Pediatric Supratentorial Astrocytoma

  • Etiology: Astrocytic tumor
  • Imaging CT: Isodense or hypodense region of positive mass effect often without enhancement
  • Imaging MRI:
    — Infiltrating tumor where there is no identifiable border between the tumor and normal brain tissue
    — T1WI: Isointense to hypointense compared to white matter
    — T1WI post contrast: No to minimal enhancement
    — T2WI: Cause expansion of the surrounding cortex
    — FLAIR: Mass-like hyperintense signal that incompletely suppresses and always follows the white matter distribution
  • DDX:
  • Complications:
  • Treatment: Surgical
  • Clinical: Seizure is most common presentation

Radiology Cases of Supratentorial Astrocytoma

CT of supratentorial astrocytoma
Axial CT without contrast of the brain shows a low density mass in the region of the pineal gland and left thalamus that has a punctate area of high density within it representing either calcification or hemorrhage. The mass is having mass effect on the third ventricle resulting in obstructive hydrocephalus and transependymal flow of cerebrospinal fluid.

Radiology Cases of Supratentorial Anaplastic Astrocytoma

MRI of gliomatosis cerebri
Three contiguous axial FLAIR MRI images (above left, above right, below left) show a high signal intensity infiltrative mass without much mass effect centered in the left frontal lobe which crosses the corpus callosum into the right front lobe and right central white matter. Axial T1 MRI with contrast of the brain (below right) shows the mass to have faint enhancement.