Journal of the Korean Radiologica l Society 1995 ; 33( 1) : 15-20

MR Imaging of Solid Cerebellar Tumors in Adult 1

Sung Wook Choo , M.D.2 , Kee Hyun Chang , M.D. , Moon Hee Han , M.D. ,
In Kyu Yu , M.D. , Kyu Ho Choi , M.D.3 , Ki Jun Kim , M.D.3 , Hong Sik Byun , M.D.2

Purpose: The solid variety of cerebellartumors in aduit is reiatively uncommon.

This study is to describe the characteristic MR findings of various solid cerebellar
tumors in adult.
Methods: Twenty three cerebellar sol id tu mors from 22 consecutive patients
over age of 15 with surgical confirmations were retrospectively evaluated with
MR imaging. Histologicdiagnosis included hemangioblastoma (n=6 ), metastasis
(n=6 ), high-grade astrocytoma (n = 3 ), and medulloblastoma (n=8). The MR
findings were reviewed with attention to the size, the signal intensity of the
tumors , pattern of enhancement , tumoral margin , degree of peritumoral edema ,
signal void vascular structures within and/ or around the tumor , and location in
relation to attachmenttothe pial surface ofthetumor
’
Resu ts: Solid hemangioblastomas consistently showed slightly low or iso sig-
nal intensity on T1-weighted images and high intensity on T2-weighted images ,
dense homogeneous enhancement , and signal void vessels within and/ or around
the mass. Metastatic tumors showed various findings with predominantly low or
iso signal intensity on T2-weighted images. Medulloblastomas was midline
and / or paramidline in location , and had larger mass formation. High-grade
astrocytomas revealed nonspecific MR findings with no signal void vessels .
Conclusion: Hemangioblastoma , metastasis , malignant astrocytoma , and
med 비 loblastoma should be included in differential diagnosis of solid cerebellar
tumors in adult. Dense homogeneous enhancement and signal void vessels are
characteristic of hemangioblastoma. The signal intensity of the tumor, and pres-
ence of signal void vessels , location and enhancement pattern can be some value
in differential diagnosis of s 이 id cerebellartumors in adult.

Index Words: Brain neoplasms , MR

wledge , however , there have been only a few docu-

INTRODUCTIOI\l
Infratentotial tumors in adult are relatively uncom-
mon and have a histologic distribution different from
those of the supratentorial location. Cerebellar solid
tumors in adult are less common than those in children
(1 - 3). Magnetic resonance (MR) imaging has currently
been used as an imaging modality of choice in ev-
aluating most intracranial diseases (1 - 5). To our kno-
'Oepartment ofR adiol ogy , Seoul National UniversityColl ege of Medicine
20epartment ofRadiol ogy , Samsung Medical Center
30epartment of Radiology , Cathol ic University Medical Col lege
이 연구는재단법인 한국방사선연구재단 1993 년도 MR 연구비 지원에 의하여
이루어졌음
ReceivedFebruary28 , 1995 ;AcceptedJuly3 , 1995
Address reprint requests to : Sung Wook choo , M. 0. , Oepartment 01 Radiology ,
Samsung Medical Center 50 Ilwon-dong , Kangnam-ku , Seoul, 135-230 Korea
Te l. 82- 2- 341 Q- 2518 Fax. 82-2-341 0- 2559
ments on the MR findings of solid cerebellar tumors in
adult (1 , 3 , 6 , 7). The purpose of this study is to describe
the MR findings of solid cerebellar tumors in adult and
to evaluate the characteristics on MR imaging , if any , in
each of these tumors
PATIENTSand METHODS
Brain MR images of consecutive 22 patients with
pathol og ically - confi rmed twenty th ree sol i d cerebell ar
tumors were retrospectively reviewed. Fifteen were
men and seven women , aged 15 to 52 years. Six
patients with hemangioblastoma , five with metastasis ,
three with high-grade astrocytoma , and eight with
medulloblastoma were included in this study. Meta-
stases were from lung in two , and one each from gas-

n
Journal 01 the Korean Radiologica l Society 1995 : 33( 1) ’ 15-20

trointestinal tract , kidney , and breas t. Metastasis from
cholangiocarcinoma showed two masses in the right
cerebellar hemisphere with same character. Fourteen
patients were examined on a 2.0 T , seven on a 1.5T and
one on a 0.5 T units. A standard spin echo pulse se-
quence was used to obtain T1 weighted (T1 WI)
• RESULTS
(500-700/30/3-6 , TR /TE/excitatio ns) , proton - den-
sity - weighted (2000-3000/30/1 -2) and T2 - weighted
(T2WI) (2000-3000/80-100/1 -2) images in sagittal ,
axial , and/or coronal planes. Contrast - enhanced
T1WIs were obtained in 20 patients after intravenous
injection of gadopentetate dimeglumine (Magnevist ,
Shering , Berlin) (0.07-0.1 mmol /kg body weight) ex-
cept each one from medulloblastoma and high grade
astrocytoma. A 256 X 256 matrix was used to obtain
images of 1 mm X 1 mm spatial resolution. Slicethick-
ness and gap were 5 -7 mm and 1-2 mm , respectively
The MR images were reviewed regarding the location ,
size , and signal intensity of the tumor , pattern of en-
hancement , tumoral margin , peritumoral edema , and
vascular signal voids. The signal intensity was de-
scribed compared with normal cortical gray matter
Degree and pattern of enhancement were visually
assessed. Peritu moral edema was visually graded into
two groups ; none to mild and moderate to severe in de-
gree
Brief characteristic MR imaging findings of sol id cer-
ebellar tumors in adult are summarized in table 1
Hemangioblastomas were located in cerebellar
hemisphere in four patients (three in the left , one in the
right) , superior vermis in one , and tonsil in one , all of
which were attached to pial surface. The tumors were
round or oval in shape , and well - defined. They ranged
from 2.0 to 3.5cm in the longest diameter. Signal inten -
sity of the tumors was isointense (n=2) (Fig. 1 a) or
slightly hypointense (n =4) relative to cortical gray mat-
ter on T1WI , and slightly hyperintense (n=3) or mark-
edly hyperintense (n=3) (Fig. 1 b) on T2W I. One tumor
exhibited rim of low signal intensity on T1 - and T2WI
(Fig. 1). AII the tumors demonstrated dense homo-
geneous enhancement , vascular signal voids within

Table 1. Briel Summary 01 MR Imaging Findings 01 SolidCerebellar Tumors in Adult

Contrast enhancement'
T1WI T2WI
No Size(cm) homo geneous heterogeneous
•• ••
Hemangioblastoma 6 2-3.5 4 2 3 3 6
Metastasis 6 2-3 3 3 2 2 5
Astr ocytoma 3 1.5-3 2 2 2
Medulloblastoma 8 above4 7 8 2 5
• • , • ,• , • , • •markedly low , low, iso , high , very high signal intensity 01 the tumors
’

*: Two patients Irom astrocytoma and medulloblastoma did not perlorm contrast enhancement study

a b c
Fig . 1. Hemangiobl astoma
a. Axial T1 -we ighted MR image (700 /30) shows a mass 01 iso signal intensity with well-delined margin in left cerebell ar hemisphere
b. On axial T2-weighted image (2500 /1 00) , the mass shows high sign al in tens ity wi th moderat e to severe peritumoral edem a. Note thin
low intensity rim and vascular signal vo ids
c. Postcontrast sagittal T1-weighted image (500 /30) shows dense homegeneous en hancement 01 the tumor
- 16 -
 Sung Wook Choo , et al : MR Imaging of Solid Cerebellar Tumors in Adult

and/or around the mass (Fig. 1c) . There was moderate
to severe degree of edema around .t he mass in all
patients.
Metastatic tumors were seen in cerebellar hemi-
sphere in four patients (four in the right including two
masses from cholangiocarcinoma , one in the left) , and
vermis in one. The tumors were 2 -3 cm sized , and
were attached to pial surface in all patients. The signal
intensity was isointense (n=3) or hypointense (n=3) on
T1 WI , and isointense (n=2) , slightly hypointense (n=1) ,
markedly hypointense (n=2) (Fig. 2a) , or hyperintense
(n=1) on T2W I. Rim of low signal intensity was seen in
one from lung cancer. Contrast enhancement was
moderate in degree and heterogeneous (n=5) (Fig. 2b) ,
or dense homogeneous (n= 1l. Peritumoral edema was
moderate to severe in degree in all patients. Signal
void vascular structures were observed in one from re-
nal cell carcinoma.
In high - grade astrocytomas , the tumors were 10-
cated in cerebellar hemisphere in all three patients ,
and were 1.5 -3 cm sized. Signal intensity of the
tumors was slightly hypointense (n=2) (Fig. 3a) or
isointense (n=1) on T1WI , and was isointense (n=2)
(Fig. 3b) or hyperintense (n=1) on T2W I. Contrast en-
hancement was moderate in degree and hetero-
geneous in all two patients with contrast-enhanced
study (Fig. 3c). Margin of the tumors was well - defined
in two patients. Peritumoral edema of moderate to
severe degree was seen in two patients. Signal void
vessels were not visualized in any patien t.
Medulloblastomas were located in the vermis (n=7)
and/or cerebellar hemisphere (n=6). Six tumors were
above 4 cm in size and below in two. Signal intensity of
the tumors was isointense (n=1) or slightly hypoin-

Fig . 2. Metastasis from cholangiocarci-

noma
a. On axial T2-weighted image (2500 /90) , the
mass in right cerebellar hemisphere shows
markedly low signal intensity with small
central necrosis of high intensity and with
moderate to severe peritumoral edema
b. Postcontrast coronal image (500 /30)
shows heterogeneous enhancement of the
mass with well-defined margin. On T1-
weighted image , the tumor was slightly
hypointense (not shown).

a b

a b c
Fig . 3. Glioblastoma multiforme
a. Coronal T1-weighted image (500 /30) shows a mass 01 slightly low signal intensity in left cerebellar hemisphere (arrows) with ill-de-
lined margin
b. On axial T2-weighted image (2500/1 00) , the mass shows isosignal intensity with moderate to severe peritumoral edema
c. Postcontrast T1-weighted coronal image (500/30) shows mild to moderate , heterogeneous enhancement 01 the mass.
껴

/
Journ al of the Korean Radiologica l Society 1995; 33( 1) : 15- 20
a b
Fig . 4. Medulloblastoma
a. Axial T1 -weighted image (500 /30) , the mass shows sl ightly low signal intensity in the vermis and extends into cerebellar hemisphere
and 4th ventricle
b. Axial T2-weighted imag e (3000 /80) , the mass shows high signal intensity with mild peritumoral edema
c. Contrast-enhanced sagittal T1-wei ghted image (500/30) shows the mass with mild to moderate and homogeneous enhancement ‘
tense (n=7) (Fig. 4a) on T1WI , and hyperintense (n=8)
(Fig. 4b) on T2W I. Contrast - enhanced MR images
obtained in 7 patients showed mild to moderate and
heterogeneous (n=5) , or homogeneous enhancement
(n=2) (Fig. 4c). Tumor margin was well-defined (n=5)
or ill - defined (n=3). Edema of moderate to severe de-
gree was seen in one , and none or mild in another
patients. Signal void vessels were seen in two patients.
DISCUSSION
Solid cerebellar tumors in adult include hemangio-
blastomas , astrocytomas of varying grades , metasta-
sis , medulloblastomas , 이 igodendrogliomas ， etc (1 - 5)
Hemangioblastoma usually arises in cerebellum or
brainstem , and may be predominantly either cystic
(60 -73 % ) or solid. The solid hemangioblastoma is
microscopically characterized by a fine hypervascular
capillary mesh in a stroma composed of polygonal
cells with no dense cellularity (6 , 8) . The signal inten-
sity of the solid portion of hemangioblastomas that is
isointense or slightly hyp 이 ntense on T1 WI and hyper-
intense on T2WI reflects low cellurarity. High vascular
components are represented by presence of vascular
signal voids and dense enhancement on MR imaging
(3 , 6 , 8). The hemangioblastomas abut the pial surface
due to vascular origin (6). In the present study , the
findings described above were seen in all patients of
hemangioblastoma. Combination of these findings , es-
pecially presence of signal void vasculatures , seems to
be characteristic of the hemangioblstoma , while not
specific. In regard to the rim of low signal intensity
around the tumor , it is uncertain whether this repre-
sents the tumor capsule.
얘
m
c
Intracerebellar metastasis represents 18 % among
intra - axial metastasis (3). Solid cerebellar metastasis
may be originated from bronchial carcinoma , breast
carcinoma , melanoma, colonic carcinoma , etc (9 , 1 이 .
Metastatic tumors demonstrate various signal inten-
sities on MR imaging , depending upon the histopa-
thology , but usually low intensity on T1WI and high in-
tensity on T2WI (3). In the present study , signal inten-
sity of the metastatic tumors on T2WI was similar to or
lower than gray matter in all patients except one. Mark-
edly low intensity on T2WI of the tumors from chol-
angiocarcinoma in one patient might be related to pref-
erential T2 - shortening effect caused by unidentified
substances from which the tumor arose (7 , 11). Met-
astasis from renal cell carcinoma in a patient showed
iso - signal intensity on T2WI , intra - and peritumoral
curvilinear vascular signal voids , and dense homo-
geneous enhancement, resembling solid hemangio-
blastoma. In angiography, both metastasis from renal
cell carcinoma and hemangioblastoma showed
hypervascular dense staining. The vascular signal
voids within and/or around cerebellar tumor suggest
either hemangioblastoma or hypervascular metasta-
sis. Attachment to the pial surface and inability to dif-
ferentiate precise location such as gray-white matter
junction were probably due to review of multidirec-
tional inspections.
Cerebellar astrocytoma occurs predominantly in the
pediatric age group and approximately 75% is of the
“ juvenile" histological character (pilocytic type) with
an excellent prognosis , while 25% is diffuse fibrillary
type with a poorer prognosis (3). Gross morphologic
appearance is various ; a solitary unilocular cyst with a
mural nodule , an entirely solid mass , and a solid mass
 Sung Wook Choo , et al: MR Imaging of Solid Cerebellar Tumors in Adult
with necrosis and cyst formation (3 , 12). MR findings of
the astrocytoma depend upon the gross morphologies
and histopathologic findings. The solid component of
benign pilocytic astrocytoma usually is hypointense
relative to cortical gray matter on T1 WI and hyperin-
tense on T2WI , because the tumor usually has micro-
cystic component with low cellularity. However , in the
solid portion of malignant astrocytoma , the signal in-
tensity is isointense relative to cortical gray matter on
both T1WI and T2WI , due to higher cellularity , as in the
cases of the present study.
Medulloblastoma may occur in adult , although it
represents the most common posterior fossa tumor in
children. Medulloblastoma originates from poorly
differentiated germinative cells of the roof of the fourth
ventricle that migrate superolaterally to the external
granular layer of the cerebellar hemisphere. While it
uaually occurs in the midline in children , the tumor has
a tendency to occur in the cerebellar hemisphere in
adul t. But this tumor arises anywhere along the path of
migration (3 , 9). The signal intensity of medullobla-
stoma usually is hyp 이 ntense to isointense relative to
the gray matter on T1 WI and slightly hyperintense on
T2W I. The tumor enhances homogeneously or hete-
rogeneously following administration of contrast ma-
terial. Dissemination of the tumor into the subara-
chnoid space and throughout the ventricle occurs most
commonly in medulloblastoma than in any other pos-
terior fossa tumor. Since contrast - enhanced MR
imaging most sensitively defines CSF dissemination ,
contrast-enhanced MR images of the entire central
nervous system including spinal cord should be
obtained , if CSF dissemination is suspected (13). In the
present study , the tumors were in the vermis and/or
cerebellar hemisphere and relatively large in size by
migration which is different from that of children , but
signal intensity of the tumors was similar
In summary , MR findings of solid cerebellar tumors
in adult including hemangioblastomas , metastases ,
malignant gliomas , and medulloblastomas were de-
scribed. Combination of iso - to low intensity on T1WI
- 19 -
and high intensity on T2WI , vascular signal voids within
and/or around the tumor , and dense homogeneous en-
hancement is characteristic of hemangioblastomas
Hypointense signal intensity ofthe tumor on both T1WI
and T2WI associated with variable contrast enhance-
ment and edema suggests metastasis. Relatively large
mass in mid and/or paramidline location can be
suggestive of medulloblastoma. Conclusively , MR
findings provide a valuable information in differential
diagnosis of solid cerebellar tumors in adul t.
REFERENCES
1. Bilaniuk LT. Adult infratentorial tumors. Semin Roentgeno/1990
; 25 : 155-173
2. Gusnard DA. Cerebellar neoplasms in children . Semin Roen
tgeno/1990 ; 25: 263-278
3. Li zak PF , Woodruff Ww. Posterior fossa neoplasms: multiplanar
imaging. Semin US CT MR 1992 ; 13: 182-206
4. Lee BCP , Kneeland JB , Deck MDF , et al. Posterior fossa lesions
magnetic resonance imaging. Radiology 1984 ; 153: 137-143
5. Randell CP , Coliins AG , Young IR , et al. Nuclear magnetic reson-
ance imaging 01 posteriorlossa tumors. AJR 1983 ; 141 :489-496
6. Lee SR , Sanches J, Mark AS , et al. Posterior lossa hemangio-
blastomas: MR imaging. Radiology 1989 ; 171 : 463-468
7. EgeJhoff JC , Ross JR , Modic MT , et al. MR imaging 01 metastatic
GJ adenocarcinoma in brain. AJNR: Am J Neuroradio/1992 ; 13
1221-1224
8. Lee SH , Rao KCVG , Zimmerman RA. Cranial MRI andCT. 3rd ed
NewYork: McGraw-H 川， 1 992 : 363-364
9. Weisberg LA. Solitary cerebellar metastases: clinicaJ and
computed tomographic correlations. Arch Neurol 1985 ; 42
336-341
10. Potts DG , Abbott GF , von Spidern JV. NationaJ cancer institute
study: evaluation olcomputed tomography in the diagnosis 01 in-
tracranial neopJasms. Radiology 1980; 136: 657-664
11. Carrier DA , Mawad ME , Kirkpatrick JB , et al. Metastatic
adenocarcinoma to the brain: MR with pathologic correlation
AJNR: Am J Neuroradio/1994 ; 15 155-159
‘
12. Naidich TP , Zimmerman RA. Primary brain tumors in children
Semin Roentgeno/1984 ; 19 : 100-114
13. Kochi M, Mihara Y, Takada A, et al. MRJ olsubarachnoid dissemi
nation 01 meduJ JobJastoma. Neuroradio/1991 ; 33 : 264-268
Journal of the Korean Radiological Society 1995; 33( 1) ; 15-20

대한밤사선의학회지 1995 ; 33(1): 15-20

성인의 소뇌 고형종양의 자기공명영상소견 1

1 서울대학교 의과대학 진 단방사선과학교실

2 삼성의료원 영상의학 진단방사선과학교실
37~톨릭대학교의과대학진단방사선과학교실

주성욱2 • 장기현 · 한문희 · 유인규 · 최규호3 • 김기준3 • 변홍식 2

목 적 :성인의 소뇌고형종괴는 흔하지 않은 질환으로， 여러 종괴의 자기공명의 특이소견을 분석하여 기술하고자 하였다.
대상 및 방법 :수술 후 병리학적으로 확진된 22 명의 23종괴들을 대상으로 하였으며， 혈관모세포종 6예， 전이암 6여 1. 성상세
포종 3여 1. 수모세포종 8예였다. 자기공명영상소견은 종앙의 크기， 신호강도， 경계， 조영증강 모앙， 주위부종， 혈관， 연막과의
부착여부 등으로 분석하였다.

결 과:고형 혈관모세포종은 모두 T1 강조영상에서 동일 혹은 저 신호강도를. T2강조영상에서 고신호강도를 보였으며， 균

질의 강한조영증강과종앙 내부나주위에 혈관이 관찰되었다.전이암은주로 T2강조영상에서 동일 혹은저신호강도를보였

다. 수모세포종은 소뇌 중앙부에 위치하고， 다른 종앙보다 크기가 컸다. 성상교세포종은 특이소견은 간찰되지 않았다.
결 론:성인의 소뇌고형종야의 감별에는 혈관모셰포종， 전이암， 성상교세포종， 수모세포종이 포함되어야 한다. 균질의 감

한 조영증강과 혈관존재는 혈관모세포종의 특이소견이다. 종앙의 신호강도， 혈간존재여부， 우|치와 조영증강 모양은 성인의
소뇌 고형종앙 감별에 도움 이 될것으로 사료된다.

- 20 -