The “Clinical Cases” section provides selected images, along with a short relevant discussion, from patient exams, contributed by the MR expert network community. This section will with time cover the breadth of clinical MR. Important aspects of imaging technique and clinical findings will be discussed. Each case will also include a downloadable file (corresponding to each presented image), enabling the user to replicate on his/her MR system the specific imaging technique employed.

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. [...]

Tethered spinal cord

This 6-year-old girl was referred to physical therapy for baseline evaluation in the spina bifida clinic and for assessment of neurogenic bowel and bladder dysfunction. At birth, this patient was diagnosed with sacral dysgenesis along with tethered cord and a lipoma within the sacral spinal canal. [...]

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. [...]

Juvenile Nasopharyngeal Angiofibroma

16 year-old male presenting with difficulty breathing through his nose, nightly snoring, stridor and recurrent infections of the upper airway. Inspection shows a red, tumor-like lesion along the posterior wall of the nasopharynx. [...]

Moderate-sized ASD and a tiny septal VSD

This is a 16-year-old female with a known history of hypoplastic right ventricle, who was being evaluated for three episodes of dizziness on standing, each lasting 5-10 minutes. [...]

Anterior Cruciate Ligament Disruption

.ima file Zip Download .ima file Zip Download .ima file Zip Download Clinical Topic Orthopedics Subtopic Trauma Examination Region Knee Key Points ACL disruption Bone marrow contusion Image Findings A complete ACL disruption is demonstrated. (ACL = Anterior Cruciate Ligament; figure A) Bone marrow contusion is seen involving the lateral femoral condyle. (figures B and C) Images Sagittal […] [...]

Perthes Lesion – Anterior Labral Separation

26 year old man who presents clinically following an anterior inferior dislocation of the left shoulder, with subsequent ventral instability [...]

Enchondroma

This 33-year-old man presented to clinic with left shoulder pain of two months duration, radiating to his fingertips. Plain film radiographs and a MR examination revealed a focal lesion in his left humeral metaphysis which was found to represent an enchondroma. [...]

Liposarcoma

This 64 year old man presented to his primary care physician complaining of hematuria. On MR examination, a mass was found in his left upper groin which was confirmed to be a liposarcoma on subsequent biopsy. [...]

Myxoid Chondrosarcoma

This 65-year-old man presented to clinic with a tender mass in the anteromedial portion of his right midthigh which had enlarged over a year’s time. He further complained of nonspecific associated symptoms, including paresthesias and occasional temperature changes in his right leg. Following the illustrated MR examination, the patient was referred for evaluation by surgical oncology. [...]

Nonossifying Fibroma

This 23-year-old woman presented to clinic complaining of right thigh pain over the last year, worse with weightbearing and at night. The subsequent plain film radiograph and MR examination revealed a lesion within the distal femoral metadiaphysis. Biopsy showed findings consistent with a nonossifying fibroma. [...]

Tenosynovial Giant-cell Tumor

This 28-year-old woman presented with an approximately 3 year history of slowly-progressive left ankle pain, worse with movement and at the end of the day. After detection of the illustrated mass, surgery was performed with pathologic examination confirming a tenosynovial giant-cell tumor. [...]

Synovial Sarcoma (monophasic fibrous type)

This 20-year-old man presented with increasing pain and swelling in his left shoulder—an ongoing problem for the prior three months. Physical exam revealed a slightly tender, indurated mass with normal overlying skin. [...]

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. [...]

Enchondroma

This 41-year-old female presented to clinic with continued pain and swelling in her left fifth finger. She reported an extensive history of injuries to that finger over the last 20 years. The patient’s MRI, illustrated below, revealed a lesion in the proximal phalanx of the left fifth finger which was confirmed as an enchondroma by subsequent surgery. [...]

Gout

This 56-year-old female presented to clinic complaining of right foot pain and swelling for the last year, particularly involving the base of the fifth metatarsal and the 3rd toe. A hard, painful nodule involving the base of the patient’s fifth metatarsal was noted on physical exam. [...]

Liposarcoma

This 56 year old man presented to clinic complaining of a mass within the musculature of his medial right thigh that had appeared approximately 5 months ago. The patient denied any associated pain or tenderness. On the illustrated MR examination, a mass was found which was confirmed as a liposarcoma by pathologic evaluation following its surgical removal [...]

Neurofibroma

This 35-year-old female presented to clinic complaining of pain and swelling posterior to her right knee of approximately 3 months duration. Physical examination confirmed the presence of a soft tissue mass in the patient’s right posterior lower leg. An MRI scan demonstrated a well-defined oval lesion, confirmed to be a neurofibroma by subsequent surgery. [...]

Ollier Disease

This 17-year-old girl initially presented as a toddler and has since suffered from multiple complications related to Ollier disease, particularly in regard to her left femur. Disease involvement initially also included the left hemipelvis. The patient subsequently underwent multiple procedures involving the femur for the correction of pathologic fractures and leg-length discrepancies. Her most recent surgery, one year ago, consisted of curettage and bone grafting of lesions in her left iliac wing and proximal femur. [...]

Osseous Lymphoma

This 92-year-old female presented to clinic with chronic right shoulder swelling and pain of several months duration which had become more severe in last 10 days. Her past history includes a diagnosis of lymphoma in the early 1980’s—a non-Hodgkin stage IIE variety with favorable histologic status. She underwent 4 cycles of CHOP therapy followed by radiation treatment. Lymphomatous involvement was initially found in her right salivary gland, right submandibular gland, and left inner cheek. Plain film radiographs and the illustrated MR examination of the patient’s right arm revealed an ill-defined mass involving right humeral metaphysis. [...]

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. [...]

Osteosarcoma

This 28-year-old man presented with increasing pain and swelling in his right shoulder for more than four months. Physical exam revealed an obvious swelling, with overlying normal skin, involving the right shoulder. Because of the swelling and pain, movement of the joint was restricted. [...]

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. [...]

Metastatic Vertebral Disease

This 56-year-old male with a history of renal cell carcinoma presented to his primary care physician complaining of intractable back pain for one week. The MR examination performed for further assessment is given. [...]