Vestibular Schwannoma

68 year old man with bilateral hearing loss. [...]

Chiari I Malformation

This is a 21-year-old male with recent headaches. The headaches are described as intermittent throbbing and result in numbness, tingling, and blurred vision. [...]

Chiari II Malformation

This is an 11-year-old male being followed for loss of cognitive abilities and facial paralysis. [...]

Arteriovenous malformation

22 year old man with left sided sensory seizures. The seizures are of focal onset, typically affecting the left arm and shoulder, with radiation to the entire left side within 2-3 seconds. He describes the seizures as an electric burning feeling that “is not pain”. [...]

Cavernous malformation or a “Cavernoma”

This is a 43 year old male with chronic headaches in the occipital region with nausea, visual disturbances, tinnitus, and vertigo. [...]

Capillary telangiectasia

27 yr old woman presented with sudden onset of hearing loss in the right ear, severe headache, dizziness, double vision six years ago. MRI of the brain at that time revealed an incidental finding of capillary telangiectasia in the right pons. During recent visit to the hospital follow up MRI was performed. [...]

Vestibular Schwannoma

57 year old man with progressive hearing loss on the left side and sensory loss of cranial nerves V2 and V3. [...]

Arteriovenous Malformation

This 43-year-old female presented to clinic with a severe headache and neck neck pain for the last two weeks. This was associated with intermittent mental status changes. [...]

Meningioma

This 62-year-old woman presented with a six month history of nausea and vomiting. Recently, the woman complains of dysosmia, experiencing the smell of ammonia. These dysosmiac episodes last for several minutes but have recently increased in frequency. [...]

Optic Sheath Meningioma

This 54 year old female patient presented with subtle, progressive, partial loss of sight involving the left eye. Clinical exam showed papilledema and atrophy of the optic nerve on the left. [...]

Suprasellar Germinoma

This 24-year-old woman presented clinically with ongoing intermittent headaches most severe in the frontal region. On physical exam, she was found to have bilateral optic atrophy and a right homonymous hemianopia. The patient was noted to have a mass on subsequent CT and MRI examinations. She underwent a frontal temporal biospy of the mass which pathologically confirmed the presence of a germinoma. [...]

Metastatic Pituitary Disease

This 53-year-old woman presented to oncology clinic complaining of new-onset headaches over the last week. In particular, these occurred intermittently, involving the region of her right eye. She also reported new-onset diplopia. The patient had a history of cervical cancer with metastatic lesions to her lungs, which were found 6 months previous. The patient’s MR examination is given, and endoscopic transnasal tumor resection was subsequently performed. [...]

Pituitary Macroadenoma

This 64-year-old man presented clinically with a complaint of vision loss over the last year. Ophthalmologic exam revealed a bitemporal hemianopsia and the patient was referred for MRI. A prolactin level was normal. The lesion was subsequently resected via an intranasal approach. [...]

Oligoastrocytoma

This 23-year-old male presented to the emergency room complaining of new-onset seizures. A subsequent MR examination revealed intra-axial large brain mass. This was found to be a low-grade glioma. This mass was biopsied and found to represent a low-grade oligo-astrocytoma. [...]

Astrocytoma

This 31-year-old man presented to the neurology department with progressive dizziness for two months along with new-onset seizures, vomiting, and weakness. He reported no history of fever or traumatic head injury. An MRI was performed for further assessment. [...]

Cavernoma

This 35-year-old woman presented to neurology clinic with a one week history of increasing confusion and new-onset seizures. Following MRI illustrated here, the patient underwent surgical treatment for the lesion illustrated herein. [...]

Brain Abscess

This 35-year-old man presented to the emergency department complaining of intermittent headaches, paresthesias, and weakness of his left thumb for nine days. The patient reported a history of fever along with these symptoms. After the MRI examination illustrated herein, the patient underwent successful surgical treatment. [...]

Cerebellar glioma

This 4-year-old boy presented to his pediatrician with ataxia and vomiting for several months. After undergoing the MRI, images from which are displayed below, the child was diagnosed with a cerebellar glioma. A VP shunt was placed emergently, although the tumor was not removed secondary to its location. The child underwent radiation therapy with modest improvement. [...]

Thalamic glioma

This 67-year-old man presented to the neurology department with increasing dizzy and weakness for approximately six months, together with restricted movements of the left upper and lower extremity. [...]

Arachnoid cyst

This 23 year old female, 21 weeks into pregnancy, complained of a history of headaches over the past several years. In the past 2 weeks, however, the headaches had worsened significantly in severity and the patient had experienced associated nausea, vomiting, photophobia, right-sided temporal and retro-orbital pain. Following the MR examination presented below, the patient underwent a right parietal craniotomy with fenestration of CSF arachnoid cyst, connecting it with the right lateral ventricle. [...]

Chiari I malformation

This 50-year-old female, who reported a history of being in a motorcycle accident approximately two years ago, complained of a one year history of severe headaches and neck pain. An MR examination revealed degenerative disease in the cervical spine associated with a Type 1 Chiari Malformation. [...]

Technical Considerations in Brain DWI

To provide imaged-guided instruction of technical considerations of diffusion-weighted imaging (DWI) for neuroradiologists. [...]

Ewing Sarcoma

This 15-year-old young boy presented clinically with a complaint of slow onset of a temporal headache, with subsequently vomiting which being serious in the last several weeks. After a physical exam that revealed swelling in the region of the right temporal bone with local tenderness, the patient was referred for a MR exam and received subsequent surgical treatment. [...]

Cerebral Magnetic Resonance Spectroscopy at 1.5T and 3T

MR spectroscopy is a powerful technique that adds metabolic information to routine MRI brain examinations. Through four cases, this article provides tips for performing cerebral MRS. Examples of additional information using this technique include differentiating cerebral neoplasms from abscesses and distinguishing solitary primary cerebral neoplasms from solitary cerebral metastatic deposits. [...]

Introduction to Advanced Techniques in MR Neuroimaging

This article provides a comprehensive introduction to advanced techniques in neuroimaging, including fMRI, DTI, DWI, ASL, SWI. [...]

AutoAlign

Three series of scout images, to be used for slice positioning in a MR scan of the brain, are illustrated. The first is a typical scout (1), using 2D FLASH technique, with images acquired, as is common today, in the three orthogonal directions. These three directions (sagittal, coronal, and axial) are respective to the main magnetic field, but not to the anatomy of the patient. Note that the patient is less than perfectly positioned, a common occurrence in clinical practice, with the cause multifactorial. The second series of scout images (2) is acquired using a 3D VIBE scan, with the scan time however no longer than for the acquisition of the three scouts shown in (1), approximately 15 seconds. Illustrated are the images already after the initial iteration in slice positioning by the AutoAlign algorithm. The third series of scout images (3) is the final result from AutoAlign, which is produced automatically without user intervention. The axial images have been correctly chosen to span the brain from the vertex to the skull base, the plane of reference (alignment) has been chosen to be the equivalent of the AC-PC line (anterior commissure to posterior commissure), and the images are orthogonal to the coronal plane. [...]

Cerebral amyloid angiography using SWI

Compared to conventional T2*-weighted imaging, a susceptibility-weighted imaging technique is very sensitive in the detection of small bleedings and vascular malformations. This case report shows that SWI is a sensitive tool for the precise assessment of CAA. His findings show that by using SWI, multiple small cortical and subcortical bleedings can be depicted in detail and can show the extent of the severity of CAA better than with conventional T2*-weighted MRI only. [...]

RESOLVE, Multishot Echoplanar Diffusion Weighted Imaging

Scans were acquired at 1.5 T with a typical diffusion weighted echoplanar (EPI) scan sequence (A), and also with a RESOLVE work-in-progress (WIP) scan sequence (B). RESOLVE is a multi-shot technique that uses 2D navigator correction with readout-segmented EPI (ISMRM 2004, p442). Axial scans of the brain in a normal volunteer, at the level of the petrous apices, are presented. The conventional single shot sequence was acquired (with complete coverage of the brain) in 0:54 min:sec. The RESOLVE (multishot) scan was acquired in 3:02 min:sec. A parallel imaging factor of 2 was used for the single shot acquisition, with no parallel imaging employed with the multishot acquisition. Partial Fourier was employed in (A), resulting in a shorter scan time but also some image blurring when compared to (B). [...]

T1 SPACE for Improved Detection of Brain Metastases

T1 SPACE provides in a reasonable scan time a high resolution 3D acquisition of the brain, with improved detection of brain metastases when compared to MP-RAGE, and is advocated as the scan of choice at 3 T [...]

New Non-Contrast MR Techniques (for MR angiography and tissue perfusion)

NATIVE enables excellent non-contrast MR angiographic imaging, with reproducible results. This new software/scan approach is particularly important given that the use of intravenous contrast media has come under recent increased scrutiny. Of relevance, the gadolinium chelates (and specifically the less stable agents in this class), which are used as MR contrast agents, have been linked to a condition called Nephrogenic Systemic Fibrosis (NSF) that can occur in patients with renal insufficiency. [...]

Improved Workflow and Performance for Contrast-Enhanced MR Angiography Sequences

Recent improvements in TWIST (dynamic contrast enhanced MRA) and more conventional non-dynamic contrast enhanced MRA are discussed. [...]

Low-grade malignant fibrous histiocytoma

This 9-year-old boy presented with vision loss in the left eye for more than one year. Ophthalmologic exam revealed no organic lesion and the patient was referred for an MRI. The lesion was subsequently resected. [...]

Fibroepithelial papilloma

This 46-year-old woman presented clinically with a complaint of gradual hearing impairment in the right ear for three years. Physical examination revealed the right parotid gland region to be swollen, with a medium-hard palpable mass. [...]

Evaluation of a Modified Stejskal-Tanner Pulsing Scheme for DWI Allowing a Marked Reduction in Echo Time at 3 T

To evaluate a modified Stejskal-Tanner diffusion gradient pulsing scheme that achieves a markedly shorter TE, by applying diffusion encoding during the entire time between the two requisite radiofrequency pulses, with respect to SNR, overall diagnostic image quality, bulk susceptibility artifact, and resulting spatial distortions (which were quantified). [...]

Diagnostic Relevant Reduction of Motion Artifacts in the Posterior Fossa by syngo BLADE Imaging

Although movement and pulsation artifacts are a frequent problem in daily routine, especially in the evaluation of pediatric patients, few articles on this topic can be found in the literature. Experience from Stuttgart shows that MR images of the posterior fossa, cerebellum and brain stem may be significantly impaired by artifacts from pulsatile flow of blood or cerebrospinal fluid even without inadvertent patient head movement. Sedation or general anesthesia rarely influence these pulsation or flow artifacts. However, accurate assessment of small brain lesions is essential in many pediatric patients, especially those with malignant brain tumors. BLADE reduces movement and pulsation artifacts in T2w FLAIR images without relevant loss of image quality. It therefore markedly improves depiction of small and low contrast brain lesions in the posterior fossa of pediatric patients. This can be crucial especially following surgery of malignant brain tumors. In the absence of major artifacts, in this study, lesions of all sizes were depicted with comparable quality by both techniques (BLADE vs conventional FSE technique). [...]

32-Channel Head Coil Imaging at 3T

Advanced head coil design with 3T imaging substantially improves the available signal-to-noise ratio (SNR), making possible a substantial reduction in scan time, the use of advanced parallel imaging, high spatial resolution imaging (reduced voxel size in 3D acquisitions, whether for imaging of the brain itself or the vasculature) and implementation of innovative imaging techniques. [...]

ADVANCED CLINICAL BRAIN IMAGING AT 3 T

SNR and Parallel Imaging Improvements Offered by a 32 Channel Head Coil Design Advanced head coil design with 3 T imaging substantially improves the available signal-to-noise ratio (SNR), making possible a significant reduction in scan time, the use of advanced parallel imaging, high spatial resolution imaging (reduced voxel size in 3D acquisitions, whether for imaging of the brain itself or the vasculature) and implementation of innovative imaging techniques. The use of higher parallel imaging factors in conventional diffusion-weighted echoplanar imaging (EPI), together with the implementation of a fast spin echo (FSE) based BLADE diffusion-weighted scan is illustrated in patients with acute infarction (the latter free of bulk susceptibility artifact and geometric image distortion). [...]

Case Report: Cortical Dysplasia

This clinical case report details the use of a 32 channel head coil and 3 T for improved visualization of presumed cortical dysplasia in a pediatric patient. [...]

Clinical Neurological Imaging on an Open Bore MRI System (MAGNETOM Espree)

An open bore MRI has the practical advantage of accommodating large or claustrophobic patients. Unfortunately, until the advent of the 1.5T MAGNETOM Espree, “open” was often synonymous with inferior image quality. However, in addition to the large 70 centimeter bore, the Espree system offers advanced coil combinations using the Total imaging matrix (Tim) and isocenter imaging technology. Together, these features allow for performance of advanced neuroimaging protocols in new clinical populations. [...]