 This will be a case-based approach to pediatric type of diffused gliomas. So this was a young child who had presented with symptoms of raised intracranial tension, seizures, etc. And these are the images, that's a T1 plane image, T2, a flare post contrast, that's a diffusion, that's the ADC map, that's the gradient and that is post contrast T1. So what one can appreciate here is that there is a large tumor which is present in close proximity or which is involved in the midline, that is the thalamus as well as the basal ganglia and has presence of T1 hyperintensity going to hemorrhage within the tumor. In addition one can also appreciate that there is this sulcal enhancement which is present along the sylvian fissure as well as along the parietoxapital fissure implying there is CSF seeding of the tumor. So this is nothing but a midline tumor which is nothing but a high grade midline glioma. In addition what one can also appreciate on this T1 post contrast sagittal spinal image is that there is extensive enhancement present along the spinal cord which can be appreciated implying there is extensive CSF seeding and unfortunately and very rarely also some of these patients can present with metastasis to other organs. In this scenario you can appreciate the focal areas of altered marrow signals by virtue of presence of metastasis to the bones. So diffuse midline gliomas have a tendency towards CSF seeding and leptomaniacal spread. So it would be pertinent to image these patients using the imaging of the entire craniospinal axis so that you detect the leptomaniacal spread of this dioplasm to other parts of the CNS as well. This is a companion pay case again a midline glioma with extensive CSF seeding as can be seen with this nodular appearance around the ventricles and then as we go down cordially into the posterior fossa we have an expanded plump or fatty pons which is partially encasing the basilar artery which is nothing but a diffuse intrinsic pontine glioma which is nothing but another form of midline glioma. So midline gliomas would classically manifest in the region of midline typically the brainstem or structures which are close to the midline like thalamus, basal ganglia or even the spinal cord. So the mutation associated with midline gliomas includes H3 case 27 mutation however that being said the glioma is no longer called mutant but rather an altered midline glioma because there are also additional mutations which can be present with these gliomas and these are the classical locations which has been alluded to usually DIPG would present at about 7 years of age and non-brainstem or something like supratentorial midline gliomas typically manifest in the third decade of life these are have presence of H3K27 mutation and usually have a dismal outlook of about 9 months to 12 months long median survival leptomaninjel dissemination is common hence the need for a complete craniospinal access imaging. Moving on to next case is a diffuse hemispheric glioma so if one encounters a tumor in a child who is under 5 years of age which is involving the hemisphere and not the midline then one can consider a diagnosis of H3G34 mutant hemispheric glioma. Another glioma is the high grade glioma which is H3 wild type and IDH wild type so if one encounters a patient in clinical practice say for example a kid with leukemia who has undergone a craniospinal irradiation and develops an intracranial glioma especially in the supratentorial compartment as a long term complication of radiotherapy one should entertain a diagnosis of this type of diffuse glioma. Next is infant type of hemispheric glioma typically as the name suggests encountered in infants again these are predominantly driven by the RAS and MAPK mutations with those having RAS MAPK mutations having better prognosis than those without and these can make a glioblastoma in the adult patients. Then a point to be noted here is that as per the WHO CNS 5-2021 classification a glioblastoma term is no more valid as far as pediatric patients are concerned so never use the term glioblastoma in pediatric patients. Moving on to pediatric type of low grade gliomas and this is one good example wherein one can appreciate that there is a tumor which is present in the right temporal lobe and on a CT scan shows dense calcification. So this is an entity known as plenty that is polymorphous low grade neuroepithelial tumor of the young and this tumor has plenty of calcifications. So if you have if the patient has a low grade tumor which is based in the temporal lobe has plenty of calcifications and does not have any high grade features like mass effect, midline shift, extensive perillational edema consider a diagnosis of this low grade tumor that is a polymorphous low grade neuroepithelial tumor of the young which has an excellent prognosis compared to any other diffuse pediatric gliomas. Moving on to circumscribed astrocytics or glial supratentorial tumors. So this is the first tumor wherein this was a young adult 17 years old who had presented with facial paracetias and features of vomiting and what can one appreciate on this T2 that there is a predominantly cystic lesion with a mural nodule which is somewhat PL or pile based and a mural nodule shows fluoride post contrast enhancement. So any diagnosis here yes that's a perfect diagnosis. So this is nothing but a classic case of a pleomorphic xanthoastrocytoma which is again a MAPK RARS driven neoplasm and hence has far better prognosis than the IDH neoplasms. So classically this is a well circumscribed predominantly cystic lesion with a mural nodule which is PL based and which shows post contrast enhancement. Again because these are slow growing tumors and often peripherally located these can be associated with scalloping of the inner table of the calvarium which can be again an indicator or pointer towards such a diagnosis. Again these tumors have the good mutation that is the BRAF V600E mutation present in the tumor and this is usually a WHO grade 2 to 3 neoplasm and not a WHO grade 4 neoplasm. Treatment involves surgical resection usually these patients do well and can even be cured of their disease by means of surgical resection. Diagnosis involves ganglion glioma which can often present as a similar tumor cystic with solid nodule but often has calcifications as well and seldom have any perillational edema. Moving on to this tumor so any takers for this this is a spotter T2 axial, T1 axial, T2 coronal and post contrast. That is a fair differential but if you look closely there is more to the images than just the tumor that is a great differential yes. Anything else that you are observing if I tell you that this child has seizures, low IQ and adenoma sebaceum and do you see anything more than this tumor yeah yes somebody said it there is a cortical tuber so if you see that there that is the cortical tuber present along the posterior horn of the lateral ventricle. In addition one can also appreciate sub ependymal nodule okay and obviously that is the large tumor which is nothing but in this case of tuberous sclerosis a SEGA, SEGA is nothing but a sub ependymal giant cell astrocytoma which is nothing but a well circumscribed pediatric neoplasm. So again about SEGA well circumscribed neoplasm often present or always present at the foremen of Manroh in the lateral ventricle probably arise from the sub ependymal nodules again by looking at this tumor and other associated features one can predict the genetic landscape naturally which is nothing but mutations in the tuberous sclerosis 1 and 2 genes. On imaging these can be iso intense on T1 and T2 weighted images can be associated with calcifications usually often these are associated with the sub ependymal nodules and tubers and there would be seldom any case of SEGA which would be appreciated in isolation. Prognosis invariably good and these patients often undergo a curative surgical resection. Differential diagnosis like most of you mentioned is a central neurocytoma but if you see the other features one can make a unifying diagnosis of tuberous sclerosis associated with the SEGA. This is another form of circumscribed tumor again a young lady who had presented with seizures and we have T1 axial, T2 axial, T2 coronal and that is the post contrast. So what one can appreciate here is that there is a tumor which is present in the parieto-oxypital region on this T2 weighted images which is predominantly solid but has somewhat tiny or small cystic areas giving it a so called bubbly appearance is associated with perillegional edema, entrapment of the occipital horn of the left lateral ventricle. So with that kind of description any possible diagnosis which comes to your mind yes somebody got this right this is a case of an astroblastoma. So remember if one encounters a bubbly tumor in the parieto-oxypital region especially in a female patient consider a diagnosis of astroblastoma because this tumor is exceedingly rare in a male patient and is about 9 times more common in a female individual. So classically these are bubbly solid cystic neoplasms present in the parietal lobe which is the common location present with the usual features of any other brain tumor and histologically these are rare glial neoplasms with peri vascular pseudo rosettes and are MN1 altered so that is the genetic mutation which drives this tumor. On imaging as we have all seen this is classically a bubbly neoplasm which invariably has a good prognosis but if anybody gives me a differential of an ependymoma it would be really difficult to challenge that diagnosis of a supratentorial ependymoma but especially in a female patient consider a diagnosis of astroblastoma as one of the prime differentials. So to summarize the circumscribed astrocytic gliomas these include pylocytic astrocytoma which is classically a posterior fossa tumor, a solid cystic lesion with a mural nodule. Next is the high grade astrocytoma with pyloid features again a posterior fossa neoplasm which has a really sinister appearance with heterogeneously enhancing tumor which can be present in the posterior fossa without any restricted diffusion allowing it to be differentiated from a medulo blastoma which would classically restrict in the posterior fossa. Next is the pleomorphic astrocytoma which xanthoastrocytoma which we have seen is an exclusively supratentorial neoplasm cystic lesion with a solid mural nodule which is PL based can be associated with scalloping of the inner table of the calvarium. Next is the SEGA which is a tumor commonly associated or always associated with tuberous sclerosis. Then is a chloride glioma is another well circumscribed neoplasm which can be encountered in the third ventricle and which shows fluoride post contrast homogeneous enhancement. And finally we encountered astroblastoma which can be a tumor present in the parietal or occipital regions again with a high female preponderance.