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Click CT images of 15-year-old male with an angiocentric glioma in the right frontal lobe. Axial unenhanced CT image (Siemens SOMATOM Definition AS+, 64-slice multidetector CT, sequential axial, 287 mAs, 120 kVp, 4.8 mm slice thickness). A heterogeneous mass centered on the right frontal lobe is demonstrated measuring 6.7 x 5.2 cm in AP and transverse dimension, respectively. The lesion causes mass effect with subfalcine herniation and approximately 6 mm of right-to-left midline shift. Effacement of the anterior horn lateral ventricle is demonstrated. No hemorrhage, no calcification, and no significant white matter edema demonstrated. The ventricles are of normal size, and no intraventricular hemorrhage is seen.

Click MR images of 15-year-old male with an angiocentric glioma in the right frontal lobe. Axial MR images from T1 protocol: Siemens MAGNETOM Avanto 1.5T. T1: with TE of 12 msec, TR 283 msec, 5 mm slice thickness. A 5.3 cm transverse x 6.9 cm anteroposterior x 6.0 cm craniocaudal T1 heterogeneously hypointense intraaxial mass is observed in the right anterior frontal lobe extending from the periventricular region up to the vertex. Irregular areas of T1 hyperintensity within the central and inferior portions of the mass are in keeping with hemorrhage. Several small cavitary regions are present within the mass. The mass compresses the anterior horn of the right lateral ventricle, and causes midline shift to the left by approximately 1.2 cm. The lateral, 3rd and 4th ventricles are not enlarged. The brainstem and cerebellum are normal. The visualized calvarium, soft tissues and craniocervical junction are unremarkable.

Click MR images of 15-year-old male with an angiocentric glioma in the right frontal lobe. Axial MR images from T2 protocol: TE 105 msec, TR 5662 msec, 5 mm slice thickness. A 5.3 cm transverse x 6.9 cm anteroposterior x 6.0 cm craniocaudal T2 heterogeneously hyperintense intraaxial mass is observed in the right anterior frontal lobe extending from the periventricular region up to the vertex. The mass is associated with adjacent T2 hyperintensity, diffusely involving the white matter of the frontoparietal regions bilaterally, right greater than left. The mass compresses the anterior horn of the right lateral ventricle, and causes midline shift to the left by approximately 1.2 cm. The lateral, 3rd and 4th ventricles are not enlarged. The visualized calvarium, soft tissues and craniocervical junction are unremarkable.

Click MR images of 15-year-old male with an angiocentric glioma in the right frontal lobe. Axial MR images from MP-RAGE with contrast enhancement (Gadovist, 0.2 ml/kg intravenously): 3D gradient echo, TE 3.4 msec, TR 1900 msec, 5 mm slice thickness. A 5.3 cm transverse x 6.9 cm anteroposterior x 6.0 cm craniocaudal intraaxial mass is observed in the right anterior frontal lobe extending from the periventricular region up to the vertex. The mass compresses the anterior horn of the right lateral ventricle, and causes midline shift to the left by approximately 1.2 cm. The lateral, 3rd and 4th ventricles are not enlarged. Post-gadolinium, the mass demonstrates mild, heterogeneous, internal enhancement. Numerous pial feeder vessels are seen. No other enhancing lesions are identified. The brainstem and cerebellum are normal. The visualized calvaria, soft tissues and craniocervical junction are unremarkable.

Click MR images of 15-year-old male with an angiocentric glioma in the right frontal lobe. Sagittal MR images from T1 protocol: Siemens MAGNETOM Avanto 1.5T. T1: with TE of 12 msec, TR 283 msec, 5 mm slice thickness. A 5.3 cm transverse x 6.9 cm anteroposterior x 6.0 cm craniocaudal T1 heterogeneously hypointense intraaxial mass is observed in the right anterior frontal lobe extending from the periventricular region up to the vertex. Irregular areas of T1 hyperintensity within the central and inferior portions of the mass are in keeping with hemorrhage. Several small cavitary regions are present within the mass. The mass compresses the anterior horn of the right lateral ventricle, and causes midline shift to the left by approximately 1.2 cm. The lateral, 3rd and 4th ventricles are not enlarged. The brainstem and cerebellum are normal. The visualized calvarium, soft tissues and craniocervical junction are unremarkable.

Click MR images of 15-year-old male with an angiocentric glioma in the right frontal lobe. Sagittal T1 MR images with delayed gadolinium contrast enhancement (Gadovist, 0.2 ml/kg intravenously): Siemens MAGNETOM Avanto 1.5T. T1: with TE of 12 msec, TR 283 msec, 5 mm slice thickness. A 5.3 cm transverse x 6.9 cm anteroposterior x 6.0 cm craniocaudal T1 heterogeneously hypointense intraaxial mass is observed in the right anterior frontal lobe extending from the periventricular region up to the vertex. Irregular areas of T1 hyperintensity within the central and inferior portions of the mass are in keeping with hemorrhage. Several small cavitary regions are present within the mass. The mass compresses the anterior horn of the right lateral ventricle, and causes midline shift to the left by approximately 1.2 cm. The lateral, 3rd and 4th ventricles are not enlarged. The brainstem and cerebellum are normal. The visualized calvarium, soft tissues and craniocervical junction are unremarkable.

Click MR images of 15-year-old male with an angiocentric glioma in the right frontal lobe. Axial diffusion tensor tractography (DTT). Protocol: Siemens MAGNETOM Avanto 1.5T. DTT: TE 88 msec, TR 3236 msec, 5 mm slice thickness. Red, blue, and green colors indicate diffusion of water molecules along the lateral, craniocaudal, and anteroposterior axes, respectively. An intraaxial mass is seen in the right frontal lobe, which causes displacement and splaying of the craniocaudally-oriented white matter fibers of the right corona radiata and centrum semiovale. Superiorly, the posterior margin of the mass is approximately 1.5-2.0 cm anterior to the precentral gyrus. However, inferiorly, along the posteromedial aspect of the mass abuts and splays the fibers radiating into the anterior limb and genu of the internal capsule.

Click MR images of 15-year-old male with an angiocentric glioma in the right frontal lobe. Axial diffusion weighted image (DWI). Protocol: Siemens MAGNETOM Avanto 1.5T. DWI: TE 121 msec, TR 5200 msec, 5 mm slice thickness, with b factor of 500. The right frontal-lobe intraaxial mass is predominantly similar to brain tissue in its apparent diffusion coefficient. Anteromedially in a solid, partially enhancing portion of the mass, corresponding to the region from which spectroscopic data were obtained (Fig 2d), the apparent diffusion coefficient measured 9.9x10^-4 mm^2/s (Fig 2c).

Click MR images of 15-year-old male with an angiocentric glioma in the right frontal lobe. Axial MR images from MP-RAGE with contrast enhancement (Gadovist, 0.2 ml/kg intravenously): 3D gradient echo, TE 3.4 msec, TR 1900 msec, 5 mm slice thickness. Post-gadolinium, the mass demonstrates mild, heterogeneous, internal enhancement. Numerous pial feeder vessels are seen. No other enhancing lesions are identified. The brainstem and cerebellum are normal. The visualized calvaria, soft tissues and craniocervical junction are unremarkable.

Click MR images of 15-year-old male with an angiocentric glioma in the right frontal lobe. Sagittal T1 MR images of the cervical spinal cord. Protocol: Siemens MAGNETOM Avanto 1.5T, with sagittal sequences using T1-weighted (T1, with echo time (TE) of 12 msec, TR 283 msec, 5 mm slice thickness). On the spine imaging, the vertebral alignment is intact, with preservation of the vertebral heights. The marrow signal is normal. The spinal cord signal is unremarkable, with no enhancing masses seen. The clivus and craniocervical junction are unremarkable. The intervertebral discs, thecal sac, intervertebral foramina and exiting nerve roots are normal. The vertebral body marrow signal intensity is normal.

Click MR images of 15-year-old male with an angiocentric glioma in the right frontal lobe. Sagittal T1 MR images of the thoracic spinal cord. Protocol: Siemens MAGNETOM Avanto 1.5T, with sagittal sequences using T1-weighted (T1, with echo time (TE) of 12 msec, TR 283 msec, 5 mm slice thickness). On the spine imaging, the vertebral alignment is intact, with preservation of the vertebral heights. The marrow signal is normal. The spinal cord signal is unremarkable, with no enhancing masses seen. The tip of the conus medullaris is normally situated, ending at the level of the L1/L2 disc. No fatty infiltration of the filum terminale is seen. The intervertebral discs, thecal sac, intervertebral foramina and exiting nerve roots are normal. The vertebral body marrow signal intensity is normal.

Click MR images of 15-year-old male with an angiocentric glioma in the right frontal lobe. Sagittal T1 MR images obtained 1 day post-resection. Protocol: Siemens MAGNETOM Avanto 1.5T, with sagittal sequences using T1-weighted (T1, with echo time (TE) of 12 msec, TR 283 msec, 5 mm slice thickness). There has been a right frontal craniotomy for removal of right frontal tumor. Gas is now present in the extra-axial space with an air fluid level in the surgical cavity and also in the subdural space. There is no evidence of a residual mass. There is continued midline shift. The anterior body of the corpus callosum on the right side has also been removed. The right frontal horn appears somewhat distorted and may communicate with the surgical cavity. There is no evidence of hydrocephalus. The posterior fossa appears unremarkable.

Click MR images of 15-year-old male with an angiocentric glioma in the right frontal lobe. Sagittal T1 MR images with contrast enhancement (Gadovist, 0.2 ml/kg intravenously) obtained 1 day post-resection. Protocol: Siemens MAGNETOM Avanto 1.5T, with sagittal sequences using T1-weighted (T1, with echo time (TE) of 12 msec, TR 283 msec, 5 mm slice thickness). There has been a right frontal craniotomy for removal of right frontal tumor. Gas is now present in the extra-axial space with an air fluid level in the surgical cavity and also in the subdural space. There is no evidence of a residual mass, however there is a small amount of enhancement lining the surgical tract and the surgical bed. A small amount of enhancing tissue is noted in the posterior aspect of the surgical bed. There is continued midline shift. The anterior body of the corpus callosum on the right side has also been removed. The right frontal horn appears somewhat distorted and may communicate with the surgical cavity. There is no evidence of hydrocephalus. No evidence of other enhancing foci or masses. The posterior fossa appears unremarkable.