 Hello, I'm Dr. Steven Pomerance from ProScan Imaging. We have a neuro and orthopedic MRI course beginning June 6 in Vancouver. And we're here today to give you a sneak peek at this exciting educational program, a course where each radiologist will work at their own individual workstation as if you are in your own practice reviewing cases. Let's take a look at a neuro case from this combined neuro and ortho review. This is a 10 year old with eye twitching. Let's have a look at the MRI, which includes a coronal T2 weighted or water weighted image, an axial fluid or water suppressed inversion recovery image or flare, and on the far right a T1 weighted image with intravenous contrast administration. Let's turn our attention to the questions. Question one. The most likely diagnosis is A, oligodendroglioma, B, D net, C, lermiduclose lesion, or D, astroblastoma. Question number two, astroblastoma, A, often calcifies with large bulky calcification, B, often presents with catastrophic bleeding, C, has high and low grade histologic types, or D is associated with fecomatoses. Question number three. All the following are true of astroblastoma except A may have punctate calcification, B occurs in 50 to 70 year olds, C, almost exclusively supertentorial, D, natural history is that of intermediate aggressive behavior. Let's go back and look at our imaging. A coronal T2 MRI shows a bubbly lesion. Some of the bubbles are actually in the solid component of the lesion. It's a peripheral lesion. There is modest or mild to modest edema, but the edema and the lesion combined produce very little mass effect. There's very little shift of the midline, and on the axial flare there's very little mass effect on the ventricular system and no obstructive hydrocephalus. Fluid attenuated inversion recovery image which suppresses the CSF also suppresses the signal of the cystic bubbly component inside our lesion. The axial T1 contrast enhanced image shows contrast enhancement of our bubbly mass. Let's go back now and answer our questions. Question one. The most likely diagnosis is correct answer, D astroblastoma. Oligodendroglioma is an adult lesion. They wouldn't occur in a 10-year-old. Oligodendroglioma is seen in the frontotemporal centrum, semi ovale, and it calcifies in almost every case. D net. This is a lesion that has a proclivity to the temporal region. It is usually not this large. It is usually not associated with this much edema. That would be the main differential diagnostic consideration. Question number two. Astroblastoma, and the correct answer is has low and high-grade histologic types. That's a super difficult advanced question as is the case. Astroblastoma does calcify, but the calcifications are not large and bulky. They're punctate microcalcification. In oligodendroglioma, the calcifications are frequently somewhat finger-like and branching. Oligodendroglioma has a much higher incidence of calcification than astroblastoma. Astroblastoma does not often present with bleeding catastrophically. In fact, it doesn't really bleed that often at all. And finally, fecomatoses may be associated with schwannoma, NF2, appendemoma, NF2, meningioma, NF2, neurofibromas, NF1, and giant cell astrocytoma in tuberous sclerosis or Bornville-Pringles syndrome. But not astroblastoma, so D is false. The correct answer by process of elimination is C. Question number three on this advanced case. All the following are true of astroblastoma except, and the correct answer is, it is not a lesion of older or middle-aged adults, 50 to 70 years of age. It is a lesion of children and adolescents. But the other choices are true. As stated previously, it may have punctate calcification. It is almost exclusively supertentorial. You'll never get shown one of these inferentorial. I've never seen one. And the natural history is that of an intermediate aggressive lesion. And while it may have edema, the edema is modest or mild, and the degree of mass effect is mild, as in this case. Astroblastoma is a rare glial neoplasm presenting in children and young adults. And characteristically, lesions are large, lobulated, supertentorial, peripheral. And they have solid and cystic bubbly components. Some of those cystic foci are inside the solid component of the lesion. We talked about edema being modest. We talked about the calcifications being small or punctate, and not uncommon. We said that they could have high and low grade variations, and they are treated often successfully with surgical excision. Appendimomas, which when supertentorial may be parenchymal, are usually in children inferentorial. And they are often intraventricular, but when they are parenchymal, they may make cystic components, which are much larger than the bubbly, smaller cysts seen in astroblastoma. D-Net is a bubbly lesion and can occur anywhere, although the mesial temporal location is most common. And if you're going to get shown one, that is likely where it's going to be. These are peripheral, but non-enhancing, wedge-shaped lesions that point towards the ventricle. It can be large, but on the average, astroblastomas are bigger. But the main differential feature of our lesion versus D-Net is the enhancement. That's key. D-Net is also a tumor of children and young adults. Oligodendrogliomas, as mentioned, have a tremendously high incidence of calcification, close to 90%, and they have a very high incidence of hemorrhage. Oligodendrogliomas present in the fourth and fifth decades, and they like, as mentioned before, the frontotemporal centrum, semio valley. So that concludes our discussion of the rare glial neoplasm, astroblastoma. We've given you some pearls to differentiate it from the look-alikes. This is an advanced case. Have a great day. Thanks. The great thing is that at the course, each participant will have their own workstation, which means they can follow the images on their workstation, while Dr. Pomeranz is demonstrating them for the audience. So for that reason, it makes it a great educational experience. And we look forward to seeing you in Vancouver.