Answer for BIR CoW 04 June 2023
DNET
Findings
Evidence of T2 hetero intense/T1 hypointense lesion without restricted diffusion and high ADC values noted in left frontal region. No evidence of gradient blooming with in the lesion Above mentioned lesion partially suppressed on FLAIR with peripheral hyperintense rim No obvious contrast enhancement with in the lesion Left frontal craniotomy defect noted
Discussion
DNET is a benign, usually cortically based lesion characterized by a multinodular architecture It can be located in any part of the supratentorial cortex. Between 45-50% are located in the temporal lobes, whereas one-third occur in the frontal lobes. The Ki-67-labeling index is usually less than 1- 2%. Frequently associated with cortical dysplasia ○ Classified as ILAE FCD type IIIb POINTS FOR DIAGNOSIS cortical/subcortical mass • "Points" toward ventricle • Multicystic/septated "bubbly" appearance ○ Hyperintense on T2WI ○ Rim of hyperintensity on FLAIR ○ Edema absent ○ Usually doesn't enhance DIFFERENTIAL DIAGNOSIS I) focal cortical dysplasia II) Ganglioglioma III)multinodular and vacuolating neuronal tumor of the cerebrum The "bubbly" appearance of DNET and FLAIR hyperintense rims are helpful distinguishing features. MVNTs are typically multifocal and occur in the deep layers of the cortex and adjacent white matter. The rare angiocentric glioma closely resembles DNET on imaging, but a hyperintense rim is seen on T1WI, not FLAIR.
Findings
Evidence of T2 hetero intense/T1 hypointense lesion without restricted diffusion and high ADC values noted in left frontal region. No evidence of gradient blooming with in the lesion Above mentioned lesion partially suppressed on FLAIR with peripheral hyperintense rim No obvious contrast enhancement with in the lesion Left frontal craniotomy defect noted
Discussion
DNET is a benign, usually cortically based lesion characterized by a multinodular architecture It can be located in any part of the supratentorial cortex. Between 45-50% are located in the temporal lobes, whereas one-third occur in the frontal lobes. The Ki-67-labeling index is usually less than 1- 2%. Frequently associated with cortical dysplasia ○ Classified as ILAE FCD type IIIb POINTS FOR DIAGNOSIS cortical/subcortical mass • "Points" toward ventricle • Multicystic/septated "bubbly" appearance ○ Hyperintense on T2WI ○ Rim of hyperintensity on FLAIR ○ Edema absent ○ Usually doesn't enhance DIFFERENTIAL DIAGNOSIS I) focal cortical dysplasia II) Ganglioglioma III)multinodular and vacuolating neuronal tumor of the cerebrum The "bubbly" appearance of DNET and FLAIR hyperintense rims are helpful distinguishing features. MVNTs are typically multifocal and occur in the deep layers of the cortex and adjacent white matter. The rare angiocentric glioma closely resembles DNET on imaging, but a hyperintense rim is seen on T1WI, not FLAIR.
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!