Magnetic resonance imaging differential diagnosis of brainstem lesions in children

Figure 15 Diffuse intrinsic pontine glioma. A 15-year-old boy with sudden onset of diplopia and right VI cranial nerve paresis. A T2 hyperintense infiltrating mass occupies more than two-thirds of the pontine transverse area. Note enlargement of the ventral portion of the brainstem (A and B). As an atypical pattern, the mass lesion in this case shows inhomogeneous enhancement on post-contrast T1 weighted images (D and E). DSC Perfusion CBV maps demonstrate relative CBV approximately 4.5 times higher than normal appearing cerebellar deep white matter (C). 1H spectroscopy demonstrates significant reduction of the NAA/Ch ratio (F). CBV: Cerebral blood volume; NAA/Ch: N-acetyl-aspartate/choline; DSC Perfusion CBV maps: Dynamic susceptibility contrast enhanced perfusion cerebral blood volume maps.