MRI characteristics of intracranial masses in the paediatric population of KwaZulu-Natal: A neuroimaging-based study

Abstract

Background: MRI is the imaging modality of choice for the assessment of intracranial masses in children. Imaging is vital in planning further management.

Objectives: The purpose of this study was to describe the common intracranial masses and their imaging characteristics in the paediatric population referred to Inkosi Albert Luthuli Central Hospital for MRI of the brain.

Method: We retrospectively reviewed the medical records of paediatric patients (aged from birth to 18 years) who underwent MRI investigations for intracranial masses between January 2010 and December 2016.

Results: A total of 931 MRI brain scans were performed. One hundred and seven scans met the inclusion criteria, of which 92 were primary brain tumours and 15 were inflammatory masses. The majority were females (56%). The mean age was 12 ± 4.52 (range of 3-18 years). The most common presenting symptom was seizures (70/107, 65.4%). We categorised the masses according to supra- and infratentorial compartments. The most common site for masses was the supratentorial compartment (n = 56, 52%). The most common masses in the supratentorial compartment were craniopharyngiomas (14/45, 31.1%), whilst in the infratentorial compartment, the most common masses were medulloblastomas (24/47, 51.1%).

Conclusion: In our series, the supratentorial compartment was the commonest site for intracranial masses. The most common tumour in the infratentorial compartment was medulloblastoma. This information is vital in formulating differential diagnoses of intracranial masses.

Keywords: brain abscess; brain tumours; intracranial masses; magnetic resonance imaging; tuberculosis.

FIGURE 1

The clinical presentation of paediatric patients with intracranial masses.

FIGURE 2

Morphologic appearance of paediatric brain tumours.

FIGURE 3

Magnetic resonance imaging features of paediatric brain tumours.

FIGURE 4

Morphologic features of paediatric infective or inflammatory intracranial masses.

FIGURE 5

Magnetic resonance imaging features of paediatric infective or inflammatory intracranial masses.

FIGURE 6

(a–f) Medulloblastoma, predominantly centred in the fourth ventricle. The mass is predominantly solid (arrows) with tiny cystic areas (*) and avid enhancement of the solid areas (b). Two images (c, d) show T2 and FLAIR low signal of dense hypercellular solid areas and fluid restriction on DWI and ADC map. Supratentorial hydrocephalus is also seen (star).

FIGURE 7

(a–e) Right cerebellar pilocytic astrocytoma. This is a large cystic mass (*) with an eccentric solid nodule (long arrow). There is enhancement of the tumour wall (short and long arrows [d]) and surrounding vasogenic oedema (star). There is no remarkable diffusion restriction (e).

FIGURE 8

(a–d) Typical diffuse intrinsic pontine glioma that expands the pons (*) and encases the patent basilar artery (arrow). It is hypointense on T1WI, hyperintense on T2WI and FLAIR and does not enhance post-gadolinium. There was no restricted diffusion (not shown).

FIGURE 9

(a, b) Heterogeneously enhancing supratentorial ependymoma with solid (arrows) and cystic (*) components and heterogeneously enhancing solid areas. Associated subfalcine herniation with midline shift is seen (arrowhead). Two images in another patient (c, d) show an infratentorial ependymoma with a similar heterogeneous imaging appearance, which is lacking restricted diffusion in (d).

FIGURE 10

(a–c) Heterogeneous craniopharyngioma in the sellar and suprasellar region with solid and cystic components (triangles). The solid components enhance post-gadolinium (*), and SWI shows blooming artefact (arrow) secondary to calcifications.

FIGURE 11

Choroid plexus carcinoma (a–d). There is a large T1 and T2 isointense mass with intense heterogeneous enhancement within the left lateral ventricle causing midline shift to the right. It shows no restriction at DWI.

FIGURE 12

Caseating tuberculoma with a solid centre (a–c). Two high parietal masses that are isointense to grey matter on T2WI with a slightly hyperintense rim (arrow), hypointense on T1WI and demonstrate rim enhancement post-gadolinium. Note the significant perilesional oedema with increased white matter signal intensity (b).