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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...
Category Archives: Head and Neck
Decade of Advances in Head and Neck Tumor Imaging Reviewed in Latest AJNR Special Collection
“Head and Neck Neoplasms” is the new Special Collection from the American Journal of Neuroradiology. Collection Editor Christine M. Glastonbury of the University of California, San Francisco assembled the articles by adopting the perspective of an academic, but predominantly clinical, neuroradiologist. “My bias was toward articles that I have found particularly useful in clinical practice, what I see incorrectly reported at tumor board cases, or that I view as having exciting clinical potential,” she explained.
The collection is arranged in three parts reflecting the core of head and neck imaging: squamous cell carcinoma, other malignant and benign … Continue reading >>
Aunt Mickey (They Look the Same until You Undress Them). Carotid-Cavernous Fistula or Something Else?
A middle age woman presented with left progressive proptosis. A contrast enhanced CT was done and showed enlargement of the left superior ophthalmic vein on the axial plane (see below). A coronal image confirmed this abnormality and demonstrated that the extraocular muscles and retro-orbital fat had a normal appearance.
Physical examination showed no chemosis, vision loss or cranial nerve palsies. Because of this the patient was brought back for repeat contrast enhanced CT of the orbits with Valsalva maneuver. This study showed mild additional enlargement of the already prominent left superior ophthalmic vein and also of the right sided one … Continue reading >>
The Microcirculation in the “Target Node“ as Outcome Prognosticator: Facts and Implications
In the recent paper of Kim et al. [1], the authors attempt for first time to examine the relationship between pharmacokinetic parameters, obtained by dynamic contrast-enhanced (DCE)-MRI, of a metastatic target node and treatment outcome in patients with neck cancer. The paper makes 3 important contributions to the DCE neck imaging: 1) adding to the evidence gained by Cao et al. [2], Kim et al. derived (based on a two-compartment pharmacokinetic model) quantitative perfusion-associated parameters 2) similarly to the work of Bisdas et al. [3] microcirculation parameters (other to blood flow, blood volume, and permeability) such as Ktrans (transfer constant), … Continue reading >>
Neonatal Pituitary Gland
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 >>
CT Still Useful for Retinoblastoma?
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 >>
Trigeminal Cystic Schwannomas
We present two cases of cystic lesions in the Meckel’s cave, both of which showed fluid-fluid levels on MR images and are consistent with trigeminal cystic schwannomas.
Fluid-fluid levels are the result of mucinous areas or microcysts, or as a result of necrosis and hemorrhage. The fluid is unclotted blood against serous fluid. In addition, in areas of necrosis, the fluid that fills a necrotic cavity early on tends to be more proteinaceous than newer interstitial fluid. In such cases, fluid separation, based on viscosity and protein content, may occur. When fluid levels are seen in masses arising from nerves, schwannoma … Continue reading >>
Window Setting for Calcified Carotid Plaques on CTA
Comment on: L. Saba and G. Mallarini. Window Settings for the Study of Calcified Carotid Plaques with Multidetector CT Angiography. AJNR Am J Neuroradiol first published on March 19, 2009 as doi: 10.3174/ajnr.A1509
In a technical note entitled “Window Settings for the Study of Calcified Carotid Plaques with Multidetector CT Angiography”, Drs. L. Saba and G. Mallarini evaluated how neuroradiologists who are reviewing CT-angiograms of the carotid arteries tend to spontaneously adjust their selection of CT window level and width, in order to accurately quantify the degree of carotid stenosis. They observed that, in the presence of calcified carotid plaques, … Continue reading >>
Thyroid Nodules and Diffusion
This month (Feb. 2009), there is an article in AJNR regarding differentiating cold thryoid nodules as benign vs. malignat on DWI. link: http://www.ajnr.org/cgi/content/full/30/2/417. A similar article by Bozgeyik et al (abstract below) appeared in the March 2009 issue of ‘Neuroradiology’ (see below). The current article in AJNR reports that malignant thyroid nodules demonstrated increased ADC values compared with benign ones, whereas the article in Neuroradiology reports lower ADC maps for malignancy. Similarly the article by Razek et al in March, 2008 AJNR (link: http://www.ajnr.org/cgi/content/full/29/3/563) reported lower ADCs for malignant nodules.
Does anyone have any thoughts on possible reasons … Continue reading >>
RE: DWI for Head and Neck Lesions – Acute Ischemic Optic Neuropathy
Here’s another case for the value of DWI for head and neck lesions.
This patient had left central retinal artery occlusion and acute ischemic optic neuropathy. There is restricted diffusion in the anterior left optic nerve which is much more obvious than the mild perineural enhancement on coronal postcontrast images.