Alisa Gean is doing a great job getting a group together to share and collaborate neuro protocols. This would be a great place from members to share protocols, and open a discussion about the best imaging techniques.
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Spinal Cord Herniation • 10,146 views
This is a case for Prof. Dr. Dillon. It is in press by our neurosurgeons and us, for the use of Duragen. Idiopathic herniation of the thoracic spinal cord: a case report and technique note. U...
Neuro Protocols • 7,715 views
Alisa Gean is doing a great job getting a group together to share and collaborate neuro protocols. This would be a great place from members to share protocols, and open a discussion about the best ima...
Possible SIH with Spinal Subdural Hygroma, What Next? • 6,341 views
[caption id="attachment_602" align="aligncenter" width="407" caption="Sag T1. Tonsils are not particularly low and no sagging of the base of the brain."][/caption] [caption id="attachment_603" alig...
Cervical Spine Nomenclature • 5,060 views
The ASNR/ASSR nomenclature document was specific for the lumbar spine. I would be interested in your opinion on the correct terminology for cervical spondylosis: what terms and why. Specifically, t...
Brachial Plexus MRI Protocol • 4,646 views
BP MRI Protocol Fall is upon us and so is the lecturing season! Like years before, this Fall I will be giving my brachial plexus lecture several times and the most commonly asked question by the au...
Intracranial Hypotension: Advice on Best Treatment • 4,485 views
Middle age female patient diagnosed with Spontaneous intracranial hypotension. Has multiple (approx 23) perineural cysts. Has undergone several blood patches and artificial CSF infusions without rel...
Embolization of Brain Arteriovenous Malformations for Cure • 4,180 views
The editorial comment in the AJNR of Jan 09 by Jayaraman and Cloft is worthy of careful scrutiny, I believe. Although in my personal experience with Onyx and NBCA, final cure rates of brain AVMs from ...
Aunt Mickey (They Look the Same until You Undress Them). Internal Capsule Infarct or Something Else? • 3,892 views
This 30 year old hypertensive female smoker presented with acute onset of right hemiparesis. Her history also included OCP use and dyslipidemia. MRI demonstrated an acute infarct in the posterior limb...
Liver Hemangiomas and Vascular Lesions of the Brain • 3,871 views
[gallery] I have a patient with 15 large liver hemangiomas and two partly calcified lesions in brain. Does anyone know of associated liver hemangiomas and vascular lesions in the brain?
More on DWI of Head and Neck Lesions • 3,870 views
Yesterday I wrote a short comment in the utility of DWI in the evaluation of head and neck lesions. While reading cases in the afternoon I came across a new patient with a retinoblastoma. This pa...
one more point – we use a vibe (siemens) seq w/FS (GE equivalent=FMPSPGR, VIBRANT, FAME or LAVA) pre and post as our workhorse post con imaging ST neck. It is a T1 weighted gradient echo sequence acquired as a slab – very fast acquisition time, very good spatial resolution, can cut into 2 mm images etc. Any experience with this seq or similar seq for neck imaging? I am worried about the contrast detection issue, but images are so detailed it might be worth the tradeoff here
In general with head and neck imaging, your protocols do not fat sat the pre T1 – several of my partners state they have found pre T1 w/FS to be helpful in the past and they want to keep pre T1 FS images going forward. I like the standard T1 personally, your thoughts on the value of pre T1 w/ FS. Several state a case in the past where they would have called enhancement without the pre FS T1…
Also, your CN 5 protocol is fairly short, with no pre con T1 images – is that all you do? Why the MRA as opposed to a CISS/FIESTA?
I was taught that sgpr T1 seq do not show enhancement as well as standard T1 seq – your CN 5 includes an spgr seq, your thoughts on less than ideal contrast detection (ucsd does the same seq as you).
I see a mix of STIR and T2 with FS in the orbit protocol – what is the rationale for one over the other? We lean toward STIR with head and neck imaging.
Lastly, our referring neurology group sees a high volume of MS patients. We have seen STIR imaging of the posterior fossa to be superior to other sequences (including PD) in the detection of wm lesions and now our ms protocol includes an axial stir seq
Thanks, Dr. Hoang. Yes, we sometimes forget that with cranial nerve work-ups, we always need to image from the origin nucleus all the way out through the end organ. Usually (except for 10 and 11 obviously) if you start behind the pontomedullary junction and go out anteriorly through the face you have most of them covered if you forget the mid brain anatomy! I have also seen the opposite of your examples where a tongue atrophy case only looked at the face and tongue itself, and missed a lesion above hypoglossal.
Thanks for this post, Rick. We are in the process of revising our head and neck MRIs. I think your dedicated protocol for CN7 to include the parotid is great. Many centers may defer to doing an IAC MRI for CN7, but I have had two recent examples whereby the cause of the facial nerve palsy was from inflammation and tumor arising from the parotid gland.
I agree, more people should comment!
Hello?!?!?!? come on people, show some love here! none of you even have anything to share, or even a comment?!?!?!?! How could this have 1,457 views and no comments?!?!?!?! I’m going to tell Mauricio!!!!