Category Archives: Brain
“Brain Tumor Imaging, Volume 1: Pretherapy” is the latest Special Collection from the American Journal of Neuroradiology. Distilling the best of the many articles related to brain tumor imaging that appear in the pages of AJNR posed a daunting task, but Editor-in-Chief Mauricio Castillo knew that Collection Editor Soonmee Cha of the University of California, San Francisco would be successful. “Dr. Cha is a respected investigator, a contributor of high quality and clinically relevant articles to AJNR and other journals, and a member of our Editorial Board,” he explained. Dr. Cha chose to categorize and present this compilation of research … Continue reading >>
1. I have read that it is OK to do the CT Perfusion study either before or after the CTA (AJNR Am J Neuroradiol 2008 29: e23-e30). I have always done the CTA first, but I would like to know what other people are doing, and what the relevant considerations are.
2. Is 80 the optimal kVp for the perfusion study?
Thanks… Continue reading >>
73 year old lady presented with six weeks history of odd behavior, increasing apathy, expressive aphasia, and mild headache. An MRI including diffusion and perfusion imaging was obtained. MRI revealed a T1 hypointense (to cortex) and slightly T2 hyperintense (to cortex) extra-axial mass in the left frontal region. There were multiple central T2 hyperintense areas. On post contrast T1 weighted sequence, there was intense enhancement of the mass except the central T2 hyperintense areas.There were prominent diffusion restriction and high rCBV in most parts of the tumor in diffusion and perfusion imaging respectively.
At this point, what is your diagnosis? … Continue reading >>
1. Focal cortical dysplasia type II: biological features and clinical perspectives. Lancet Neurol 2009; 8: 830–43
Very nice review article with histopathology, imaging and helpful graphics
2. Neuro-Behçet’s disease: epidemiology, clinical characteristics, and management. Lancet Neurol 2009; 8: 192–204.
Behcet’s disease is a multisystem relapsing inflammatory disorder of unknown cause. This review covers CNS parenchymal and nonparenchymal manifestations, as well as peripheral and uncommon variants.
3. The protective status of subtotal obliteration of arteriovenous malformations after radiosurgery: significance and risk of hemorrhage. Neurosurgery 65:709–718, 2009
Important paper evaluating the risk of AVM’s which show only early draining vein but no … Continue reading >>
51 year old lady presented with headache and gait disturbances. An MRI including perfusion imaging was obtained. MRI revealed an extra-axial, dural based mass of the posterior fossa which was isointense to gray matter on T1 weighted sequence and hyperintense to gray matter on T2 weighted sequence. There was no diffusion restriction. On T2 weighted sequence, there was wedge shaped area of perilesional T2 hyperintensity extending transversely and superiorly to involve vermis. With contrast, the lesion showed intense homogenous enhancement. On perfusion study, there was considerable increase in rCBV. Preoperatively it was diagnosed as meningioma and the patient was scheduled … Continue reading >>
A young man presented with ataxia. Brain contrast enhanced MRI was done including DWI and perfusion. T2WI showed a mixed intensity lesion in the inferior right cerebellar hemisphere which contained some “dark stripes”. DWI ADC map show restricted diffusion centrally. After contrast the lesion enhanced in a striped fashion and perfusion showed low rCBV (see below). Llermitte-Duclos disease was considered in the differential diagnosis.
Further questioning of patient disclosed that the symptoms had had a sudden onset 7 days earlier. The diagnosis of subacute infarction of the right posterior inferior cerebellar artery territory was considered as the most likely cause … Continue reading >>
A 41-year-old female with history of migraine presented to the ED with acute onset of aphasia. In addition to the aphasia, there was numbness and tingling in the right arm and face. Patient demonstrated expressive aphasia and was not able to answer questions posed in the ED. Gadolinium MR perfusion images demonstrated decreased relative cerebral blood flow (top) in the left parietal/occipital lobes and increased time-to-peak (bottom) in the contralateral cerebellar hemisphere. Although crossed cerebellar diaschisis (CCD) is seen mostly on radiotracer studies (hypometabolism on PET studies), it was nicely demonstrated in our patient. CCD occurs more often after supratentorial … Continue reading >>
This is a one month-old female with congenital hypothyroidism, hypoplasia of the thyroid gland, elevated TSH (eight times normal value), elevated FSH and LH (four times normal values), normal GH, without diabetes insipid. She is now being treated for the hypothyroidism, and we are waiting for hormonal follow-up; MRI follow-up in three to six month follow-up.
Has anyone an explanation for the focal bright spot on T1-weighted images in the cranial portion of the pituitary stalk, just down the median eminence, in the presence of a normal neurohypophysis?
Is it an “ectopic” adenohypophysis?
Is this a thin pituitary stalk in … Continue reading >>
The article “Is CT Still Useful in the Study Protocol of Retinoblastoma?“, published July 17 in the Publication Preview section of AJNR, confirms that even when high-field MRI is not available, CT can be avoided in the workup of the patient with suspected retinoblastoma, when MRI is combined with a good ophthalmoscopic exam and ocular sonography. Certainly with 3D imaging at 3T, the detection rate with MRI could reasonably be expected to be even higher, allowing us to “Image Gently” and more accurately.
The authors state that “CT is still the method of choice for detecting intraocular calcium … Continue reading >>
In reading the newly e published article in the AJNR “The Effect of Exercise on the Cerebral Vasculature of Healthy Aged Subjects as Visualized by MR Angiography” ( Posted on July 9th), there is positive feedback for those who exercise regularly. But does good plumbing (i.e. the cerebral vasculature), equate with successful aging? Since there have been suggestions that ongoing mental challenges such as solving math problems or completing Sudoku puzzles might be of significant benefit in combating age related mental decline, does anyone think that redirecting a portion of a one hour of physical exercise to mental … Continue reading >>