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Chapter 19

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1. Normal proton spectroscopy of the brain

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Figure 19-1

Normal proton spectroscopy of the brain.

NAA = N-acetyl-L-aspartate; Cr = creatine; Cho = choline; MI = Myo-inositol.

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2. Anaplastic astrocytoma

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Figure 19-2

Anaplastic astrocytoma.

A. A T2-weighted MR image of a 15-year-old patient with seizures shows a hyperintense right parietal lobe lesion. B. The enhancing tumor (arrow) on the T1-weighted image obtained after gadolinium injection is much smaller, suggesting that much of the T2 signal abnormality is due to peritumoral edema.

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3. Pilocytic astrocytoma of the thalamus

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Figure 19-3

Pilocytic astrocytoma of the thalamus.

This 11-year-old male with papilledema presented with a 2-week history of headaches and intermittent nausea, vomiting, and diplopia. A. Unenhanced CT shows a cystic mass of the left thalamus, with a solid mural nodule. There is obstructive hydrocephalus. Peritumoral edema produces hypoattenuation in the left basal ganglia and adjacent white matter. B. A coronal FLAIR MR image shows peritumoral and periventricular edema. The mural nodule is slightly hyperintense. C. There is intense contrast enhancement of the mural nodule on this T1-weighted image obtained with IV gadolinium.

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4. Pilocytic astrocytoma

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Figure 19-4

Pilocytic astrocytoma.

A. A coronal FLAIR image of a 9-year-old child shows a large cystic lesion in the right parietal lobe. There is a multinodular intraluminal component medially (arrow). There is extensive hyperintense perilesional edema. B. The medial solid component enhances intensely with IV gadolinium on this T1-weighted sequence. The margins of the tumor cyst are well-defined.

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5. Diffuse astrocytoma

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Figure 19-5

Diffuse astrocytoma.

This is an 8-year-old girl with right hemiparesis, aphasia, and seizures. A, B. T2-weighted images show hyperintensity in a large region of the left cerebral hemisphere, without a definable mass. There is rightward shift of midline structures. C. The contrast enhancement characteristics of the brain are normal. Stereotactic biopsy demonstrated a high-grade astrocytoma.

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6. Gemistocytic astrocytoma

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Figure 19-6

Gemistocytic astrocytoma.

A. There is a large hypointense area in the right frontoparietal region on this T1-weighted MR image. Mild mass effect is present. B. This infiltrative tumor is hyperintense on a FLAIR sequence. C. Most of the lesion is isointense on this contrast-enhanced T1-weighted image. There are ...

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