CincyKidsRad

Cincinnati Children's Radiology

Pilocystic astrocytoma of the spinal cord

Sagittal T2 weighted (image 1), sagittal T1-weighted postcontrast (image 2), and axial T2 (image 3) MRI of the cervical spine shows a large expansile pilocystic astrocytoma arising from the cervical spinal cord. Pilocystic astrocytoma is the most common spinal cord tumor in children. They most commonly occur in the thoracic portion of the spinal cord causing fusiform enlargement.

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Sagittal T1 weighted postcontrast (image 1) and axial T2-weighted (Image 2) MRI shows an expansile mass (arrow) of the cervical spinal cord consistent with an astrocytoma. The mass has a solid (arrow) and cystic (arrowhead) component. Children with a spinal cord tumor may present in a delayed fashion with symptoms of back pain, progressive motor weakness, progressive scoliosis, gait disturbance, and muscle rigidity. Astrocytomas are the most common spinal cord tumor in children followed by ependymomas.

Axial T2 (image 1), sagittal T1 (image 2), and axial T1-weighted postcontrast (image 3) MRI show a cystic mass with a solid mural nodule (arrow) in the left cerebellar hemisphere, indicative of a juvenile pilocytic astrocytoma (JPA). JPAs are WHO grade 1 tumors and typically arise in the cerebellum. They are the most common primary brain tumor of childhood and occur in the first two decades of life.

Sagittal T1 (image 1), coronal T2 (image 2), and axial susceptibility-weighted MRI (image 3) reveal a cavernous malformation (arrow) within the cervical spinal cord. Cavernous malformations are predominantly found in the brain, with spinal cord lesions accounting for approximately 5% of malformations. Spinal cavernous malformations most commonly occur in the thoracic region. Unlike brain lesions, spinal cord cavernous malformations are usually asymptomatic but may present with acute, stepwise neurological decline or a gradual progression of symptoms.

Sagittal (image 1) and axial (image 2) T2-weighted MRI of the cervical spinal cord in a child with von Hippel-Lindau disease show an expansile T2 hyperintense tumor (arrow) of the cervical spinal cord. What is your diagnosis of this tumor? #FridayQuizDay #FridayQuiz