Presentation
Signs of raised intracranial pressure.
Patient Data
Small rounded well-defined soft tissue mass (15 mm) centered on the body of the fornix, displaying isosignal to the cortical grey matter on both T1 and T2, high signal FLAIR with no calcification or hemorrhagic component on GE sequences. On DWI this mass is also isointense to the cortical grey matter with almost identical ADC. The post contrast sequences demonstrate a moderate heterogeneous enhancement. A mass effect is noted on the interventricular foramina with moderate dilatation of the lateral ventricles (obstructive hydrocephalus).
Case Discussion
MRI features are of a well defined heterogeneously enhancing mass centered on the forniceal body with moderate bi ventricular obstructive hydrocephalus, suggestive of a glioma.
On imaging, the main differential diagnosis includes:
- colloid cyst: ~50% high signal on T1, no enhancement
- meningioma: rarely seen in this age group, homogeneous enhancement
- subependymal giant cell astrocytoma: almost exclusively in young patients with tuberous sclerosis
- others: pilocytic astrocytoma, lymphoma
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