Imaging spectrum of pontine lesions,approach and differential diagnosis - A pictorial review

Congress:

ECR 2020

Poster Number:

C-11916

Type:

Educational Exhibit

Keywords:

Not applicable, Neoplasia, Metabolic disorders, Congenital, Contrast agent-intravenous, MR-Angiography, MR, CT, CNS, Neuro

Authors:

R. HASSAN¹, S. Patwari², H. C. Chadaga², R. Sutanto³, A. P. Mangalappilly²; ¹Bangalore /IN, ²Bangalore/IN, ³Tangerang/ID

DOI:

10.26044/ecr2020/C-11916

DOI-Link:

https://dx.doi.org/10.26044/ecr2020/C-11916

Fig. 1: ANTERIOR SURFACE OF PONS

Fig. 5: Entero virus encephalitis: 3 year old with fever, headache and altered...

Fig. 19: Neuromyelitis optica. Axial FLAIR and T1 post contrast images demonstrate FLAIR...

Fig. 25: CLIPPERS: Hyper intense lesions seen in FLAIR (a) , T1 w post contrast image...

Fig. 30: Pontine glioma: Axial T2 (a), FLAIR(b),T1w post contrast (c) images...

Fig. 29: Neuro behcet’s: Axial FLAIR (a,b,c) and post contrast (d,e,f) images...

Fig. 45: CENTRAL TEGMENTAL TRACT HYPERINTENSITY High T2 signal of the central...

Fig. 46: MSA- TYPE C- Coronal (c),axial (b) and FLAIR (c) image demonstrates,...

Fig. 9: Tuberculoma: T2/FLAIR hyper intense (b, d), ring enhancing lesion...

Learning objectives

To llustrate the various pathologies that affect pons and demonstrate their classical findings

Background

The pons ("bridge of Varolius") is the middle bulbous portion which acts as a relay between the cerebellum and cerebral hemispheres to conduct signals from the brain. The pons develops from theembryonicmetencephalon(part of the hindbrain, developed from the rhombencephalon), alongside the cerebellum. ANATOMY OF PONS It has two parts (2) : Basis pontis(ventral part) Pontine tegmentum(dorsal part) The basis pontis consists of white matter tracts (anterior and lateral corticospinal, corticobulbar and corticopontine tracts) with transverse fibers contributing to the bulk of the pons. The pontine...

Findings and procedure details

The imaging characteristics of the pontine pathologies, in cases we came across in our hospital, were analysed, the specific imaging features were reviewedwith the clinical details to diagnose and establish an approach tonarrow down the differential diagnosis. I) INFECTIVE DISORDERS: Below table summarisesthe salient imaging features of some of the important infective diseases of the pons. Fig. 3 Fig. 4 1.ENTERO VIRUS ENCEPHALITIS Fig. 5 2.RHOMBOENCEPHALITIS Rhombencephalitisrefers to inflammatory diseases affecting the hindbrain (brain stem and cerebellum) Fig. 6 Fig. 7 Fig. 8 3.TUBERCULOMA Tuberculoma...

Conclusion

It is essential to be aware of the radiological appearances of important pontine pathologies to not overlook them, to avoid uncertainty in diagnosis and thus to ensure timely and appropriate clinical management.

Personal information and conflict of interest

R. Hassan K; Bangalore/IN - nothing to disclose S. Patwari; Bangalore/IN - nothing to disclose H. C. Chadaga; Bangalore, KA/IN - nothing to disclose R. Sutanto; Tangerang/ID - nothing to disclose A. P. Mangalappilly; Bangalore, KA/IN - nothing to disclose

References

1.Osborn's Brain - 2nd Edition [Internet]. Elsevier.com. 2020 [cited 20 January 2020]. Available from: https://www.elsevier.com/books/osborns-brain/osborn/978-0-323-47776-5 2.Radiopaedia.org, the wiki-based collaborative Radiology resource [Internet]. Radiopaedia.org. 2020 [cited 20 January 2020]. Available from: https://radiopaedia.org/