Mass Lesions of the Brain: A Differential Diagnostic Approach

  • Guido Wilms


After careful examination of the computed tomography (CT) and magnetic resonance (MR) images of a patient with a cerebral mass lesion, the neuroradiologist aims at getting as close as possible to the final anatomopathological diagnosis. The final diagnostic proposition is the result of an intellectual process of stepwise examination of the radiological features, with quick exclusion of some impossible or improbable entities, comparison with images in his or her personal “database” accumulated through neuroradiological training, literature search, and experience. Together these allow a diagnosis or at least a ranking of possible tumors within the differential diagnostic list.


Apparent Diffusion Coefficient Pilocytic Astrocytoma Perfusion Magnetic Resonance Imaging Perfusion Magnetic Resonance Weighted Magnetic Resonance Image 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Osborn AG, Blaser S, Salzman K (2004) Diagnostic imaging: Brain. Amirsys, Salt Lake CityGoogle Scholar
  2. 2.
    Wilms G, Demaerel P, Sunaert S (2005) Intra-axial brain tumours. Eur Radiol 15(3):468–484PubMedCrossRefGoogle Scholar
  3. 3.
    Kornreich L, Schwarz M, Karmazyn B et al (2005) Role of MRI in the management of children with diffuse pontine tumors: a study of 15 patients and review of the literature. Pediatr Radiol 35(9):872–879PubMedCrossRefGoogle Scholar
  4. 4.
    Schneider JF, Viola A, Confort-Gouny S et al (2007) Infratentorial pediatric brain tumors: the value of new imaging modalities. J Neuroradiol 34(1):49–458PubMedGoogle Scholar
  5. 5.
    Tzika AA, Zarifi MK, Goumnerova L et al (2002) Neuroimaging in pediatric brain tumors: Gd-DTPA-enhanced, hemodynamic, and diffusion MR imaging compared with MR spectroscopic imaging. AJNR Am J Neuroradiol 23(2):322–333PubMedGoogle Scholar
  6. 6.
    Goraj B, Spiller M, Valsamis MP et al (1995) Determinants of signal intensity in MRI of human astrocytomas. Eur Radiol 5:74–82CrossRefGoogle Scholar
  7. 7.
    Osborn AG, Preece MT (2006) Intracranial cysts: radiologicpathologic correlation and imaging approach. Radiology 239(3):650–664PubMedCrossRefGoogle Scholar
  8. 8.
    White ML, Zhang Y, Kirby P, Ryken TC (2005) Can tumor contrast enhancement be used as a criterion for differentiating tumor grades of oligodendrogliomas? AJNR Am J Neuroradiol 26(4):784–790PubMedGoogle Scholar
  9. 9.
    Carrier DA, Mawad ME, Kirkpatrick JB, Schmid MF (1994) Metastatic adenocarcinoma to the brain: MR with pathologic correlation. Am J Neuroradiol 15:155–159PubMedGoogle Scholar
  10. 10.
    Fulham MJ, Melisi JW, Nishimiya J et al (1993) Neuroimaging of juvenile pilocytic astrocytomas: an enigma. Radiology 189:221–225PubMedGoogle Scholar
  11. 11.
    Koeller KK, Henry JM (2001) From the archives of the AFIP: superficial gliomas: radiologic-pathologic correlation. Armed Forces Institute of Pathology. Radiographics 21(6):1533–1556PubMedGoogle Scholar
  12. 12.
    Jelinek J, Smirniotopoulos JG, Parisi JE, Kanzer M (1990) Lateral ventricular neoplasms of the brain: differential diagnosis based on clinical, CT, and MR findings. Am J Neuroradiol 11:567–574PubMedGoogle Scholar
  13. 13.
    Koeller KK, Rushing EJ (2003) From the archives of the AFIP: medulloblastoma: a comprehensive review with radiologicpathologic correlation. Radiographics 23(6):1613–1637PubMedCrossRefGoogle Scholar
  14. 14.
    Smirniotopoulos JG, Murphy FM, Rushing EJ et al (2007) Patterns of contrast enhancement in the brain and meninges. Radiographics 27(2):525–551PubMedCrossRefGoogle Scholar
  15. 15.
    Stadnik TW, Demaerel P, Luypaert RR et al (2003) Imaging tutorial: differential diagnosis of bright lesions on diffusionweighted MR images. Radiographics 23(1):e7PubMedCrossRefGoogle Scholar
  16. 16.
    Asari S, Makabe T, Katayama S et al (1994) Assessment of the pathological grade of astrocytic gliomas using an MRI score. Neuroradiology 36:308–310PubMedCrossRefGoogle Scholar
  17. 17.
    Dean BL, Drayer BP, Bird CR et al (1990) Gliomas: classification with MR imaging. Radiology 174:411–415PubMedGoogle Scholar
  18. 18.
    Cha S, Lupo JM, Chen MH et al (2007) Differentiation of glioblastoma multiforme and single brain metastasis by peak height and percentage of signal intensity recovery derived from dynamic susceptibility-weighted contrast-enhanced perfusion MR imaging. AJNR Am J Neuroradiol 28(6):1078–1084PubMedCrossRefGoogle Scholar
  19. 19.
    Ginsberg LE, Fuller GN, Hashmi M et al (1998) The significance of lack of MR contrast enhancement of supratentorial brain tumors in adults: histopathological evaluation of a series. Surg Neurol 49(4):436–440PubMedCrossRefGoogle Scholar
  20. 20.
    Sugahara T, Korogi Y, Tomiguchi S et al (2000) Posttherapeutic intraaxial brain tumor: the value of perfusion-sensitive contrast-enhanced MR imaging for differentiating tumor recurrence from nonneoplastic contrast-enhancing tissue. Am J Neuroradiol 21(5):901–909PubMedGoogle Scholar
  21. 21.
    Lev MH, Ozsunar Y, Henson JW et al (2004) Glial tumor grading and outcome prediction using dynamic spin-echo MR susceptibility mapping compared with conventional contrast-enhanced MR: confounding effect of elevated rCBV of oligodendroglimoas. Am J Neuroradiol 25(2):214–221PubMedGoogle Scholar
  22. 22.
    Al-Okaili RN, Krejza J, Wang S et al (2006) Advanced MR imaging techniques in the diagnosis of intraaxial brain tumors in adults. Radiographics 26(Suppl 1):S173–S189PubMedCrossRefGoogle Scholar
  23. 23.
    Al-Okaili RN, Krejza J, Woo JH et al (2007) Intraaxial brain masses: MR imaging-based diagnostic strategy — initial experience. Radiology 243(2):539–550PubMedCrossRefGoogle Scholar
  24. 24.
    Calli C, Kitis O, Yunten N et al (2006) Perfusion and diffusion MR imaging in enhancing malignant cerebral tumors. Eur J Radiol 58(3):394–403PubMedCrossRefGoogle Scholar
  25. 25.
    Law M, Yang S, Babb JS et al (2004) Comparison of cerebral blood volume and vascular permeability from dynamic susceptibility contrast-enhanced perfusion MR imaging with glioma grade. Am J Neuroradiol 25(5):746–755PubMedGoogle Scholar
  26. 26.
    Hayashida Y, Hirai T, Morishita S et al (2006) Diffusionweighted imaging of metastatic brain tumors: comparison with histologic type and tumor cellularity. AJNR Am J Neuroradiol 27(7):1419PubMedGoogle Scholar
  27. 27.
    Cotton F, Ongolo-Zogo P, Louis-Tisserand G et al (2006) Diffusion and perfusion MR imaging in cerebral lymphomas. Neuroradiol 33(4):220–228CrossRefGoogle Scholar
  28. 28.
    Covarrubias DJ, Rosen BR, Lev MH (2004) Dynamic magnetic resonance perfusion imaging of brain tumors. Oncologist 9(5):528–537PubMedCrossRefGoogle Scholar
  29. 29.
    Masdeu JC, Quinto C, Olivera C et al (2000) Open-ring imaging sign: highly specific for atypical brain demyelination. Neurology 54(7):1427–1433PubMedGoogle Scholar

Copyright information

© Springer-Verlag Italia 2008

Authors and Affiliations

  • Guido Wilms
    • 1
  1. 1.Department of RadiologyUniversity Hospitals K.U.LeuvenBelgium

Personalised recommendations