Enhanced lesion in a sub cortical white matter in a child.

1- If we see a lesion with pattern of enhancement in a sub cortical white matter in a child; the first thing to do is to identify the pattern of this enhancement.
2- If it is diffusely enhanced mural nodule within a non enhanced cyst; your diagnosis could be one of the following:

• A) Pleomorphic xanthoastrocytoma.
• B) Hemangioblastoma.
• C) Juvenile pilocytic astrocytoma.

3- If it is in the form of ring enhanced lesion; look if it is single or multiple; if it is single your differential diagnosis could be  one of the following:

• Ganglioglioma.
• Oligodendroglioma.
• Low grade astrocytoma.
• DNET.
• Pleomorphic xanthoastrocytoma.
• Pilocytic astrocytoma.

Mnemonic GOLD 2 P

4- If it is multiple; look to the regularity and thickness of the wall.

5- If it is regular and thin with dot sign; your diagnosis is neurocystecercosis.

6- If it is regular and thin with large peri focal edema; your diagnosis is abscess.

7- If it is irregular and thick; your diagnosis is metastases.