Multiple cerebellar hemangioblastomas

Multiple cerebellar hemangioblastomas on MR, perfusion imaging (ASL). Two small nodular enhancing lesions, with mild accompanying vasogenic edema, are noted within the cerebellum in this patient with von Hippel Lindau syndrome. Arterial spin labeling (ASL) is an alternative technique to first pass perfusion MR, the latter acquired during bolus gadolinium chelate administration typically using echoplanar […] [...]

Multiple cerebellar hemangioblastomas on MR, von Hippel Lindau syndrome

Multiple cerebellar hemangioblastomas on MR, von Hippel Lindau syndrome. The highly vascular nature of hemangioblastomas is illustrated on this axial thick MIP from a contrast enhanced, 3D gradient echo, short TE, short TR T1-weighted scan. Part of the on-line supplement to Neuroradiology – The Essentials with MR and CT (© 2015) [...]

Multiple cerebral aneurysms, due to myxomatous emboli

Several small lesions with peripheral hemosiderin are noted on the axial T2-weighted scan, one with marked associated vasogenic edema. Comparison of axial source images from a TOF exam both prior to and with contrast enhancement reveals a small focus of enhancement within one of the previously noted lesions. A lateral projection from DSA confirms multiple […] [...]

Multiple sclerosis

The axial FLAIR image reveals numerous punctate, predominantly discrete, small hyperintense foci in the supraventricular white matter. Cord lesions and characteristic callosal lesions on the sagittal FLAIR image confirm the diagnosis of multiple sclerosis, with the caveat that the lesion load is very high in this patient. A post-contrast T1-weighted axial scan reveals lesions without […] [...]

Multiple sclerosis, interval development of a new small callosal lesion on a 2-year follow-up exam

Multiple sclerosis, interval development of a new small callosal lesion on a 2-year follow-up exam. Multiple immediate periventricular small punctate high signal intensity plaques are noted on sagittal FLAIR scans, characteristic for MS. Also present are several plaques within the frontal and occipital white matter. Note the interval development of a small plaque with a […] [...]

Multiple sclerosis, visualization of plaques with differing MR techniques

As with most brain lesions, MS plaques demonstrate low signal intensity on T1- and high signal intensity on T2-weighted scans. Of note is that some MS plaques manifest low signal intensity on T1-weighted scans relative to normal appearing white matter, so called “Black Holes”. These are felt to represent areas of irreversible demyelination and axonal […] [...]

New infarction bordering a chronic infarct, in an 89-year-old patient

The axial FLAIR and FSE T2-weighted scans reveal extensive chronic deep white matter ischemia (with abnormal mild hyperintensity), together with generalized cortical atrophy and more focal atrophy in the left MCA posterior division, reflecting a prior chronic infarct. There is also abnormal high signal intensity adjacent to the largest area of cystic change, which could […] [...]

Non-obstructing clot/thrombus in the basilar artery

Methemoglobin clot is visualized medially within a focal aneurysmal dilatation of the basilar artery on axial and coronal T1-weighted scans. Evaluation of axial T2-weighted and DWI scans reveals a small acute infarct, located within the brainstem just medial to the clot, and presumed to be secondary to occlusion of small paramedian penetrating branches from the […] [...]

Obstructive hydrocephalus, extraventricular, due to meningitis

The ventricles are prominent, with a generalized absence of sulci. There is abnormal high signal intensity on the FLAIR scans in the immediate periventricular region, consistent with interstitial edema due to increased ventricular pressure. On the post-contrast scans there is diffuse mild enhancement of the leptomeninges, consistent with meningitis. Part of the on-line supplement to […] [...]

Occipital lobe hematoma

Occipital lobe hematoma, in an elderly patient with prominent dilated perivascular spaces and extensive cerebral amyloid angiopathy (chronic microbleeds). A large left-sided parenchymal hemorrhage is seen on CT and MR. The CT was acquired 6 days prior to the MR exam. On MR, there is only mild accompanying vasogenic edema (seen best on the T2-weighted […] [...]

Olfactory groove meningioma

A large, midline, extraaxial lesion is noted within the low frontal region, with homogeneous enhancement on post-contrast coronal and axial images. On the former, the lesion is noted to extend inferiorly to the region of the left olfactory bulb. Part of the on-line supplement to Neuroradiology – The Essentials with MR and CT (© 2015) [...]

Oligodendroglioma, WHO grade II

A mass lesion is noted on the right, in the posterior frontal lobe, somewhat peripherally located and expansile in nature. The lesion is hyperintense on T2-weighted scans, and fairly homogeneous in nature. There was no abnormal contrast enhancement (image not shown). In neoplastic disease, choline is increased and NAA decreased, relative to normal brain, a […] [...]

Pilocytic astrocytoma

A large, relatively well-circumscribed, mass lesion is seen involving the right cerebellum in this 3-year old child. There is marked compression of the fourth ventricle and midbrain, with midline shift. There is a large solid enhancing component medially, with a cystic component laterally and enhancement as well of the cyst wall. Note that the cystic […] [...]

Pineal parenchymal tumor (WHO grade III)

An enhancing mass is noted with its epicenter in the region of the pineal gland. The ventricular system is enlarged, due to compression of the cerebral aqueduct. Hemorrhage is common with pineal parenchymal tumors, and is visualized in the current case (specifically hemosiderin, with low signal intensity) on the T2 FSE and DWI scans, but […] [...]

Pituitary macroadenoma with hemorrhage

The sella is expanded by a mass lesion, which extends superiorly to compress the optic chiasm. There is extensive hemorrhage therein, representing a combination of intracellular and extracellular methemoglobin. Note post-contrast the enhanced pituitary infundibulum, draped over the left side of the mass. The coronal scan on the far right of the figure was obtained […] [...]

Schwannoma at C3-4 on the left, within the neural foramen and compressing the cord

An enhancing mass lesion is seen, centered within the neural foramen – the latter is enlarged, indicating that the lesion is long standing in nature. There is marked cord compression, with abnormal high signal intensity within the cord on the T2-weighted exam, indicative of either gliosis or edema. The patient presented clinically with numbness in […] [...]

Recurrent epidermoid

On the FLAIR scan there is a region of abnormal signal intensity, isointense to brain, to the right of the medulla. This could be related to abnormal soft tissue, or simply reflect artifact due to CSF pulsation. On the FSE T2-weighted scan, and the post-contrast T1-weighted scan, the question of subtle abnormal soft tissue in […] [...]

Skull hemangioma, CT

A solitary, sharply marginated, expansile lesion with a sunburst pattern (on images reconstructed with a bone algorithm) is visualized on unenhanced CT. The inner and outer tables of the skull are intact, with the outer table substantially expanded (and the inner table relatively unaffected). The MR in this patient is presented in a separate accompanying […] [...]

Skull hemangioma, MR

A large, well defined, expansile diploic space lesion is noted involving the left frontal bone, with slight hypo- and hyperintensity relative to brain on T1- and T2-weighted images. There is prominent enhancement, due to the presence of abundant vessels therein, which microscopically can be capillary, cavernous, or mixed in type. Part of the on-line supplement […] [...]

Tethered cord

The cord extends to the sacral region, without a change in caliber or distinct conus. The cord ends in a lipoma, with tethering posteriorly. (Case provided courtesy of Reto Sutter, MD, Leitender Arzt, Radiologie, Uniklinik Balgrist, Zürich) Part of the on-line supplement to Neuroradiology – The Essentials with MR and CT (© 2015) [...]

Small acute cerebellar infarct

Small acute cerebellar infarct, superior cerebellar artery (SCA) distribution. A portion of the SCA territory is noted to be involved on the left, with abnormal high signal intensity on both T2- and diffusion weighted scans. The high signal intensity on T2-weighted scans denotes vasogenic edema, with the findings on DWI – specifically restricted diffusion, confirmed […] [...]

Small acute left MCA infarct

Small acute left MCA infarct, with severe chronic small vessel white matter ischemic disease. The CT reveals only severe, bilateral, chronic ischemic disease (with abnormal low attenuation), which is also well seen on the FLAIR scan from the MR exam (with abnormal high signal intensity). The diffusion weighted scan enables detection of a small acute […] [...]

Small cavernous malformation

Small cavernous malformation, best visualized on susceptibility weighted imaging (SWI). Detection of this small, medial, posterior frontal cavernous malformation is poorest on FLAIR, of the presented scans, and best on SWI. Multiple research articles in the scientific literature have shown that SWI is more sensitive for detection of cerebral cavernous malformations than T2-weighted gradient echo […] [...]

Small solid lateral cerebellar hemangioblastoma, in a patient with von Hippel Lindau syndrome

Small solid lateral cerebellar hemangioblastoma, in a patient with von Hippel Lindau syndrome. A small nodular enhancing lesion, with mild surrounding vasogenic edema, is noted in the right cerebellar hemisphere. The appearance on imaging is not specific for any one diagnosis, with metastatic disease likely first in terms of differential diagnosis, in the absence of […] [...]

Small solid superior cerebellar hemangioblastoma

Small solid superior cerebellar hemangioblastoma on MR, with perfusion imaging. Very high CBV is noted in a small nodular enhancing lesion, consistent with a hemangioblastoma, in this 41 year old patient with von Hippel Lindau syndrome and multiple other parenchymal lesions. Although 60% of hemangioblastomas of the brain are cystic, with a mural nodule, 40% […] [...]

Subacute parenchymal hemorrhage

A small fluid collection is noted in the superior left thalamus, with a complete hemosiderin rim demonstrated on the coronal T2* GRE scan. This 50 year old patient presented with a hypertensive hemorrhage on CT in the left thalamus 2 months prior to the MR. The residual of such bleeds on MR can be as […] [...]

Subacute PICA infarct

There is abnormal high signal intensity on T2- and diffusion-weighted axial scans in the left PICA territory. The ADC map however does not demonstrate restricted diffusion, thus identifying the findings on DWI to represent “T2 shine through”. The absence of a true diffusion change dates the infarct to be more than 1 week old, thus […] [...]

Subacute PICA infarct (including AICA)

Subacute PICA infarct, which also includes the AICA territory. Sagittal and axial CT sections reveal abnormal low attenuation in both the PICA and AICA territories (the inferior cerebellum). Note that the tonsil is involved (visualized on the axial CT exam), which is part of the PICA territory. On MR, there is abnormal high and low […] [...]

Superior cerebellar artery aneurysm

A predominantly hyperintense lesion is noted on the right, anterior to the pons, causing mild adjacent deformity. Additional scans identify the abnormal high signal intensity to represent methemoglobin, in a SCA aneurysm that is predominantly thrombosed and has only a small residual patent component (medially). The TOF exams, with thick coronal and axial MIPs illustrated, […] [...]

Temporal evolution of a cerebral hematoma on CT

The patient presented with trauma from a fall, with the first scan shown 5 days after hospitalization. The follow-up scan was obtained a month later. A large left acute (hyperdense) occipital hematoma is noted with moderate surrounding vasogenic edema (hypodense). A month later there has been evolution of the hematoma in its CT appearance, with […] [...]

Tentorial meningioma

A large extra-axial mass lesion is seen with a broad base along the tentorium. Note the compression of the cerebral peduncles, best seen on the axial exam. A classic finding is also seen, for the diagnosis of a meningioma, specifically a CSF cleft circumferential to the lesion (well visualized on the axial scan). Such a […] [...]

Thrombosis of the superior sagittal sinus with resultant parenchymal hemorrhage

Axial and coronal enhanced CT scans reveal parenchymal hemorrhage in the left frontal lobe. Also note the empty delta sign on the coronal scan, consistent with thrombosis of the superior sagittal sinus. The hemorrhage and accompanying vasogenic edema are well seen on the T2-weighted GRE scan, with the low signal intensity consistent with either deoxyhemoglobin […] [...]

Utility of B0 images and BLADE, for T2-weighted scans in uncooperative patients

A multishot DWI with b=1000 reveals an infarct involving the left caudate head that age wise is < 7-10 days (demonstrating restricted diffusion, which was confirmed on the ADC map, not show). The b=0 image is slightly less blurred, on the basis of patient motion, given that this is a single image acquisition, as opposed […] [...]

Ventriculitis

On the T2-weighted scan there is subtle abnormal signal intensity (slightly less than normal CSF) in the posterior portion of the atria of the lateral ventricles. Abnormal high signal intensity (restricted diffusion) is present in this area on the diffusion-weighted scan, with ependymal enhancement post-contrast, both findings consistent with infection. Part of the on-line supplement […] [...]

Case Report: Assessment of Renal Allograft Function with DTI and Tractography

The article discusses technical considerations and various clinical applications of the DESS sequence. 3D DESS techniques have advantages in assessment of pediatric cartilage pathology including higher SNR, increased cartilage-to-fluid contrast and isotropic resolution, which helps to reduce partial volume effects. 3D DESS techniques are also of essential importance in the pediatric population due to the lack of ionizing radiation. [...]

Clinical MRI

This textbook is made available courtesy of the author and copyright holder, Val M. Runge, MD, for individual educational use only, both for viewing on the web and for download. [...]

Imaging of Cerebrovascular Disease

The portions of this textbook listed are made available for viewing on the web only, as a courtesy of the publisher, Thieme. Five cases are available permanently on the site, and five cases rotate each month so that over a two year time period, the entire content of the textbook is covered [...]

Essentials of Clinical MR, 2nd edition

Essentials of Clinical MR, 2nd edition 1 Cover 2 Title, Editors 3 Table of Contents 4 Foreword 5 Preface 6 Contributors 7 Acknowledgments 8 Abbreviations 9 Dedication Section I – Brain Chapter 1 Supratentorial Brain Neoplasms Chapter 2 Infratentorial Brain Neoplasms Chapter 3 Metastatic Brain Disease Chapter 4 Meningiomas Chapter 5 Internal Auditory Canal Neoplasms Chapter 6 Sellar_Parasellar Neoplasms Chapter 7 Diploic […] [...]

Essentials of Clinical MR

The portions of this textbook listed are made available for viewing on the web only, as a courtesy of the publisher, Thieme. Five cases are available permanently on the site, and five cases rotate each month so that over a two year time period, the entire content of the textbook is covered [...]

Clinical 3 T Magnetic Resonance

The portions of this textbook listed are made available for viewing on the web only, as a courtesy of the publisher, Thieme. Five cases are available permanently on the site, and five cases rotate each month so that over a two year time period, the entire content of the textbook is covered [...]

The Physics Of Clinical MR Taught Through Images

The portions of this textbook listed are made available for viewing on the web only, as a courtesy of the publisher, Thieme. Six cases are available permanently on the site, and five cases rotate each month so that over a two year time period, the entire content of the textbook is covered. [...]