...]

Pituitary macroadenoma with hemorrhage

The sella is expanded by a mass lesion, which extends superiorly to compress the optic chiasm. There is extensive hemorrhage therein, representing a combination of intracellular and extracellular methemoglobin. Note post-contrast the enhanced pituitary infundibulum, draped over the left side of the mass. The coronal scan on the far right of the figure was obtained […] [...]

Schwannoma at C3-4 on the left, within the neural foramen and compressing the cord

An enhancing mass lesion is seen, centered within the neural foramen – the latter is enlarged, indicating that the lesion is long standing in nature. There is marked cord compression, with abnormal high signal intensity within the cord on the T2-weighted exam, indicative of either gliosis or edema. The patient presented clinically with numbness in […] [...]

Skull hemangioma, CT

A solitary, sharply marginated, expansile lesion with a sunburst pattern (on images reconstructed with a bone algorithm) is visualized on unenhanced CT. The inner and outer tables of the skull are intact, with the outer table substantially expanded (and the inner table relatively unaffected). The MR in this patient is presented in a separate accompanying […] [...]

Skull hemangioma, MR

A large, well defined, expansile diploic space lesion is noted involving the left frontal bone, with slight hypo- and hyperintensity relative to brain on T1- and T2-weighted images. There is prominent enhancement, due to the presence of abundant vessels therein, which microscopically can be capillary, cavernous, or mixed in type. Part of the on-line supplement […] [...]

Small solid lateral cerebellar hemangioblastoma, in a patient with von Hippel Lindau syndrome

Small solid lateral cerebellar hemangioblastoma, in a patient with von Hippel Lindau syndrome. A small nodular enhancing lesion, with mild surrounding vasogenic edema, is noted in the right cerebellar hemisphere. The appearance on imaging is not specific for any one diagnosis, with metastatic disease likely first in terms of differential diagnosis, in the absence of […] [...]

Small solid superior cerebellar hemangioblastoma

Small solid superior cerebellar hemangioblastoma on MR, with perfusion imaging. Very high CBV is noted in a small nodular enhancing lesion, consistent with a hemangioblastoma, in this 41 year old patient with von Hippel Lindau syndrome and multiple other parenchymal lesions. Although 60% of hemangioblastomas of the brain are cystic, with a mural nodule, 40% […] [...]

Tentorial meningioma

A large extra-axial mass lesion is seen with a broad base along the tentorium. Note the compression of the cerebral peduncles, best seen on the axial exam. A classic finding is also seen, for the diagnosis of a meningioma, specifically a CSF cleft circumferential to the lesion (well visualized on the axial scan). Such a […] [...]