0:00

Thus far, we've discussed the differential diagnosis

0:04

for astrocytoma and ependymoma,

0:07

recognizing that none of the imaging

0:09

findings are absolutely reliable in making that distinction,

0:14

we usually say that we're somewhere

0:15

around the 70% range.

0:17

We can do a little bit better with the next lesion.

0:20

On this case, we again have a cervical spine lesion,

0:23

and we see that the lesion has both a cystic

0:27

as well as solid portion to it.

0:30

Now, as I magnify this one image,

0:33

you might ask the question, well,

0:35

is it truly cystic or is that just cord edema?

0:40

And for that, we look at the STIR image as well.

0:43

And what we can see is, once again,

0:46

that there does appear to be a fluid area that

0:50

is corresponding to the darker signal

0:52

intensity on the T1-weighted scan, more likely

0:55

representing fluid rather than actual cord edema,

0:59

which would be not as dark on the T1-weighted scan.

1:03

So let me just magnify the T1-weighted scan,

1:06

and try to use my pointer here.

1:09

Okay, so this is what I'm referring to.

1:11

This is darker than edema.

1:13

Edema might be up here,

1:15

but this darker area is what is represented

1:20

as a more cystic area to this mass.

1:22

Now, unfortunately,

1:24

astrocytomas and ependymomas

1:26

may have cystic areas,

1:28

but let's look at the post-gadolinium enhanced image

1:31

on this patient.

1:33

On the post-gadolinium enhanced scan...

1:36

Let's magnify.

1:38

What we see is a mass that has a solid area of

1:43

contrast enhancement,

1:45

associated with the cystic area,

1:47

and it's relatively well-defined and small in size.

1:52

Just going to try to

1:55

window this a little bit better for maximum benefit.

2:00

Once again, the cystic component,

2:02

the solid component,

2:03

and then a small cystic component below.

2:06

So this well-defined mass associated with

2:10

nodular enhancement, as well as a cystic component,

2:15

is more indicative of the hemangioblastoma

2:20

for the diagnosis.

2:23

One would look for additional lesions and

2:26

lesions in the posterior fossa in order to

2:29

make sure that the patient does not have the

2:31

syndrome of Von Hippel Lindau disease.

2:34

Von Hippel Lindau disease has multiple

2:37

hemangioblastomas, and in point of fact,

2:40

it may have other lesions such as renal cell

2:43

carcinoma or pancreatic cystadenomas, et cetera.

2:47

In the temporal bone,

2:49

one can also see the endolymphatic sac tumor,

2:53

which may be associated with

2:55

von Von Hippel Lindau

2:56

But this is a pretty good classic case of

3:00

mural nodule with cyst, small lesion,

3:04

well-defined hemangioblastoma of the spinal cord.

3:09

We say that with hemangioblastoma,

3:11

one third of patients who have spinal cord

3:14

hemangioblastomas have Von Hippel Lindau disease

3:18

and one third of patients who have Von Hippel Lindau disease

3:22

have a spinal hemangioblastoma.