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previously visited 080819 ANAPLASTIC EPENDYMOMA (SUPRATENTORIAL) Random Case
Authored By: pedrad CSH, Radiologist, Chung Shan Medical University Hospital, Taiwan.
Patient: 9 year old male
History: Chief complain: Neck stiffness for one week.
Images:small[medium]largeas-submittedimages only

Fig. 1: CT without contrast, coronal

Fig. 2: CT without contrast, coronal, bone window

Fig. 3: MRI, axial, T1WI, T2WI, Gd enhancement, DWI, ADC

Fig. 4: chemical shift MR imaging

Fig. 5: chemical shift MR imaging with metabolite map (NAA/Cr)

Fig. 6: chemical shift MR imaging with metabolite map (Cho/Cr)

Fig. 7: single voxel proton MR spectroscopy

Fig. 8: proton MR spectroscopy, normal and lesion

Fig. 9: Diffusion-weighted echo-planar MR imaging with fractional anisotropy maps and colored-fractional anisotropy maps

Fig. 10: Diffusion-weighted echo-planar MR imaging with 3D diffusion tensor tractography
Images:small[medium]largeas-submittedimages only
Findings:

<1>. Multidetector row CT scan of brain with multiplanar
 reconstruction, and without intravenous contrast:
<2>. 1.5 Tesla MRI of brain with T1 weighted echo train spin echo,
 T2 weighted echo train spin echo, T2 weighted fluid-attenuated
 inversion recovery echo train spin echo, diffusion-weighted
 echo-planar MR imaging, single voxel proton MR spectroscopy,
 chemical shift MR imaging with metabolite map, diffusion-weighted
 echo-planar MR imaging with fractional anisotropy maps,
 colored-fractional anisotropy maps, and 3D diffusion tensor
 tractography, and with intravenous gadolinium-enhanced images:

1. A high attenuation lobulated big mass (figure 1) with iso-T1
   and T2 signals and contrast enhancement (figure 3), about
   7.6cm in greatest dimension, in left parietal lobe, with
   extension into left thalamus but minimal perifocal low density,
   long T2 edema, in favor of brain tumor.
2. Presence of faint calcifications of the lesion (arrow in figure),
   some degree scalloped erosion of adjacent parietal skull (arrow
   in figure 2), and extensive cystic change of the lesion.
3. Besides, marked restricted water diffusibility of the solid
   part (figure 3) with marked reduced the ratio of
   N-acetylaspartate(NAA)/total Creatine (Cr) (figure 4,5),
   elevated the ratio of choline (Cho)/total Creatine (Cr)
   (figure 4,6), and presence of abnormal peak of lactate
   (arrow in figure 7).
4. Presence of mass effect of the lesion with dilatation of left
   lateral ventricle frontal horn, may due to compression of
   foramen of Monro by the tumor.
5. Besides, uncal herniation with mild obliteration of left
   suprasellar cistern and medial deviation of cerebral white matter
   tract (figure 9,10), due to tumor mass effect alos.

Diagnosis: Excisional biopsy: anaplastic ependymoma (supratentorial)
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Additional Details:

Case Number: 18922278Last Updated: 09-08-2008
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Anatomy: Cranium and Contents   Pathology: Neoplasm
Modality: CT, MR, 3D ReconstructionAccess Level: Readable by all users
Keywords: ependymoma, dwi, diffusion, tractography, dti, spectroscopy, mrs,ACR: 132.3636
Case has been viewed 512 times.

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