Weekly Image Challenge – March 26, 2023

What is the most likely diagnosis in a 4 years old boy with headache, vomiting, and restricted extra-ocular movements?

  1. Germinoma
  2. Atypical teratoid/rhabdoid tumor
  3. Pineoblastoma
  4. Choriocarcinoma
  5. Vein of Galen malformation


It is an atypical teratoid/rhabdoid tumor (ATRT): iso-intense on T1, hyper-intense on T2, and contrast-enhancing. It shows diffusion restriction.

Pineoblastoma, germ cell tumors, and choriocarcinoma were a close differential as they can be cystic cum solid, but they generally have vivid contrast enhancement and are iso-intense on T2.

Meningioma generally occurs in older adults and has a dural tail.

The vein of Galen malformation would appear as a flow void on T2, and homogenously enhance in continuity with the vascular system.