ARRS 2022 Abstracts


E1912. Comprehensive Review of Intraventricular Tumors
  1. Issa Khoury; Montefiore Medical Center
  2. Jacqueline Bello; Montefiore Medical Center
  3. Keivan Shifteh; Montefiore Medical Center
Intraventricular tumors make up 10% of tumors in the CNS. The differential diagnosis for intraventricular neoplasms can be broad. Many of them have similar patterns of contrast enhancement, and many of them have similar patterns of signal intensity.The location of the lesion in the ventricular system-along with knowledge of the patient's age, sex, and underlying conditions will help narrow the differential diagnosis. In this presentation, we would like to review normal and variant anatomy of the intraventricular system, as well as common and rare pathologies, including primary and secondary intraventricular tumors. In addition, authors will also provide clinical features and epidemiology will help guide diagnostic considerations.

Educational Goals / Teaching Points
The goals of this exhibit are to review relevant ventricular anatomy, especially as it relates to intraventricular neoplasms; discuss the differential diagnosis of intraventricular tumors and their clinical features; discuss the relevant epidemiology for a broad range of intraventricular tumors; list the specific imaging characteristics of intraventricular neoplasms; and explain how to create a focused and clinically meaningful differential diagnosis using patient demographics and specific tumor location.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Anatomic and embryological development of the ventricular system will be reviewed. Examples of normal and variant anatomy of the epithelial lining of the ventricles, subependymal plate, septum pellucidum, arachnoid granulations, and choroid plexus will be given, followed by differential diagnosis of primary and secondary intraventricular neoplasms. Subdivisions of primary intraventricular neoplasms will be based on specific anatomic location (ventricular margins, septum pellucidum, and choroid plexus). Relevant epidemiology, clinical features, and imaging criteria of several pathologies will be reviewed, such as ependymomas, subependymomas, subependymal giant cell tumors, central neurocytomas, choroid plexus neoplasms, meningiomas, metastases, lymphoma, primitive neuroectodermal tumors, and atypical teratoid/rhabdoid tumors (ATRT). Management considerations will be discussed.

Masses of the intraventricular system share many common imaging features, as well as similar clinical findings and epidemiological characteristics. As such, a focused classification system is essential for the proper diagnosis and characterization of these lesions. Subdivisions based on specific anatomic location can be used to help create a clinically meaningful differential diagnosis. Cases of primary intraventricular tumors include those of ventricular margin origin (ependymomas, subependymomas, SEGA, epidermoid), those of septum pellucidum origin (central neurocytoma), and those of choroid plexus origin (papilloma, carcinoma, meningioma, metastasis). Cases of secondary intraventricular tumors include ATRT, medulloblastoma, and craniopharyngioma.