Presentation
Signs of raised intracranial pressure.
Patient Data
Mixed solid and cystic intra-axial mass of left cerebellar location. The solid component appears isointense to the cortical grey matter on T1 and T2, and slightly hyperintense on FLAIR with vivid heterogeneous enhancement. The cystic component appears hypointense on T1, and FLAIR, and hyperintense on T2 with peripheral enhancement and no restricted diffusion. No hemorrhagic component or calcification is seen on the GE sequence. Surrounding vasogenic edema with a mass effect on the fourth ventricle which is laminated and displaced to the right as well as on the brainstem with tonsillar herniation. Mild dilatation of the third and lateral ventricles with no transependymal edema.
Case Discussion
MRI features of mixed solid and cystic cerebellar tumor suggestive of pilocytic astrocytoma.
On imaging, the main differential diagnoses include:
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usually seen in adults. In children, usually associated with von Hippel-Lindau disease
cyst wall usually does not enhance
smaller mural nodule with angiographic contrast blush
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typically arise from the midline (especially the vermis and roof of the fourth ventricle) rather than the cerebellar hemisphere
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tends to fill the fourth ventricle and protrude out of the foramen of Luschka and foramina of Magendie
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atypical teratoid/rhabdoid tumor
larger heterogeneously enhancing mass