Pediatric Brain and Spine: An Atlas of MRI and Spectroscopy

505 Pages·2005·129.81 MB·English

by  L.M. Ketonen

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Pediatric Brain and Spine
An Atlas of MRI and Spectroscopy
Ketonen · Hiwatashi · Sidhu · Westesson
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L.M.Ketonen
A.Hiwatashi
R.Sidhu
P.-L.Westesson
Pediatric Brain
and Spine
An Atlas of MRI
and Spectroscopy
With 1427 Figures
123
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ISBN 3-540-21340-6 Library ofCongress Control Number:2004111251
Springer Berlin Heidelberg NewYork
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Preface
This is an atlas on contemporary MR imaging ofthe reer in neuroradiology she has continuously gathered
pediatric central nervous system.We have concen- interesting cases. When Dr. Ketonen moved from
trated on brain imaging,but have an extensive chap- Massachusetts General Hospital in Boston to the Uni-
ter on the spine and a smaller chapter on the head versity ofRochester it was quite obvious,looking into
and neck. her new office,that she had a very extensive collec-
The book starts with a chapter on the normal tion of such cases.She would have needed a much
myelinization and normal variance.We are including larger office than the one we were able to offer her
chapters on malformations,inherited conditions,in- just to store her enormous teaching file.Seeing her
fection,tumors,trauma,vascular abnormalities,and phenomenal collection ofcases and pairing that with
spine abnormalities.The last chapter ofthe book is a our positive experience writing our previous book,
miscellaneous chapter that includes all those cases Diffusion-Weighted MR Imaging of the Brain,it was
that did not fit well in other categories.The chapter obvious that we had both an idea and the material for
on trauma and brain damage includes an extensive another neuro-imaging book.We decided on the top-
section on CNS manifestations of nonaccidental pe- ic ofpediatric neuro-imaging with Dr.Ketonen as the
diatric trauma.There is an also an exciting chapter lead author.We started out with the intention ofhav-
on fetal MR imaging describing some of the more ing ten cases per chapter,but it soon became obvious
common abnormalities seen in prenatal imaging.We that the number of cases would double for many of
have intentionally avoided discussing some of the the chapters.The book is based mainly on Dr.Keto-
ethical aspects offetal imaging. nen’s collected cases,backed up by the University of
Cases in this book range from those commonly Rochester’s teaching file,started many years ago by
seen in clinical practice to many exceedingly rare Dr.Numaguchi.We have incorporated cases of fetal
conditions.The book format has allowed us to illus- MR imaging (Chap.11) that we borrowed from Dr.
trate these unusual cases generously,and in many we Susan Blaser ofthe Children’s Hospital in Toronto.
have been able to include MR proton spectroscopy Dr.Akio Hiwatashi has been instrumental in cor-
and diffusion images.We included a few CT images recting,manipulating and formatting the images for
when they were an essential part of the diagnosis, this book.Dr.Ravinder Sidhu has been the lead per-
classic presentations or showed the abnormalities the son for looking up background information and
best.It was not our intention to publish a textbook, making sure we have the most appropriate and up-to-
but rather an atlas-type book on pediatric neuro-MR date references.Dr.Westesson has been the leader of
imaging. We have concentrated on multiple high- the project and has kept it moving forward while
quality images,which will allow the clinician to iden- writing the head and neck chapter.The contribution
tify an unknown case relatively quickly by simply ofSusan Blaser has been instrumental.Her outstand-
comparing the images ofhis patient with the images ing collection of prenatal MR cases constitutes the
in the book. A short discussion is associated with bulk ofChap.11.In addition we have enjoyed the help
each case,but for more detailed and in-depth infor- of Drs Lawrence Buadu and Sudhir Kathuria for the
mation we refer to existing textbooks. chapters on miscellaneous conditions and nonacci-
The book is a collaboration between four authors dental trauma (child abuse).
and three collaborators all with different back- Our experience from working with Springer on
grounds,training from different parts of the world our earlier book was totally positive from the begin-
and with different clinical experiences.Dr.Leena Ke- ning to the end.The printing,editing and image qual-
tonen is the lead author and has a long-term interest ity along with the layout ofthe book were first quali-
in pediatric neuro-imaging.During her 20-year ca- ty and the publisher proved to be able to produce this
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VI Preface
quality work in a short period of time.This experi- Bühler, our graphic designer at the University of
ence has been repeated with this second project.It Rochester, Margaret Kowaluk, and our secretaries,
should be mentioned that we started this book in De- Belinda De Libero and Jeanette Griebel. Special
cember of2003 after the RSNA and it was published thanks go to our families for sacrificing the time and
less than one year later,which is a remarkable accom- energy that we invested in this project.
plishment thinking ofhow many high-quality images
were included.We would like to thank the editors at Rochester,New York
Springer,Dr.Heilmann and Mrs.Dörthe Mennecke- October 2004
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Authors and Collaborators
Susan Blaser,MD Leena M.Ketonen,MD,PhD
Associate Professor ofNeuroradiology Professor ofRadiology
The Hospital for Sick Children Director,Pediatric Neuroimaging
Division ofNeuroradiology Division ofDiagnostic
and Department ofMedical Imaging and Interventional Neuroradiology
The University ofToronto Department ofRadiology
Toronto,Ontario,Canada University ofRochester School ofMedicine
[email protected] and Dentistry
Rochester,New York,USA
[email protected]
Lawrence Buadu,MD,PhD
Fellow,Division ofDiagnostic
and Interventional Neuroradiology Ravinder Sidhu,MD
Department ofRadiology Visiting Assistant Professor
University ofRochester School ofMedicine Division ofDiagnostic
and Dentistry and Interventional Neuroradiology
Rochester,New York,USA Department ofRadiology
[email protected] University ofRochester School ofMedicine
and Dentistry
Rochester,New York,USA
Akio Hiwatashi,MD [email protected]
Fellow,Division ofDiagnostic
and Interventional Neuroradiology
Department ofRadiology Per-Lennart Westesson,MD,PhD,DDS
University ofRochester School ofMedicine Professor ofRadiology
and Dentistry Director,Division ofDiagnostic
Rochester,New York,USA and Interventional Neuroradiology
[email protected] Department ofRadiology
and Professor ofClinical Dentistry
University ofRochester School ofMedicine
Sudhir Kathuria,MD and Dentistry
Fellow,Division ofDiagnostic Rochester,New York,USA
and Interventional Neuroradiology
Professor ofOral Diagnostic Sciences
Department ofRadiology
State University ofNew York at Buffalo
University ofRochester School ofMedicine
Buffalo,New York,USA
and Dentistry
Rochester,New York,USA Associate Professor ofOral Radiology
[email protected] University ofLund
Lund,Sweden
[email protected]
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Contents
Lissencephaly . . . . . . . . . . . . . . . . . . . . 39
1 Normal Brain Myelination Gray Matter Heterotopia . . . . . . . . . . . . . . 40
and Normal Variants . . . . . . . . . . . . . . 1 Subependymal Nodular Heterotopia . . . . . 40
Focal Subcortical Heterotopia
Introduction . . . . . . . . . . . . . . . . . . . . . 1 with Agenesis ofCorpus Callosum . . . . 41
Chronological Imaging Atlas Focal Subcortical Heterotopia . . . . . . . . . 43
ofNormal Myelination . . . . . . . . . . . . . 2 Band Heterotopia (“Double Cortex”) . . . . . 44
Cavum Septi Pellucidi,Cavum Vergae Holoprosencephaly . . . . . . . . . . . . . . . . . 45
and Cavum Velum Interpositum. . . . . . . . 11 Septo-Optic Dysplasia in a Teenager. . . . . . 45
Cavum Septi Pellucidi and Vergae . . . . . . . 11 Septo-Optic Dysplasia. . . . . . . . . . . . . . 46
Cavum Velum Interpositum . . . . . . . . . . 12 Alobar Holoprosencephaly . . . . . . . . . . . 47
Ventriculus Terminalis . . . . . . . . . . . . . . . 14 Semilobar Holoprosencephaly . . . . . . . . . 48
Semilobar Holoprosencephaly
with Pierre-Robin Syndrome. . . . . . . . 49
2 Congenital Brain Malformations . . . . . . 17 Chiari Malformations . . . . . . . . . . . . . . . 51
Chiari I Malformation
Introduction. . . . . . . . . . . . . . . . . . . . . 17 with Low but Rounded Tonsils . . . . . . . 51
Corpus Callosum Agenesis/Dysgenesis. . . . . . 19 Unilateral Chiari I Malformation
Completely Absent Corpus Callosum . . . . . 19 with Pointed Tonsils . . . . . . . . . . . . 52
Near Complete Agenesis ofCorpus callosum. 20 Chiari II (Arnold-Chiari) Malformation . . . 53
Pericallosal Lipoma. . . . . . . . . . . . . . . . . 22 Chiari II and Meningomyelocele
Curvilinear Lipoma . . . . . . . . . . . . . . . 22 in a Newborn. . . . . . . . . . . . . . . . . 54
Nodular Midline (“Callosal”) Lipoma . . . . . 23 Chiari III and Occipital Encephalocele . . . . 55
Hydranencephaly . . . . . . . . . . . . . . . . . . 25 Chiari III and Spina Bifida . . . . . . . . . . . 56
Case 1.Hydranencephaly Dandy-Walker Syndromes . . . . . . . . . . . . . 58
with Increasing Head Size. . . . . . . . . . 25 Dandy-Walker Variant
Case 2.Hydranencephaly with Enlargement ofFourth Ventricle. . . 58
with Increasing Head Size. . . . . . . . . . 26 Dandy-Walker Variant
Case 3.Hydranencephaly with No Separate Fourth Ventricle. . . . . 59
with Microcephaly. . . . . . . . . . . . . . 27 Dandy-Walker Variant
Cephalocele and Meningocele . . . . . . . . . . . 28 with Elevation ofTorcula . . . . . . . . . . 60
Occipital Encephalocele . . . . . . . . . . . . 28 Joubert’s Syndrome. . . . . . . . . . . . . . . . . 61
Parietal Cephalocele . . . . . . . . . . . . . . 29 Rhombencephalosynapsis . . . . . . . . . . . . . 63
Parietal Cephalocele . . . . . . . . . . . . . . 30 CloverleafSkull Syndrome
Skull Base Encephalocele . . . . . . . . . . . . 31 (Kleeblattschädel Anomaly) . . . . . . . . . . 64
Parietal Meningocele . . . . . . . . . . . . . . 32 Hemimegalencephaly. . . . . . . . . . . . . . . . 66
Spinal Lipomeningocele . . . . . . . . . . . . 33
Micrencephaly with Lissencephaly . . . . . . . . 34
Generalized Cortical Dysplasia . . . . . . . . . . 35
Schizencephaly . . . . . . . . . . . . . . . . . . . 37
Open Lip Schizencephaly (Type II) . . . . . . 37
Unilateral Closed Lip Schizencephaly (Type I) 38
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3 Inherited Neurological Diseases 4 Infection . . . . . . . . . . . . . . . . . . . . 125
and Disorders of Myelin. . . . . . . . . . . 69
Introduction . . . . . . . . . . . . . . . . . . . . 125
Introduction . . . . . . . . . . . . . . . . . . . . 69 Meningitis and Complications ofMeningitis . . 127
Hereditary Myelin Disorders . . . . . . . . . . . 70 Acute Pyogenic Meningitis . . . . . . . . . . 127
Krabbe’s Disease Subacute Pyogenic Meningitis
(Globoid Cell Leukodystrophy) . . . . . . 70 with Hydrocephalus . . . . . . . . . . . . 128
Mucopolysaccharidoses (MPS) . . . . . . . . 73 Suppurative Meningitis with Subdural
Zellweger Syndrome. . . . . . . . . . . . . . 78 Effusions and Cortical Ischemia . . . . . 128
Adrenoleukodystrophy . . . . . . . . . . . . 79 Suppurative Meningitis and Brain Infarct . . 130
Neuronal Ceroid Lipofuscinosis (NCL). . . . 80 Meningitis with Multiple Infarcts. . . . . . . 131
Mitochondrial Disorders . . . . . . . . . . . 83 Candida Meningitis . . . . . . . . . . . . . . 132
Cerebellar Degeneration Associated Brain Abscess. . . . . . . . . . . . . . . . . . . . 133
with Coenzyme Q10 Deficiency. . . . . . 90 Empyema. . . . . . . . . . . . . . . . . . . . . . 135
Hallervorden-Spatz Disease. . . . . . . . . . 91 Subdural Empyema with Cortical
Defects in Genes Encoding and Meningeal Involvement. . . . . . . . 135
the Myelin Proteins . . . . . . . . . . . . . . 93 Subdural Empyema . . . . . . . . . . . . . . 136
Pelizaeus-Merzbacher Disease . . . . . . . . 93 Epidural Empyema. . . . . . . . . . . . . . . 137
p10 p9 Translocation. . . . . . . . . . . . . . 95 Septic Emboli . . . . . . . . . . . . . . . . . . . 138
18q Syndrome . . . . . . . . . . . . . . . . . 97 Nocardiosis . . . . . . . . . . . . . . . . . . . . 139
Disorders in Amino Acid Citrobacter Infections. . . . . . . . . . . . . . . 141
and Organic Acid Metabolism . . . . . . . . 98 Citrobacter Meningitis and Cerebritis . . . . 141
Phenylketonuria (PKU) . . . . . . . . . . . . 98 Chronic Citrobacter Cerebritis . . . . . . . . 142
Propionic Acidemia . . . . . . . . . . . . . . 100 Herpes Simplex Virus Encephalitis. . . . . . . . 143
Maple Syrup Urine Disease (MSUD) . . . . . 101 Neonatal Herpes Simplex
Galactosemia . . . . . . . . . . . . . . . . . . 102 Virus Encephalitis Type 2 . . . . . . . . . 143
Late-Onset Type ofOrnithine Neonatal Herpes Simplex
Transcarbamylase (OTCD) Deficiency Virus Encephalitis Type 2 . . . . . . . . . 144
with a Recent Occipital Infarct . . . . . . 104 Herpes Simplex Virus Encephalitis Type 1. . 147
Miscellaneous . . . . . . . . . . . . . . . . . . . 106 Congenital Cytomegalovirus Infection . . . . . 149
Multiple Sclerosis (MS) . . . . . . . . . . . . 106 Cytomegalovirus Encephalitis . . . . . . . . . . 151
Acute Disseminated Encephalomyelitis Viral Encephalitis (Influenza Encephalopathy). 152
(ADEM). . . . . . . . . . . . . . . . . . . 110 Congenital Human Immunodeficiency Virus
Perisylvian Syndrome . . . . . . . . . . . . . 112 (HIV) Infection. . . . . . . . . . . . . . . . . 153
Merosin-Deficient Congenital Cysticercosis . . . . . . . . . . . . . . . . . . . . 157
Muscular Dystrophy (CMD). . . . . . . . 114 Intraventricular Cysticercosis. . . . . . . . . 157
Vanishing White Matter (VWM) Disease . . 115 Subarachnoid Cysticercosis . . . . . . . . . . 157
Megalencephalic Leukoencephalopathy Parenchymal Cysticercosis . . . . . . . . . . 158
with Subcortical Cysts (MLC) Calcified Cysticercosis. . . . . . . . . . . . . 159
and Normal Development. . . . . . . . . 117 Tuberculosis . . . . . . . . . . . . . . . . . . . . 160
Delayed Myelination. . . . . . . . . . . . . . 119 Tubercular Meningitis. . . . . . . . . . . . . 160
Autoimmune Polyglandular Syndrome Intracranial Tuberculoma. . . . . . . . . . . 160
(APS) . . . . . . . . . . . . . . . . . . . . 121 Tuberculous Abscesses . . . . . . . . . . . . . . 161
Osmotic Myelinolysis Limbic Encephalitis
(Extrapontine Myelinolysis). . . . . . . . 123 (Paraneoplastic Limbic Encephalitis) . . . . 162
Acute Cerebellitis . . . . . . . . . . . . . . . . . 164
Rasmussen’s Encephalitis . . . . . . . . . . . . . 165
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Contents XI
Trigeminal Neurofibroma. . . . . . . . . . . . . 218
5 Posterior Fossa Tumors . . . . . . . . . . . 167 Eosinophilic Granuloma . . . . . . . . . . . . . 220
Craniopharyngioma. . . . . . . . . . . . . . . . 220
Introduction . . . . . . . . . . . . . . . . . . . . 167 Pituitary Adenoma . . . . . . . . . . . . . . . . 222
Diffusion-Weighted Imaging (DW imaging) 167 Pituitary Macroadenoma . . . . . . . . . . . 222
MR Spectroscopy. . . . . . . . . . . . . . . . 167 Pituitary Microadenoma (Prolactinoma) . . 224
Medulloblastoma . . . . . . . . . . . . . . . . . 169 Subependymal Giant Cell Astrocytoma (SEGA) 225
Solid Medulloblastoma . . . . . . . . . . . . 169 Atypical Meningioma . . . . . . . . . . . . . . . 226
Hemorrhagic/Necrotic Medulloblastoma . . 170 Congenital Brain Tumors . . . . . . . . . . . . . 229
Medulloblastoma with CSF Seeding . . . . . 172 Congenital Teratoma . . . . . . . . . . . . . 229
Cerebellar Pilocytic Astrocytoma . . . . . . . . 173 Congenital Glioblastoma Multiforme . . . . 230
Mostly Solid Cerebellar Pilocytic Orbital Juvenile Pilocytic Astrocytoma (JPA). . 230
Astrocytoma . . . . . . . . . . . . . . . . 173 Optic Pathway Glioma . . . . . . . . . . . . . . 232
Cystic Cerebellar Pilocytic Astrocytoma Hypothalamic Hamartoma
with Mural Nodule. . . . . . . . . . . . . 175 (Hamartoma ofTuber Cinereum) . . . . . . 233
Ependymoma . . . . . . . . . . . . . . . . . . . 176
Brain Stem Glioma . . . . . . . . . . . . . . . . 178
Epidermoid Tumor . . . . . . . . . . . . . . . . 180 7 Brain Damage. . . . . . . . . . . . . . . . . 235
Arachnoid Cyst. . . . . . . . . . . . . . . . . . . 181
Von Hippel-Lindau Disease (VHL). . . . . . . . 182 Introduction . . . . . . . . . . . . . . . . . . . . 235
Acute Lymphoblastic Leukemia Nonaccidental Trauma . . . . . . . . . . . . . . 236
(Precursor B) . . . . . . . . . . . . . . . . . . 184 Scalp Injury (Subgaleal Hemorrhage) . . . . 236
Chordoma . . . . . . . . . . . . . . . . . . . . . 185 Skull Fracture . . . . . . . . . . . . . . . . . 237
Subdural Hemorrhage. . . . . . . . . . . . . 238
Subarachnoid Hemorrhage . . . . . . . . . . 239
6 Supratentorial Brain Tumors. . . . . . . . 187 Parenchymal Hemorrhage and Ischemia . . 240
Diffuse Axonal Injury . . . . . . . . . . . . . 241
Introduction . . . . . . . . . . . . . . . . . . . . 187 Hypoxic Ischemic Injury . . . . . . . . . . . 242
DW Imaging . . . . . . . . . . . . . . . . . . 188 Infarct. . . . . . . . . . . . . . . . . . . . . . 243
MR Spectroscopy. . . . . . . . . . . . . . . . 188 Atrophy . . . . . . . . . . . . . . . . . . . . . 244
Glioblastoma Multiforme (GBM). . . . . . . . . 189 Venous Sinus Thrombosis. . . . . . . . . . . 245
Juvenile Pilocytic Astrocytoma (JPA) . . . . . . 191 Thalamic Infarcts in a
Mixed Pleomorphic Xanthoastrocytoma Shaken Infant Syndrome . . . . . . . . . 245
(PXA) and Ganglioglioma . . . . . . . . . . 192 Epidural and Subdural Hematoma. . . . . . . . 247
Oligodendroglioma . . . . . . . . . . . . . . . . 194 Epidural Hematoma (EDH) . . . . . . . . . . 247
Ependymoma . . . . . . . . . . . . . . . . . . . 197 Subdural Hematoma (SDH). . . . . . . . . . 249
Choroid plexus papillomas . . . . . . . . . . . . 199 Contusion . . . . . . . . . . . . . . . . . . . . . 251
Choroid Plexus Papilloma in the Trigone . . 199 Diffuse Axonal Injury (DAI) . . . . . . . . . . . 252
Choroid Plexus Papilloma at the Foramen DAI in Corpus Callosum and Parenchyma . 252
ofMonro . . . . . . . . . . . . . . . . . . 201 Hemorrhagic Contusion with DAI . . . . . . 254
Gliomatosis Cerebri . . . . . . . . . . . . . . . . 202 Multiple Areas ofDAI in Corpus Callosum . 255
Ganglioglioma . . . . . . . . . . . . . . . . . . . 203 DAI with Excitotoxic Mechanism. . . . . . . 256
Central Neurocytoma . . . . . . . . . . . . . . . 206 Periventricular Leukomalacia (PVL),
Dysembryoplastic Neuroepithelial Tumor Preterm Hypoxic Ischemic
(DNET) . . . . . . . . . . . . . . . . . . . . . 208 Encephalopathy (HIE). . . . . . . . . . . . . 258
Germinoma ofthe Pineal Region . . . . . . . . 208 Periventricular Leukomalacia
Pineal Teratoma . . . . . . . . . . . . . . . . . . 210 with White Matter Aplasia . . . . . . . . 258
Pineoblastoma . . . . . . . . . . . . . . . . . . . 211 Periventricular Leukomalacia
Pineal Embryonal Carcinoma . . . . . . . . . . 212 with Thin Corpus Callosum. . . . . . . . 259
Primitive Neuroectodermal Tumor (PNET) . . 214 Unilateral PVL . . . . . . . . . . . . . . . . . 260
Atypical Teratoid Rhabdoid Tumor . . . . . . . 215 Periventricular Leukomalacia with
Esthesioneuroblastoma . . . . . . . . . . . . . . 217 Dystrophic Parenchymal Calcification . . 260