Neuroradiology Differentials (copy)
Terms
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- Persistent embyronic ICA to vertebrobasilar connections
-
trigeminal (#1)
hypoglossal
otic
proatlantic artery - Intraaxial hemorrhage
-
HTN (#1)
tumor, trauma
AVM/aneurysm
coagulopathy, amyloid angiopathy
emboli
hemorrhagic infarction
vasculitis -
Aneurysm
(class by shape) -
saccular - degen, trauma, mycotic, vasculopathy
fusiform - atherosclerotic
dissecting - trauma > vasculopathy > spontaneous - SAH
-
aneurysm (#1)
trauma
AVM
coagulopathy
extension of parenchymal bleed
idiopathic
spinal AVM - Vascular malformations
-
AVM
capillary telangiectasia
cavernous malformation
venous anomaly
vein of Galen AVM or varix - Stroke - causes
-
atherosclerosis
cardiac emboli
arterial dissection, vasculopathy
IVDA
venous thrombosis
blood dyscrasias - Venous sinus thrombosis
-
pregnancy
dehydration
infection
tumor
hypercoagulable state
trauma - Primary brain injury
-
epidural hematoma
SDH
subdural hygroma
DAI
cortical contusion - Secondary brain injury
-
cerebral herniation
diffuse cerebral edema
arterial diss (spont, trauma, HTN, vasculopathy, migraine, IVDA)
CCF - Extraaxial masses (hemisphere)
-
meningioma
mets
lymphoma
arachnoid cyst
dermoid/epidermoid
fluid (blood or pus)
hemangiopericytoma - Extraaxial masses (clivus/prepontine cistern)
-
meningioma
mets
chordoma
chondrosarcoma - Intraaxial masses (hemisphere)
-
astrocytoma / GBM
oligodendro/ganglio -glioma
lymphoma
mets
PNET and DNET -
Intraaxial masses
(sella) -
adenoma
craniopharyngioma
Rathke’s cyst
mets
abscess
sarcoid
EG stalk -
Intraaxial masses
(brainstem) -
astrocytoma
GBM -
Intraaxial masses
(pineal region) -
germinoma
teratoma
pineocytoma
pineoblastoma -
Intraaxial masses
(cerebellum) -
astrocytoma
medulloblastoma
hemangioblastoma
mets
ependymoma
choroid plexus papilloma -
Intraaxial masses
(temporal lobe in young patient) -
ganglioglioma
DNET
JPA
PXA - Multiple lesions
-
TUMOR
mets, GBM, lymphoma
INFECTION
abscess, fungus, cysticercosis, toxo
VASCULAR
embolic infarcts, multifocal bleed, DAI, contusions, cav. hemangiomas, vasculitis - Corpus callosum lesions
-
TUMOR - GBM, lymphoma, lipoma, mets (rare)
DEMYELINATING - MS, ADEM, PML
INFARCT- always involves cingulate gyrus
TRAUMA- DAI - Intrasellar masses
-
pituitary adenoma
apoplexy
craniopharyngioma
Rathke’s cyst
mets
aneurysm
abscess
lymphocytic hypophysitis -
Suprasellar masses
(mnemonic full list) -
SATCHMOE -
- Sellar lesion / sarcoid
- Aneurysm, arachnoid cyst
- Teratoma
- Craniopharyngioma
- Hypothalamic glioma
- Mets, meningioma
- Optic nerve glioma
- EG, epidermoid/dermoid - Posterior fossa tumors (adults)
-
mets
hemangioblastoma
astrocytoma
choroid plexus papilloma
meningioma
epidermoid
dysplastic gangliocytoma - Posterior fossa tumors (children)
-
JPA
medulloblastoma
brainstem glioma
ependymoma - Brain tumor in infant
-
teratoma (#1)
PNET
choroid plexus papilloma
astrocytoma - Intraventricular tumors (adults)
-
astrocytoma
subependymoma
meningioma
mets
cysticercosis - CPA mass
-
SAME
Schwannoma (acoustic)
Aneurysm, Arachnoid cyst
Meningioma, Mets
Epidermoid, Ependymoma -
Cystic mass
benign and tumor ddx's -
TUMOR - cystic astrocytoma/ GBM, hemangioblastoma, mets, necrotic pituitary adenoma, craniopharyngioma
BENIGN - epidermoid/dermoid, arachnoid cyst, porencephalic cyst, colloid cyst, cavum variants, Rathke’s cyst, thrombosed aneurysm - Diffuse infiltrative
-
lymphoma
gliomatosis cerebri
white matter disease - Restricted diffusion
-
infarct
infection
possibly subacute hemorrhage - Metastasis (intraaxial)
-
lung
breast
colon
melanoma - Metastasis (extraaxial)
-
breast
lymphoma
prostate
neuroblastoma - Brain metastasis (hemorrhagic)
-
melanoma
renal
chorioCA
thyroid - Tumors with CSF seeding
-
choroid plexus papilloma
ependymoma
PNET (medulloblastoma)
pineoblastoma
germinoma
GBM - Hyperdense lesion on CT
-
lymphoma, medulloblastoma/PNET
ependymoma, germinoma, GBM
hemorrhagic or mucinous mets
osteogenic tumor
hemorrhage, aneurysm
meningioma, colloid cyst - Calcified intraparenchymal lesions
-
--oligodendroglioma, ependymoma, mucinous adenoCA, osteogenic sarcoma
--toxo, CMV, cysticercosis, TB
--AVM, aneurysm, TS, Sturge-Weber, hematoma
sellar lesions - meningioma, craniopharyngioma, germ cell tumor, aneurysm - T2 hypointense lesions
-
ferritin, hemosiderin, deoxyhemoglobin, intracellular methemoglobin
melanin, calcification, fibrous tissue, high protein concentration
lymphoma, myeloma, neuroblastoma, meningioma, flow void - T1 hyperintense lesions
-
Gd
methemoglobin, melanin, certain states of calcium
fat (dermoid)
high protein concentration (colloid cyst)
slow flow - Differential of choroid plexus mass
-
Papilloma
Carcinoma
Hemangioma
Xanthogranuloma
Metastasis - Lesions with strong enhancement
-
meningioma
medulloblastoma/PNET
paraganglioma
HIV-associated lymphoma
GBM
AVM / aneurysm - Ring enhancement
-
GBM, mets, lymphoma
Infarct, contusion, bleed (resolving)
Abscess, AIDS
RTX
Demyelinating disease - Diffuse meningeal enhancement
-
meningitis
carcinomatosis (lymphoma,mets)
post-op
SAH
intracranial hypotension
CSF leak - Basilar meningeal enhancement
-
INFECTION - TB (#1), fungal, pyogenic (more common on convexity), cysticercosis
TUMOR - lymphoma, leukemia, carcinomatosis
INFLAMMATORY- sarcoid, rheumatoid pachymeningitis, drugs, pantopaque, ruptured dermoid - Ependymal enhancement
-
TUMOR - lymphoma, mets, CSF seeding (PNET, GBM)
INFECTION- spread of meningitis, CMV (rare)
INFLAMMATORY- ventriculitis (postshunt or after instrumentation), posthemorrhage - T2 hypointense basal ganglia lesions
-
old age
any degenerative dz(MS, Parkinson’s)
childhood hypoxia - T2 hyperintense basal ganglia lesions
-
-TUMOR- lymphoma, NF
-ISCHEMIA- hypoxic encephalopathy, venous infarct
-NEURODEGENERATIVE dz (uncommon), Leigh’s dz
-TOXIN- CO, CN, H2S, hypoglycemia, methanol
-INFECTION- Crypto, parasites - T1 hyperintense basal ganglia lesions
-
dystrophic Ca++(any cause)
hepatic failure
NF
manganese - Basal ganglia calcification
-
- Physiologic (#1)
- Hyperparathyroidism
- TORCH, AIDS, TB, toxo, cysticercosis (common)
- Lead, CO, RTX, chemo
- Fahr’s disease
- Mitochondrial (common)
- Ischemic-hypoxic injury - White matter disease
-
-DEMYELINATING (MS, ADEM, CPM)
-DYSMYELINATING Leukodystrophies
-TUMOR (lymphoma, mets)
-INFLAMMATORY (Lyme, sarcoid, HIV, PML, CMV)
-VASCULOPATHY (sm vessel ischemia, vasculitis, HTN, eclampsia, migraines, RTX, chemo, cyclosporine, IVDA) - Wallerian degeneration
-
infarction
trauma
demyelinating
radiation
neurodegenerative
tumor - Neurodegenerative disorders
-
WM - demyelinating, dysmyelinating
GM - Alzheimer’s, Pick’s, multiinfarct dementia, Parkinson’s, lysosomal storage disorders, Wernicke’s, Creutzfeldt-Jakob, mesial temporal sclerosis
BG - Huntington’s, Wilson’s, Fahr’s, Leigh’s, ALS - Cerebellar atrophy
-
oligopontocerebellar degeneration
alcohol
dilantin
hemosiderin deposition - Noncommunicating hydrocephalus
-
Foramen of Monro obstruction:
3rd V mass, colloid cyst, oligodendroglioma, central neurocytoma, SEGA, ependymoma, suprasellar mass
aqueduct obstruction:
cong aqueductal stenosis, ventriculitis, IVH, tumor (mesencephalic, pineal, post 3rd ventr)
4th ventricle obstr:
DW malf, IVH, infection, subependymoma, exophytic brainstem glioma, posterior fossa mass - Communicating hydrocephalus
- meningitis (infectious, carcinomatous), SAH, surgery, venous thrombosis; NPH
- Cystic supratentorial congenital anomalies
- holoprosencephaly, hydrancephaly, aqueductal stenosis, callosal dysgenesis, porencephaly, arachnoid cyst, cystic teratoma, epidermoid/dermoid, vein of Galen AVM
- Posterior fossa cystic abnormalities
-
- DW malformation (vermian hypo/aplasia and large post fossa)
- DW variant (normal post fossa and vermian hypoplasia)
- megacisterna magna (nl vermis)
- retrocerebellar arachnoid cyst (must show mass effect)
- Chiari 4 (near complete absence of cerebellum)
- epidermoid/ dermoid
- cystic tumor
- Joubert’s syndrome (superior vermian hypo/aplasia)
- rhomboencephalosynapsis (vermian hypo/aplasia + fusion) - Absent septum pellucidum
-
holoprosencephaly
ACC
septooptic dysplasia
Chiari 2 - Migration and sulcation anomalies
- lissencephaly, schizencephaly, polymicrogyria, pachygyria, cortical heterotopia (focal, diffuse, subependymal), hemimegalencephaly
- Phakomatoses
-
NF
-I :fibromas, CN2 gliomas, sphenoid dysplasia
-II :MISME, bilat CN8 neuroma
TS
-Hamartomas, Tubers, SEGA, WM lesions;
+renal, bone, lung dz
VHL
-hemangioblastomas (cerebellum, stem, retina), renal (CA+cysts), adrenal (pheo), pancreas (cysts, CA, islet tumors)
Sturge-Weber
-tram-track Ca++ of cortex, leptomeningeal angiomas (p>o>f lobes), big choroid plexus - Diffuse marrow involvement
-
mets, myeloma
lymphoma, leukemia
anemia
Paget’s
FD - Spinal cord compression
-
criteria
- no CSF around cord, AP diam (<7mm), cord deformed
causes
- infection (TB, pyogenic)
- compression fx(CA, trauma)
- spondylosis /disk dz (HNP, hypertrophy of ligaments, osteophyte, FJD)
- primary bone d/o(Paget’s)
- epidural hematoma -
Spinal lesion
Intramedullary -
TUMOR
-astrocytoma (#1), ependymoma (#2)
-hemangioblastoma, lymphoma, mets (rare)
DEMYELINATING dz/myelitis
SYRINX
AVM
TRAUMA(contusion)/ RTX
sarcoid -
Spinal Lesion:
Intradural extramedullary -
-nerve sheath tumor (#1)
-meningioma, mets (drop)
-lipoma, teratoma
-arachnoid cyst
-arachnoiditis/meningitis
-AVM/AVF -
Spinal lesion
Extradural -
-Disc disease (fragment, discitis)
-mets, lymphoma
-epidural abscess or hematoma
-lipomatosis (thoracic)
-synovial cyst
extramedullary hematopoiesis
Tarlov cyst - Syrinx
-
Primary:
- Chiari malformations
- spinal dysraphism
- Dandy-Walker
- diastematomyelia
Acquired:
- tumor (astrocytoma, ependymoma)
- trauma (spinal cord injury, vascular insult)
- inflammatory (arachnoiditis/ meningitis, SAH) - External auditory canal
- exostoses, malignant otitis externa, atresia
- Clivus mass
-
chordoma
chondrosarcoma
plasmacytoma
mets, lymphoma
FD
EG - Petrous apex mass
-
cholesterol granuloma
mucocele
petrous apicitis
epidermoid
mets, myeloma
chondrosarcoma
meningioma
aneurysm - Soft tissue mass in middle ear
-
cholesteatoma
cholesterol granuloma
glomus tympanicum tumor
aberrant ICA
high or dehiscent jugular bulb - Intracanalicular IAC masses
-
exclusively intracanalicular
- acoustic neuroma
- facial neuroma
- hemangioma
- lipoma
not primarily intracanalicular
- meningioma
- epidermoid - Hearing loss
-
conductive
- otitis media
- cholesteatoma
- otosclerosis
- trauma (longitudinal fx)
sensorineural
- idiopathic hereditary
- acoustic neuroma
- trauma (transverse fracture) - Pulsatile tinnitus
- aberrant ICA, jugular bulb anomalies, glomus jugulare, glomus tympanicum, AVM, ICA aneurysm at petrous apex
- Jugular fossa mass
- glomus jugulare (#1), NF (#2), schwannoma, chondrosarcoma, mets
- Orbital masses by etiology
-
tumor
lymphoma, mets (neuroblastoma, breast), lymphangioma, rhabdomyosarc, hemangiopericytoma, neurofibroma, dermoid
inflammatory
pseudotumor, thyroid ophthalmopathy, cellulitis, abscess, Wegener’s
vascular
carotid-cavernous fistula, venous varix, thrombosis of superior ophthalmic vein, hemangioma (old: cavernous; kids: capillary)
trauma
hematoma, FB, lens dislocation - Extraconal disease in the orbit
-
* Nasal dz: infection, cancer
* Orbital bone dz: subperiosteal abscess, osteomyelitis, FD, tumors, trauma
* Sinus dz: mucocele, invasive infections, neoplasm
* Lacrimal gland dz: adenitis, lymphoma, pseudotumor, tumor - Intraconal disease
-
well-defined margins - hemangioma, schwannoma, orbital varix, meningioma
ill-defined margins - pseudotumor, infection, lymphoma, mets
muscle enlargement - pseudotumor, Graves’, myositis, carotid-cavernous fistula - Vascular orbital lesions
-
tumor -
hemangioma, lymphangioma, hemangioendothelioma, hemangiopericytoma, meningioma, hypervascular mets
vascular (enlarged sup ophthalmic vn) - carotid cavernous fistula, cavernous thrombosis, orbital varix, ophthalmic artery aneurysm - Optic neuritis
- abnormal T2 signal and enhancement but not enlarged - MS, sarcoid, infection
- Optic neuropathy
- abnormal T2 signal only - compression, ischemia, pharmacologic, toxins, trauma
- Optic nerve tumor
-
* glioma
* meningioma
abnormal T2 signal and enhancement and nerve enlarged - Optic nerve sheath enlargement
-
TUMOR- CN2 glioma, meningioma, meningeal carcinomatosis, mets, lymphoma, leukemia
INFLAMMATORY- optic neuritis, pseudotumor, sarcoid
increased ICP
TRAUMA- hematoma - Tramtrack enhancement of orbital nerve
-
optic nerve meningioma
optic neuritis
idiopathic
pseudotumor
sarcoid
lymphoma, leukemia
perioptic hemorrhage
mets
normal variant - Ocular muscle enlargement
-
thyroid ophthalmopathy (#1, painless)
pseudotumor (painful)
infection from adj sinus
TB, sarcoid
carotid cavernous fistula
hemorrhage - Orbital mass in a child
-
LO VISON
Leukemia
Optic nerve glioma
Vascular (hemangioma)
Inflammation
Sarcoma, rhabdomyosarcoma
Ophthalmopathy/pseudotumor
Neuroblastoma - Adult orbital masses
-
hemangioma
schwannoma
melanoma
meningioma
lymphoma
pseudotumor
trauma - Cystic orbital lesions
- dermoid, epidermoid, teratoma, ABC, cholesterol granuloma, colobomatous cyst
- T1 hyperintense orbital masses
- tumor - melanoma, retinoblastoma, choroidal mets, hemangioma; detachment - Coat’s disease, persistent hyperplastic primary vitreous, trauma; other - hemorrhage, phthisis bulbi
- Globe calcifications
-
tumor - retinoblastoma (95%), astrocytic hamartoma (TS, NF), choroidal osteoma
infection (chorioretinitis) - toxoplasmosis, herpes, CMV, rubella
other - phthisis bulbi (ca++ in endstage dz, shrunken bulb), optic nerve drusen (most common cause calcifs in adults, bilateral) - Micropthalmia
- persistent hyperplastic primary vitreous, retinopathy of prematurity, congenital rubella, phthisis bulbi
- Sudden onset proptosis
- orbital varix, hemorrhage into cavernous hemangioma or lymphangioma, CCF, thrombosis of superior orbital vein
- Lacrimal gland enlargement
- benign lymphoid hyperplasia, pseudotumor, sarcoid, Sjogren syndrome, pleomorphic adenoma, adenoid cystic CA, lymphoma, leukemia, dacryoadenitis
- Diffuse bone abnormality
- FD, Paget’s, thalassemia, osteopetrosis, craniometaphyseal dysplasia, mets
- Radioopaque sinus
-
normal variant - hypoplasia, unilateral thick bone
sinusitis (acute w AFL; chronic w thick mucosa and ret cysts) - allergic, aspergillosus, mucor, sarcoid, Wegener’s
solid masses - SCC, polyp, inverted papilloma, lymphoma, juvenile angiofibroma (most common tumor in children), mucocele (expansile, a/w CF in kids), esthesioneuroblastoma, mets, osteoma, FD
postsurgical - Caldwell-Luc - Mucosal space mass
- SCC, lymphoma, rhabdomyosarcoma, melanoma, adenoids, juvenile angiofibroma, Thornwald’s cyst
- Parapharyngeal and carotid space masses
- salivary gland tumors (80% benign), vagal schwannoma, cervical sympathetic plexus schwannoma, glomus vagale, nasopharyngeal CA, lymphadenopathy, abscess, cellulitis
- Prevertebral mass
- mets, chordoma, osteomyelitis, abscess, hematoma
- Sublingual space mass
- lymphangioma, ranula, hemangioma, lingual thyroid, inflammatory
- Simultaneous sublingual and submandibular space mass
- diving ranula, lymphangioma, abscess
- Post-styloid parapharyngeal mass
- salivary tissue, nerves, nodes, glomus tumor
- Prestyloid parapharyngeal mass
- pleomorphic adenoma, Warthin’s, mucoepidermoid, adenoid cystic, branchial cleft cyst, neurogenic tumor, hemangioma, node
- Bilateral parotid low attenuation lesions
-
HIV lymphoepithelial cysts
Sjogren’s
Warthin’s tumor
infection - Enlarged parotids
- obesity, DM, alcohol, cirrhosis, malnutrition, drugs
- Sialoliths
- sarcoid, Sjogren’s, HPT
- Cystic extrathyroid lesions
-
NECK:
* branchial cleft cyst (lat to carotid)
* thyroglossal duct cyst (midline)
* ranula (retention cyst of sublingual glands)
* retention cysts of mucous glands (parotid)
* cystic hygroma (lymphangioma, most common < 2y/o)
NASOOROPHARYNX:
Thornwald’s cyst, mucus retention cyst, necrotic SCC
LARYNX & PARALARYNGEAL:
laryngocele, mucus retention cyst - Cystic thyroid lesions
- colloid cyst, cystic degeneration, cystic papillary tumor, cystic mets
- Bilateral thyroid masses
- lymphoma, mets (RCC, lung), multiple primary tumors, MNG, thyroiditis, cysts
- Neck lymphadenopathy
-
enlarged Waldeyer’s ring - lymphoma, mononucleosis, HIV
skin lesions - KS, sarcoid, lymphoma, CA, cat-scratch, TB, Actinomycosis
enlarged nodular salivary glands - HIV, Sjogren, sarcoid, lymphoma, cat-scratch
calcified - thyroid CA, treated lymphoma, sarcoid, silicosis, TB - Solid neck mass
- SCC of larynx or nasooropharynx, lymphadenopathy, parotid tumor, neurofibroma, glomus tumor, dermoid, teratoma, infection, granulomatous inflammation, ectopic thyroid
- Vascular head and neck mass
-
glomus - carotid body, vagale, jugulare, tympanicum
hemangioma
AVM
aneurysm (often ICA) - pseudoaneurysm, posttraumatic - Vocal cord paralysis
- tumor, post-op, iatrogenic, idiopathic
-
AIDS -
what are the ENT complications? -
ENT complications in 50%
parotid - multiple intraparotid cystic masses (benign lymphoepithelial lesion), lymphadenopathy
sinonasal - sinusitis, KS
oral cavity - Candida, periodontal an gingival infections
pharynx/larynx - opportunistic infections, epiglottitis, lymphoma
temporal bone (rare) - otitis media, otitis externa - Odontogenic
- cysts, ameloblastoma, odontogenic carcinoma or sarcoma; nonodontogenic - osteosarcoma, chondrosarcoma, Ewing’s, myeloma
-
Intraventricular mass
(child) -
choroid plexus papilloma
ependymoma
medulloblastoma
teratoma
astrocytoma -
Intraventricular mass
(lateral ventricle) -
age 0-15:
-PNET -choroid plexus papilloma
Age 15-30:
-glioma -JPA
Over 30:
-subependymoma
-astrocytoma
-mets
-oligodendroglioma
-meningioma
-central neurocytoma -
Intraventricular mass
(3rd ventricle) -
Age 0-15:
- astrocytoma
- EG of stalk
- germinoma
- extrinsic craniopharyngioma
Age 15-30: - colloid cyst
Over 30:
- glioma - mets
- pituitary or pineal mass
- Other (aneurysm, sarcoid) -
Intraventricular mass
(4th ventricle) -
age 0-15:
- ependymoma
- medulloblastoma
age 15-30:
- choroid plexus papilloma
Over 30:
- mets
- hemangioblastoma
- subependymoma - basal ganglia bright on T1
-
Hypo and pseudohypoparathyroidism
HyperPTH
Hallervordin-Spatz
Hyperalimentation
Hemorrhage
CO
NF - What are the nodal stations of the neck?
-
Lvl I Submental(A)/submand(B)
Level II- Upper IJ
Level III- Middle jugular
Level IV - Low jugular
Level V- Posterior triangle
- A- Above cricoid arch
- B- Betw arch & clavicle
Level VI- Upper visceral
Level VII- Sup mediastinal -
Progression of hematoma
Age/stage
main component
T1 and T2 signal -
<1d___oxyhemoglobin____Lo__Hi
0-2d__deoxyhemogl______Lo__Lo
2-14d_intracel methem__Hi__Lo
10-21d_extracel methem_Hi__Hi
>21d___hemosiderin_____Lo__Lo -
Suprasellar mass ddx
adults vs. pedi -
adults
--macroadenoma (#1)
--meningioma
--glioma
--craniopharyngioma
--aneurysm
children
--craniopharyngioma (#1)
--glioma
--germinoma
--hypothalamic hamartoma
--EG - Causes of orbital inflammation
-
Orbital cellulitis
Mucormycosis
Graves
Orbital pseudotumor
Sarcoidosis
Wegener's granulomatosis - Skull base tumors
-
Chordoma
Chondroma/Chondrosarcoma
Plasmacytoma
Paraganglioma
Nerve sheath tumors
Cholesteatoma
Mets -
Posterior fossa tumor in adult
intra-axial -
1. Metastasis (lung, breast)
2. Hemangioblastoma
3. Lymphoma
4. Lipoma -
Posterior fossa tumor in adult
extra-axial -
"hit in head with a MACE:
Meningioma
Acoustic neuroma
Chordoma/Choroid papilloma
Epidermoid -
intramedullary spinal mass ddx
- with basic MR signal for each -
Ependymoma: mix T1, hi T2
Astrocytoma: iso-loT1, iso-hiT2
Hemangioblastoma: lo T1, hi T2
(also w cysts and flo voids)
Mets: iso T1, iso-hi T2
(gray nodule with edema) -
Intradural (but extramed) spinal mass ddx
- with basic MR signal for each -
Meningioma- iso T1, var T2
Neurinoma- iso T1, hi T2
Neurofibroma- iso T1, mix hiT2
Lipoma- hi T1, lo T2
Mets- iso T1, iso-hi T2 -
Extradural spinal mass ddx
(with basic MR signal for each) -
* Mets: lo T1, mild hi T2
* Epidermoid: lo T1, hi T2
* Lymphoma: iso T1, iso-hi T2
* Lipoma(/tosis): hi T1, lo T2
* Teratoma: mix T1 and T2 -
"Other" spinal mass ddx
- with MR signal -
Arachnoid cyst - lo T1, hi T2
Chordoma- iso T1, mix T2
Arthopathic pseudotumor- iso-lo on both -
DDx
Intraventricular mass
T1 Dark
T2 Bright
Non-enhancing -
Arachnoid cyst
Cysticercosis
Colloid cyst (3rd vent)
Cystic crangiopharyngioma
Cystic meningioma
DW cyst (4th vent)
Epidermoid (4th vent)
Neuroepithelial cyst -
DDx
Intraventricular mass
CSF signal -
Arachnoid cyst
Cysticercosis
DW cyst or variant
Mega cisterna magna -
DDx
Intraventricular mass
T1 Dark
T2 Dark
Enhancing -
Acute hematoma
Calcified SEGA
Calcified glomus of choroid plexus
Dense or calcified mets (colon, prostate)
Meningioma with Ca++ -
DDx
Intraventricular mass
T1 bright
T2 dark -
Colloid cyst
CSF flow
Dermoid
Early subacute bleed
Craniopharyngioma (calcifed)
Lipoma
Pantopaque
Xanthogranuloma of choroid -
DDx
Intraventricular mass
T1 bright
T2 bright -
Dermoid
Flow
Intraventricular craniopharyngioma
Late subacute bleed -
Infratentorial Pediatric Neoplams
DDx -
JPA
Brain stem astrocytoma
Medulloblastoma/PNET
Ependymoma
Other
medullomyoblastoma
rhabdoid
anaplastic ependymoma -
Differential for nodular meningeal enhancement -
* Infect granulomatous dz (TB, fungal)
* Inflammatory meningitis (sarcoid)
* Lymphoid (lymphoma, plasmacytoma)
* Carcinomatous meningitis
* Meningioma - Differential diagnosis of a calcified brain mass:
-
Adults
o Meningioma
o Oligodendroglioma
o Aneurysm / AVM
o Calcified Tuberculoma
Children/Adolescents
o Giant Cell Astrocytoma
o Ependymoma
o Ganglioglioma
o AVM - Differential Diagnosis for a midline, clival-centric mass:
-
o Chordoma
o Chondrosarcoma
o Epidermoid
o Meningioma
o Rhabdomyosarcoma
o Nasopharyngeal tumors
o Plasmacytoma
o Lymphoma