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Magnetic resonance imaging of the brainstem in children, part 2: acquired pathology of the pediatric brainstem

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Abstract

Part 1 of this series of two articles describes conventional and advanced MRI techniques that are useful for evaluating brainstem pathologies. In addition, it provides a review of the embryology, normal progression of myelination, and clinically and radiologically salient imaging anatomy of the normal brainstem. Finally, it discusses congenital diseases of the brainstem with a focus on distinctive imaging features that allow for differentiating pathologies. Part 2 of this series of two articles includes discussion of neoplasms; infections; and vascular, demyelinating, toxic, metabolic and miscellaneous disease processes affecting the brainstem. The ultimate goal of this pair of articles is to empower the radiologist to add clinical value in the care of pediatric patients with brainstem pathologies.

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References

  1. Barkovich AJ, Raybaud C (2019) Intracranial, orbital, and neck masses. In: Pediatric neuroimaging. Lippincott Williams & Wilkins, Philadelphia

  2. Pfaff E, El Damaty A, Balasubramanian GP et al (2019) Brainstem biopsy in pediatric diffuse intrinsic pontine glioma in the era of precision medicine: the INFORM study experience. Eur J Cancer 114:27–35

    Article  PubMed  Google Scholar 

  3. Bounajem MT, Karsy M, Jensen RL (2020) Liquid biopsies for the diagnosis and surveillance of primary pediatric central nervous system tumors: a review for practicing neurosurgeons. Neurosurg Focus 48:E8

    Article  PubMed  Google Scholar 

  4. Johnson DR, Guerin JB, Giannini C et al (2017) 2016 updates to the WHO brain tumor classification system: what the radiologist needs to know. Radiographics 37:2164–2180

    Article  PubMed  Google Scholar 

  5. Hoffman LM, Veldhuijzen van Zanten SEM, Colditz N et al (2018) Clinical, radiologic, pathologic, and molecular characteristics of long-term survivors of diffuse intrinsic pontine glioma (DIPG): a collaborative report from the International and European Society for Pediatric Oncology DIPG registries. J Clin Oncol 36:1963–1972

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Makepeace L, Scoggins M, Mitrea B et al (2020) MRI patterns of extrapontine lesion extension in diffuse intrinsic pontine gliomas. AJNR Am J Neuroradiol 41:323–330

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Raybaud C, Ramaswamy V, Taylor MD, Laughlin S (2015) Posterior fossa tumors in children: developmental anatomy and diagnostic imaging. Childs Nerv Syst 31:1661–1676

    Article  PubMed  Google Scholar 

  8. Brandao LA, Young Poussaint T (2017) Posterior fossa tumors. Neuroimaging Clin N Am 27:1–37

    Article  PubMed  Google Scholar 

  9. Tisnado J, Young R, Peck KK, Haque S (2016) Conventional and advanced imaging of diffuse intrinsic pontine glioma. J Child Neurol 31:1386–1393

    Article  PubMed  PubMed Central  Google Scholar 

  10. Mohme M, Fritzsche FS, Mende KC et al (2018) Tectal gliomas: assessment of malignant progression, clinical management, and quality of life in a supposedly benign neoplasm. Neurosurg Focus 44:E15

    Article  PubMed  Google Scholar 

  11. Fisher PG, Breiter SN, Carson BS et al (2000) A clinicopathologic reappraisal of brain stem tumor classification. Identification of pilocystic astrocytoma and fibrillary astrocytoma as distinct entities. Cancer 89:1569–1576

    Article  CAS  PubMed  Google Scholar 

  12. Grimm SA, Chamberlain MC (2013) Brainstem glioma: a review. Curr Neurol Neurosci Rep 13:346

    Article  PubMed  Google Scholar 

  13. Upadhyaya SA, Koschmann C, Muraszko K et al (2017) Brainstem low-grade gliomas in children — excellent outcomes with multimodality therapy. J Child Neurol 32:194–203

  14. Barkovich AJ, Raybaud C (2019) Neurocutaneous disorders. In: Pediatric neuroimaging. Lippincott Williams & Wilkins, Philadelphia

  15. Spyris CD, Castellino RC, Schniederjan MJ, Kadom N (2019) High-grade gliomas in children with neurofibromatosis type 1: literature review and illustrative cases. AJNR Am J Neuroradiol 40:366–369

  16. Guzman-De-Villoria JA, Ferreiro-Arguelles C, Fernandez-Garcia P (2010) Differential diagnosis of T2 hyperintense brainstem lesions: part 2. Diffuse lesions. Semin Ultrasound CT MR 31:260–274

    Article  PubMed  Google Scholar 

  17. Jubelt B, Mihai C, Li TM, Veerapaneni P (2011) Rhombencephalitis/brainstem encephalitis. Curr Neurol Neurosci Rep 11:543–552

  18. Quattrocchi CC, Errante Y, Rossi Espagnet MC et al (2016) Magnetic resonance imaging differential diagnosis of brainstem lesions in children. World J Radiol 8:1–20

    Article  PubMed  PubMed Central  Google Scholar 

  19. Rossi A, Martinetti C, Morana G et al (2016) Neuroimaging of infectious and inflammatory diseases of the pediatric cerebellum and brainstem. Neuroimaging Clin N Am 26:471–487

    Article  PubMed  Google Scholar 

  20. Alper G, Knepper L, Kanal E (1996) MR findings in listerial rhombencephalitis. AJNR Am J Neuroradiol 17:593–596

    CAS  PubMed  PubMed Central  Google Scholar 

  21. Arslan F, Ertan G, Emecen AN et al (2018) Clinical presentation and cranial MRI findings of Listeria monocytogenes encephalitis: a literature review of case series. Neurologist 23:198–203

    Article  PubMed  Google Scholar 

  22. Lee KY (2016) Enterovirus 71 infection and neurological complications. Korean J Pediatr 59:395–401

    Article  PubMed  PubMed Central  Google Scholar 

  23. Maloney JA, Mirsky DM, Messacar K et al (2015) MRI findings in children with acute flaccid paralysis and cranial nerve dysfunction occurring during the 2014 enterovirus D68 outbreak. AJNR Am J Neuroradiol 36:245–250

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Gologorsky RC, Barakos JA, Sahebkar F (2013) Rhomb- and bickerstaff encephalitis: two clinical phenotypes? Pediatr Neurol 48:244–248

    Article  PubMed  Google Scholar 

  25. Rollins N, Pride GL, Plumb PA, Dowling MM (2013) Brainstem strokes in children: an 11-year series from a tertiary pediatric center. Pediatr Neurol 49:458–464

    Article  PubMed  Google Scholar 

  26. Sciacca S, Lynch J, Davagnanam I, Barker R (2019) Midbrain, pons, and medulla: anatomy and syndromes. Radiographics 39:1110–1125

    Article  PubMed  Google Scholar 

  27. Geibprasert S, Pongpech S, Jiarakongmun P et al (2010) Radiologic assessment of brain arteriovenous malformations: what clinicians need to know. Radiographics 30:483–501

    Article  PubMed  Google Scholar 

  28. Haque R, Kellner CP, Solomon RA (2008) Cavernous malformations of the brainstem. Clin Neurosurg 55:88–96

    PubMed  Google Scholar 

  29. Giannetti AV, Rodrigues RB, Trivelato FP (2008) Venous lesions as a cause of sylvian aqueductal obstruction: case report. Neurosurgery 62:E1167–E1168

    PubMed  Google Scholar 

  30. Guhl S, Kirsch M, Lauffer H et al (2011) Unusual mesencephalic developmental venous anomaly causing obstructive hydrocephalus due to aqueductal stenosis. J Neurosurg Pediatr 8:407–410

    Article  PubMed  Google Scholar 

  31. Yagmurlu B, Fitoz S, Atasoy C et al (2005) An unusual cause of hydrocephalus: aqueductal developmental venous anomaly. Eur Radiol 15:1159–1162

    Article  PubMed  Google Scholar 

  32. Saba L, Pascalis L, Mallarini G (2011) Magnetic resonance imaging of pontine capillary telangectasia. Eur J Radiol 80:771–775

    Article  PubMed  Google Scholar 

  33. Milh M, Villeneuve N, Chapon F et al (2009) Transient brain magnetic resonance imaging hyperintensity in basal ganglia and brain stem of epileptic infants treated with vigabatrin. J Child Neurol 24:305–315

    Article  PubMed  Google Scholar 

  34. Pearl PL, Vezina LG, Saneto RP et al (2009) Cerebral MRI abnormalities associated with vigabatrin therapy. Epilepsia 50:184–194

    Article  CAS  PubMed  Google Scholar 

  35. McErlean A, Abdalla K, Donoghue V, Ryan S (2010) The dentate nucleus in children: normal development and patterns of disease. Pediatr Radiol 40:326–339

    Article  PubMed  Google Scholar 

  36. Kim E, Na DG, Kim EY et al (2007) MR imaging of metronidazole-induced encephalopathy: lesion distribution and diffusion-weighted imaging findings. AJNR Am J Neuroradiol 28:1652–1658

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Rossi Espagnet MC, Pasquini L, Napolitano A et al (2017) Magnetic resonance imaging patterns of treatment-related toxicity in the pediatric brain: an update and review of the literature. Pediatr Radiol 47:633–648

    Article  PubMed  Google Scholar 

  38. Barkovich AJ, Raybaud C (2012) Metabolic, toxic and inflammatory brain disorders. In: Pediatric neuroimaging. Lippincott Williams & Wilkins, Philadelphia, pp 81–239

    Google Scholar 

  39. Arii J, Tanabe Y (2000) Leigh syndrome: serial MR imaging and clinical follow-up. AJNR Am J Neuroradiol 21:1502–1509

    CAS  PubMed  PubMed Central  Google Scholar 

  40. Saneto RP, Friedman SD, Shaw DW (2008) Neuroimaging of mitochondrial disease. Mitochondrion 8:396–413

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Barkovich A, Raybaud C (2012) Congenital malformations of the brain and skull. In: Pediatric neuroimaging. Lippincott Williams & Wilkins, Philadelphia, pp 367–568

    Google Scholar 

  42. Kim TJ, Kim IO, Kim WS et al (2006) MR imaging of the brain in Wilson disease of childhood: findings before and after treatment with clinical correlation. AJNR Am J Neuroradiol 27:1373–1378

    CAS  PubMed  PubMed Central  Google Scholar 

  43. Hattingen E, Blasel S, Nichtweiss M et al (2010) MR imaging of midbrain pathologies. Clin Neuroradiol 20:81–97

    Article  CAS  PubMed  Google Scholar 

  44. Hegde AN, Mohan S, Lath N, Lim CC (2011) Differential diagnosis for bilateral abnormalities of the basal ganglia and thalamus. Radiographics 31:5–30

    Article  PubMed  Google Scholar 

  45. King AD, Walshe JM, Kendall BE et al (1996) Cranial MR imaging in Wilson's disease. AJR Am J Roentgenol 167:1579–1584

    Article  CAS  PubMed  Google Scholar 

  46. Al-Maawali A, Yoon G, Feigenbaum AS et al (2016) Validation of the finding of hypertrophy of the clava in infantile neuroaxonal dystrophy/PLA2G6 by biometric analysis. Neuroradiology 58:1035–1042

    Article  CAS  PubMed  Google Scholar 

  47. Jan W, Zimmerman RA, Wang ZJ et al (2003) MR diffusion imaging and MR spectroscopy of maple syrup urine disease during acute metabolic decompensation. Neuroradiology 45:393–399

    Article  PubMed  Google Scholar 

  48. Thomas B, Al Dossary N, Widjaja E (2010) MRI of childhood epilepsy due to inborn errors of metabolism. AJR Am J Roentgenol 194:W367–W374

    Article  PubMed  Google Scholar 

  49. Miller GM, Baker HL Jr, Okazaki H, Whisnant JP (1988) Central pontine myelinolysis and its imitators: MR findings. Radiology 168:795–802

    Article  CAS  PubMed  Google Scholar 

  50. Aw-Zoretic J, Harrell A, Rubin JP, Palasis S (2020) Pediatric demyelinating disease: emerging patterns from multiple sclerosis to anti-myelin oligodendrocyte glycoprotein-associated encephalomyelitis. Neurographics 10:139–151

    Article  Google Scholar 

  51. Zuccoli G, Panigrahy A (2010) Symmetrical central tegmental tract (CTT) hyperintense lesions. Pediatr Radiol 40:S175

    Article  PubMed  Google Scholar 

  52. Aguilera-Albesa S, Poretti A, Honnef D et al (2012) T2 hyperintense signal of the central tegmental tracts in children: disease or normal maturational process? Neuroradiology 54:863–871

    Article  PubMed  Google Scholar 

  53. Salzman KL, Osborn AG, House P et al (2005) Giant tumefactive perivascular spaces. AJNR Am J Neuroradiol 26:298–305

    PubMed  PubMed Central  Google Scholar 

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Correspondence to Sumit Pruthi.

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Sarma, A., Heck, J.M., Bhatia, A. et al. Magnetic resonance imaging of the brainstem in children, part 2: acquired pathology of the pediatric brainstem. Pediatr Radiol 51, 189–204 (2021). https://doi.org/10.1007/s00247-020-04954-0

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