Pilocytic astrocytomas range in appearance: Large cystic component with a brightly enhancing [[mural nodule]]: 67% nonenhancing cyst wall: 21% enhancing cyst wall: 46% heterogeneous, mixed solid and multiple cysts and central necrosis: 16% completely solid: 17% Enhancement is almost invariably present (~95%). Up to 20% may demonstrate some calcification. Haemorrhage is a rare complication. ===MRI=== “Classic” MRI finding: posterior fossa cyst with an enhancing mural nodule. The cyst wall sometimes enhances, usually as a thin rim (biopsy negative for neoplasm, enhancement may be reactive ((Beni-Adani L, Gomori M, Spektor S, et al. Cyst wall enhancement in pilocytic astrocytoma: neoplastic or reactive phenomena. Pediatr Neurosurg. 2000; 32:234–239))). Signal characteristics include: T1: iso to hypointense solid component compared to adjacent brain T2: hyperintense solid component compared to adjacent brain {{::cerebellar_pilocytic_astrocytoma_mri.jpg?300|}} [[Apparent diffusion coefficient]] (ADC) values have been shown to assist in differentiating cerebellar pilocytic astrocytomas and [[medulloblastoma]]s. Previous studies have applied only ADC measurements and calculated the mean/median values. The 25th percentile for mean (MD) yields the best results for the presurgical differentiation between pediatric cerebellar pilocytic astrocytomas and medulloblastomas. The analysis of other [[DTI]] metrics does not provide additional diagnostic value ((Wagner MW, Narayan AK, Bosemani T, Huisman TA, Poretti A. Histogram Analysis of Diffusion Tensor Imaging Parameters in Pediatric Cerebellar Tumors. J Neuroimaging. 2015 Sep 2. doi: 10.1111/jon.12292. [Epub ahead of print] PubMed PMID: 26331360. )).