CNS Note

 Vasogenic edema, around the tumor, had 3 grade , (2 cm around the lesion,
> 2 cm but less than ½ cerebral hemisphere, more than ½ cerebral
hemisphere
 Meningioma (solitary fibrous tumor) / and hemangiopericytoma HPC. Have
3 grade SFT (grade 1, curable), HPC (II atypical, & III anaplastic) =
recurrence and metastasis.

Meningioma Hemangiopericytoma
Restricted n ADC (dark) low ADC
Never involve the bone Brain invasion
Dural base
Homogenous enhancement Homogenous enhancement

 Meningioma: calcification 20%, bone sclerosis, brain edema 40%, hyper on

CT, Iso T1, T2, & FLAIR, Dural tail (reactive meningeal thickening), cystic
components may have, but solid is same ccc. Extra-axial , CSF cleft sign .
 Multiple meningioma (meningioma en plaque) ass with NF2, children, M>F,
4th-6th decade

1
CNS Note

 Intraosseous meningioma (lateral orbital wall in connection with greater

wing). DDx Fibrous dysplasia
 HPC-II; no calcification, nor hyperostosis; high recurrence; DDx metastasis,
lymphoma.
---------------------

Lymphoma

 Intra-axial, homogenous enhancement, usually single, may be multiple, and

invade the corpus callusom, response to steroid, iso T1, T2, & FLIAR. No
calcium, no dural base, can cross the midline.
 AIDS= lymphoma, or toxoplasma , lymphoma of AIDS don’t cause
diffusion restriction
-----------------------

Pilocytic astrocytoma

 Low Grade glioma, paediatric 5-15 y, posterior fossa tumour, is cyst with
enhancing mural nodule, exception note: (enhancing wall, contrast diffusion
inside the cyst, internal haemorrhage (obscured the nodule), wall
calcification rarely.

Sub-ependymal GCA

 Ass with tuberous sclerosis, rare, frontal horn of lateral ventricle,

homogenous enhancement, calcium in the wall of the ventricle, & within.

Pleomorphic xanthoastrocytoma: L. Grade

 Supra-tentorial cyst with enhancing mural nodule.

ODG I

 4th -5th decade, M>F, hypo on CT, Hypo T1, Hyper T2, Hyper FLAIR,
heterogeneous lesion, not enhance on CT, same as diffuse astrocytoma (II)

Anaplastic astrocytoma (III)

 Patchy enhancement (hetero) or ring enhancement, no haemorrhage or

necrosis, Hypo T1, Hyper T2, Hyper FLAIR, heterogeneous enhancement.
2
CNS Note

GBM

 Enhance either heterogeneous or ring non uniform, primary and secondary

(better prognosis). Diffusion free; while abscess diffusion restriction.
 Location: Frontal lobe or temporo-occipital, cross midline. Hypo T1, Hyper
T2.

Gliomatosis cerebri

 Supra-tentorial, involve at least three cerebral lobe, non enhancing, 20-40y,

Hypo T1, Hyper T2, FLAIR, not restricted.

Multicentric glioma

Metastasis

 Any type of enhancement,



Homogenous enhancement

 Meningioma, HPC, Lymphoma, GC astrocytoma (T. sclerosis

Heterogeneous enhancement

 Pilocytic Astrocytoma, Anaplastic astrocytoma

Enhancing mural nodule

 Pilocytic astrocytoma, Pleomorphic xanthoastrocytoma (PXA)

Non enhancement

 Diffuse astrocytoma, infiltrating glioma, intracranial cyst

3
CNS Note