Dysembryoplastic neuroepithelial tumor diagnosis [Neurosurgery Wiki]

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====== Dysembryoplastic neuroepithelial tumor diagnosis ======

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According to Daumas-Duport and colleagues, the criteria for the diagnosis of [[Dysembryoplastic neuroepithelial tumor]] should include: 

(1) [[partial seizure]]s, with or without secondary generalization beginning before age 20 

(2) no [[neurological deficit]] or presence of a stable and likely congenital neurological deficit 

(3) cortical topography of the lesion as best demonstrated on MRI

(4) no mass effect on CT or MRI (except if related to a [[cyst]])
((Daumas-Duport C, Varlet P, Bacha S, Beuvon F, Cervera-Pierot P, Chodkiewicz JP. Dysembryoplastic neuroepithelial tumor: Nonspecific histological forms:A study of 40 cases. J Neurooncol 1999;41:267-80.)).

Radiographic features

DNETs are typically predominantly cortical and well circumscribed tumours.

CT

if cortical may scallop the inner table of of the skull vault (44-60%), but no erosion
the cranial fossa can be minimally enlarged at times
calcification in ~30% (more common histologically) 
low density
no enhancement
MRI

Typically seen as a cortical lesion with hardly any surrounding vasogenic oedema. 

T1

generally hypointense c.f adjacent brain

T1 C+ (Gd)

may show enhancement in ~20-30% of cases,
enhancement may be heterogeneous or a [[mural nodule]]

T2
generally high signal
high signal 'bubbly appearance'
FLAIR
mixed signal intensity with bright rim sign
partial suppression of some of the "bubbles"
FLAIR is helpful in identifying the small peripheral lesions with similar intensity to CSF
T2* 
calcification relatively frequent
haemosiderin staining uncommon as bleeding into DNETs is only occasional
DWI
no restricted diffusion
MR spectroscopy
non-specific although lactate may be present