Imaging of Brain Tumors with Histological Correlations

306 Pages·2002·23.692 MB·English

by  G. Karkavelas, N. Tascos (auth.), Antonios Drevelegas MD (eds.)

A. DREVELEGAS (Ed.)
Imaging of Brain Tumors with Histological Correlations
Springer-Verlag Berlin Heidelberg GmbH
A. DREVELEGAS (Ed.)
Imaging
of Brain Tumors
with
Histological Correlations
With 248 Figures in 508 Separate Illustrations
some in color
i
Springer
ANTONIOS DREVELEGAS, MD
Radiology Department
AHEPA University Hospital
Thessaloniki
Greece
ISBN 978-3-662-04953-2 ISBN 978-3-662-04951-8 (eBook)
DOI 10.1007/978-3-662-04951-8
Library of Congress Cataloging-in-Publication Data
Imaging of brain tumors with histological correlations / [e dited by] Antonios Drevelegas. p. ; cm.
Includes bibliographical references and index.
1. Brain - Imaging. 2. Brain - Tumors - Diagnosis. 3. Brain - Histopathology. I. Drevelegas, Antonoios,
1947 -
[DNLM: 1. Brain Neoplasms - diagnosis. 2. Brain Neoplasms - pathology. 3. Diagnostic Imaging.
WL 358 I3l 2002]
RC280.B7 146 2002
616.99'2810754 - dc21
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Originally published by Springer-Verlag Berlin Heidelberg New York in 2002.
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Preface
The purpose of this book is to bring a new understanding to bear on the diagnosis of
brain tumors by linking radiographic image characteristics to the underlying pathology.
Brain tumors are relatively uncommon compared with other neoplasms (e. g., lung,
breast, gastrointestinal). They require special study, however, since they are pathologi
cally complicated, difficult to diagnose, and account for high morbidity.
Although many excellent neuroradiological books have been written, few of them
focus especially on the diagnosis of brain tumors. In this book brain tumors are dis
cussed in detail. Special emphasis is placed on CT and MRI findings in relation to the
pathology of each tumor. As pathology is the "mother" of radiology this approach may
be the best way to understand in depth the imaging manifestations of brain tumors. The
illustrative examples herein were chosen on the basis of their clarity or complexity, their
teachability, and their significance for diagnosis and treatment.
The book comprises 13 chapters. Chapter 1 deals with the epidemiology and classifi
cation of brain tumors. Chapter 2 discusses different imaging modalities and their con
tribution to the diagnosis of brain tumors. Special emphasis is laid on the latest develop
ments (e. g., diffusion, perfusion, BOLD imaging) and on potential future applications of
MRI. Chapters 3 -12 constitute an in-depth study of imaging characteristics of different
brain tumors on CT and MRI. The images' contribution to diagnosis and their corre
spondence to certain pathologic appearances are particularly stressed. Finally, a state-of
the-art chapter on nuclear medicine is included to cover the impact of SPECT and PET
imaging on brain tumor diagnosis.
We hope that this book will serve as a teaching tool and practical reference for the
diagnosis of brain tumors and will enhance the reader's diagnostic performance.
A. Drevelegas
Contents
Epidemiology, Histologic Classification and Clinical Course
of Brain Tumors ........................ .
G. KARKAVELAS, N. TASKOS
2 Imaging Modalities in Brain Tumors 11
A. DREVELEGAS
3 Molecular Abnormalities in Gliomas 27
A. C. GOUSSIA, K. POLYZOIDIS, A. P. KYRITSIS
4 Low-Grade Gliomas ............. . . 37
A. C. CHRISTOFORIDIS, A. DREVELEGAS, E. C. BOUREKAS,
G. KARKAVELAS
5 High-Grade Gliomas ............................... 109
A.DREVELEGAS,G.KARKAVELAS
6 Pineal Tumors .......... . ............. 137
A. K. STRINGARIS, K. LIMPEROPOULOS, C. SAMARA
7 Embryonal Tumors ............. 147
A. DREVELEGAS
8 Tumors of the Cranial Nerves .......................... 155
H. TANGHE, P.M. PARIZEL
9 Meningeal Tumors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177
A. DREVELEGAS, G. KARKAVELAS, D. HOURMOUZI, G. BOULOGIANNI,
A. PET RID IS, A. DIMITRIADIS
10 Lymphomas and Hemopoietic Neoplasms ................... 215
A. DREVELEGAS
11 Masses of the Sellar and Juxtasellar Region .. . . . . . . . . . . . . . . . . . 227
E. C. BOUREKAS, J. W. MILLER, G.A. CHRISTOFORIDIS
12 Brain Metastasis ............ 253
N.J. PATRONAS
13 Scintigraphy in Brain Tumors . . . . . . . . . . . . . . . . . . . . . . . . 277
G. SFAKIANAKIS, E. SFAKIANAKI
Subject Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 299
List of Contributors
G. BOULOGIANNI, MD A. C. GOUSSIA, MD
Radiologist Research Fellow of Neurosurgical Institute
Aristotle Medical Center University of Ioannina
Thessaloniki Ioannina
Greece Greece
E. C. BouREKAs, MD, PH. D. G. KARKAVELAS, MD, PH. D.
Assistant Professor of Radiology Associate Professor of Radiology
Department of Radiology Department of Pathology
The Ohio State University Medical Center Aristotle University of Thessaloniki
Columbus, Ohio School of Medicine
USA Thessaloniki
Greece
G. A. CHRISTOFORIDIS, MD, PH. D.
Assistant Professor of Radiology A. P. KYRITSIS, MD, PH. D.
Department of Radiology Professor of Neurology
The Ohio State University Medical Center Medical School
Columbus, Ohio University of Ioannina
USA Ioannina
Greece
D. CHOURMOUZI, MD
Radiologist K. LIMPEROPOULOS, MD
Aristotle Medical Center Consultant Radiologist
Thessaloniki Radiology Department
Greece General Hospital
Athens
A. S. DIMITRIADIS, MD, PH. D. Greece
Associate Professor of Radiology
Aristotle Univerity of Thessaloniki J. W. MILLER, MD
School of Medicine Assistant Professor of Radiology
Thessaloniki Department of Radiology
Greece The Ohio State University School of Medicine
Columbus, Ohio
A. DREVELEGAS, MD, PH. D. USA
Associate Professor of Radiology
Aristotle Univerity of Thessaloniki P. M. PARIZEL, MD, PH. D.
School of Medicine Professor of Radiology
Formerly Chief of Radiology Department Department of Radiology
G. Papanikolaou Hospital University of Antwerp
Thessaloniki Edegem
Greece Belgium
N.J. PAT RONAS, MD, PH. D. G.N. SFAKIANAKIS, MD, PH. D.
Professor of Radiology Division of Nuclear Medicine (D-57)
National Institute of Health University of Miami School of Medicine
Maryland Miami, Florida
USA USA
A. PETRIDIS, MD A.K. STRINGARIS, MD, PH. D.
Consultant Radiologist Fellow in Neurology
G. Papanikolaou General Hospital Georg -August -Universit1:it Gottingen
Thessaloniki Department of Neurology
Greece Gottingen
Germany
K. POLYZOIDIS, MD, PH. D.
Associate Professor of Neurosurgery H. TANGHE,MD
Medical School Section of Neuroradiology
University of Ioannina Department of Radiology
Ioannina University Hospitals Dijkzigt/Sophia/Daniel
Greece Erasmus University Medical Centre
Rotterdam
C. SAMARA, MD The Netherlands
Consultant Radiologist
Radiology Department N. TASKOS, MD, PH. D.
General Hospital Associate Professor of Neurology
Athens Department of Neurology
Greece Aristotle University of Thessaloniki
School of Medicine
E. SFAKIANAKI, MD Thessaloniki
Department of Radiology Greece
Division of Nuclear Medicine
University of Miami
Jackson Memorial Medical Center
Miami, Florida
USA
x I
List of Contributors
1 Epidemiology, Histologic Classification
and Clinical Course of Brain Tumors
G.KARKAVELAs,N.TASCOS
make it necessary to take into consideration the age
1.1 Introduction 1 parameter, and to consider adult and pediatric brain
1.2 Epidemiology 1
tumors separately.
1.2.1 Pediatric Brain Tumors
As a result, for any therapeutic decision or prognos
1.2.2 Adult Brain Tumors 2
tic determination all these factors, i. e. age, location and
1.3 Clinical Course 2
pathology, have to be noted.
1.4 Histologic Classification and Grading 3
1.5 Incidence and Clinical Course by Age
and Location 6 1.2
1.5.1 Adult Brain Turnors 6 Epidemiology
1.5.1.1 Supratentorial 6
1.5.1. J.l Intra-axial 6
1.2.1
1.5.1.1.2 Extra-axial 8
Pediatric Brain Tumors
1.5.1.2 lnfratentorial 8
1.5.1.2.1 Intra-axial 8
Fifteen to 20 % of all intracranial tumors occur in chil
1.5.1.2.2 Extra-axial 8
dren under 15 years of age, with the peak occurrence
1.5.2 Pediatric Brain 'fumors 8
between 4 and 8 years of age. The incidence of brain
1.5.2.1 Supratentorial 8
tumors in children has been estimated to be 2.5 per
1.5.2.2 Infratentorial 8
100,000 children per year, the vast majority of these
References 9
tumors being primary. Only 1 -2 % of all brain tumors
occur in children under 2 years of age [2-4].
In neonates brain tumors are uncommon, represent
1.1 congenital tumors and have a different histologic and
Introduction topographical distribution than those that occur in
young children and adolescents. They are more likely
Brain tumors are divided into primary (70%) and sec to develop in the supratentorial region than in the pos
ondary (30%). About 24,000 primary brain tumors are terior fossa. The most common primary brain tumors
diagnosed each year in the United States and account in the neonatal period are teratomas, embryonal
for 20% of malignancies before the age 15 years. The tumors and congenital glioblastoma multiforme [5].
estimated incidence is 8.2 per 100,000 people. Although In children between the ages of 2 and 10 years,
these tumors are not common ( < 1.5 % of all cancers) in primary brain tumors are generally more benign than
comparison with tumors of other organs (e. g. lung, those found in neonates. Seventy percent of these
breast or colon), they deserve a unique position in tumors develop beneath the tentorium [3,6].
tumor oncology because of their histopathologic com About 30 % of posterior fossa tumors in children are
plexity and biologic behavior. Noteworthy is the fact cerebellar astrocytomas (most often pilocytic), 35-
that despite their low incidence they have a high mor 40 % are medulloblastomas (arising more than 90 % of
tality among adult cancer patients and even more in the time in the vermis of the cerebellum), 25 % are
children [1]. brain stem gliomas and 10-15% are ependymomas of
Topographical and histological classifications, as the fourth ventricle.
well as correlations of topography with pathology, In children younger than 3 years of age, 30 % of all
allow clinicians to better study, understand and handle intracranial tumors are ependymomas [7,8].
brain tumors. These tumors are found in any location
and in patients of any age. Differences in epidemiology,
location and pathology between children and adults
I
Epidemiology, Histologic Classification and Clinical Course of Brain Tumors 1