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Imaging of Brainstem Lesions

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Brainstem Tumors

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Abstract

Brainstem lesions can arise from the midbrain, pons, or medulla. Oftentimes, these lesions will affect adjacent nuclei/pathways or result in mass-effect within the posterior fossa. Imaging of brainstem lesions can be achieved by utilizing multiple modalities, each of which offer modality-specific advantages and disadvantages. Imaging may include magnetic resonance imaging (MRI), computed tomography (CT), and/or positron emission tomography (PET) imaging. Ultrasound imaging may also be utilized to evaluate the posterior fossa of newborns. The density of the skull base typically presents an obstacle for imaging of the posterior fossa. MRI is the modality of choice for the evaluation and characterization of brainstem lesions. Imaging characteristics of different brainstem lesions can provide invaluable pretreatment information to aid in the diagnosis, assess impact on adjacent structures, and assist in treatment planning. When evaluating neoplastic lesions, imaging may also serve to distinguish between neoplastic progression versus development of post-treatment changes. In this chapter, we provide an overview of the typical imaging appearance of common neoplastic and non-neoplastic lesions within the brainstem.

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Abbreviations

18F-FDG PET:

18F-2-fluoro-2-deoxy-D-glucose positron emission tomography

18F-FET PET:

18F-fluoro-ethyl-tyrosine positron emission tomography

1H-MRS:

1H-MR-spectroscopy

1H-MRSI:

1H-Magnetic resonance spectroscopic imaging

3D:

Three-dimensional

ADC:

Apparent diffusion coefficient

ADEM:

Acute disseminated encephalomyelitis

ASL:

Arterial spin labeling

AVM:

Arterio-venous malformation

BBB:

Blood brain barrier

BSCMs:

Brainstem cavernous malformations

BSGs:

Brainstem Gliomas

b-SSFP:

Balanced steady-state free procession

CBF:

Cerebral blood flow

CBV:

Cerebral blood volume

Cho:

Choline

CISS:

Constructive interference in steady state CN: cranial nerve

CNS:

Central nervous system

CPA:

Cerebellopontine angle cistern

Cr:

Creatine

CSF:

Cerebral spinal fluid

CT:

Computed tomography

DCE:

Dynamic contrast enhancement

DIPG:

Diffuse intrinsic pontine glioma

DRO:

Dentate-rubro-olivary

DSC:

Dynamic susceptibility contrast

DTI:

Diffusion tensor imaging

DTT:

Diffusion tensor tractography

DVA:

Developmental venous anomaly

DWI:

Diffusion weighted imaging

DWI/DTI:

Diffusion weighted or tensor imaging

ED:

Emergency department

EV71:

Enterovirus 71

FA:

Fractional anisotropy

FIESTA:

Fast imaging employing steady-state acquisition

FLAIR:

Fluid-attenuated inversion recovery

HOD:

Hypertrophic olivary degeneration

HSV1:

Herpes simplex virus 1

HU:

Hounsfield units

IAC:

Internal auditory canal

ICH:

Intracranial hemorrhage

ION:

Inferior olivary nucleus

IV:

Intravenous

MRI:

Magnetic resonance imaging

MS:

Multiple sclerosis

MTT:

Mean transit time

NAA:

N-acetylaspartate

ODS:

Osmotic demyelination syndrome

PCNSL:

Primary central nervous system lymphoma

PET:

Positron emission tomography

PPH:

Primary pontine hemorrhage

PWI:

Perfusion weighted imaging

rCBV:

Relative cerebral blood volume

RE:

Rhombencephalitis

SWI:

Susceptibility-weighted imaging

TB:

Tuberculosis

TTP:

Time-to-peak

WHO:

World Health Organization

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Author information

Authors and Affiliations

  1. Division of Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, MD, USA

    Miguel A. Flores & Sachin K. Gujar

  2. Division Chief, Neuroradiology, University Hospitals, Case Western Reserve University, Cleveland, OH, USA

    Ari M. Blitz

  3. Radiologist-in-Chief and Edward B. Singleton Chair of Radiology, Department of Radiology, Texas Children’s Hospital and Baylor College of Medicine, Houston, TX, USA

    Thierry A. G. M. Huisman

Authors
  1. Miguel A. Flores
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  2. Ari M. Blitz
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  3. Sachin K. Gujar
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  4. Thierry A. G. M. Huisman
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Corresponding author

Correspondence to Thierry A. G. M. Huisman .

Editor information

Editors and Affiliations

  1. Department of Neurosurgery, Institute for Brain Protection Sciences, Johns Hopkins University School of Medicine, Johns Hopkins All Children’s Hospital, Saint Petersburg, FL, USA

    George I. Jallo

  2. Department of Neurosurgery, Institute for Brain Protection Sciences, Johns Hopkins University School of Medicine, Johns Hopkins All Children’s Hospital, Saint Petersburg, FL, USA

    Mohammad Hassan A. Noureldine

  3. Institute of Neuroscience, Geisinger Medical Center, Geisinger Commonwealth School of Medicine, Danville, PA, USA

    Nir Shimony

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Flores, M.A., Blitz, A.M., Gujar, S.K., Huisman, T.A.G.M. (2020). Imaging of Brainstem Lesions. In: Jallo, G., Noureldine, M., Shimony, N. (eds) Brainstem Tumors. Springer, Cham. https://doi.org/10.1007/978-3-030-38774-7_3

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