Epidural hematoma, spine, illustrating image composition

Composed sagittal T2-weighted, T1-weighted, and post-contrast T1-weighted images are presented. Each image is an automatically generated composition of two high-resolution independent cervicothoracic and thoracolumbar image acquisitions. The patient was on aspirin and Plavix, and presented with urinary retention and poor anal sphincter tone, consistent with a lesion compressing the conus medullaris. A predominantly deoxyhemoglobin epidural […] [...]

Hydatid cysts of the sacrum, ileum and L5

In the spine, with hydatid disease, there is typically slow resorption of trabeculae, without bony expansion, with a conglomeration of daughter cysts. This accounts for the multilocular appearance on MR, with high signal intensity on T2-weighted sequences. (Case provided courtesy of Reto Sutter, MD, Leitender Arzt, Radiologie, Uniklinik Balgrist, Zürich) Part of the on-line supplement […] [...]

Paget disease of the lumbar spine and pelvis

Both the L1 and L2 vertebral bodies (together with their respective posterior elements) are involved, with the vertebral bodies expanded in the antero-posterior dimension and L2 a characteristic “picture frame” vertebra. There is involvement as well of the pelvis together with the sacral vertebral bodies. Coarse and thickened trabeculae are particularly evident in the iliac […] [...]

Cholesterol granuloma

A large expansile lesion is noted in the right petrous apex, hyperintense on both T1- and T2-weighted scans, without diffusion restriction or internal contrast enhancement. The imaging findings are characteristic, with one exception – that a peripheral hemosiderin rim is not present. The lesion was resected through a transnasal, transclival route. Part of the on-line […] [...]

Cerebral abscess

A small lesion with a thin, uniform rim of contrast enhancement and moderate associated vasogenic edema is noted in the left postcentral gyrus. Note that the periphery of the lesion is slightly hypointense on the coronal FLAIR scan, which is characteristic of an abscess, together with restricted diffusion (well seen in this patient, but with […] [...]

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 […] [...]


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 […] [...]