-
DDx: Rim enhancing mass(es) with surrounding vasogenic edema
"MAGIC"
- Metastases(es) - Shaggy inner wall, DWI - usually
- Abscess(es) - smooth rim enhancing inner wall, DWI+, fever
- -Bacterial
- -Toxoplasmosis
- Glioma - usually aggressive if vasogenic edema is present, DWI - usually
- Infarcts - DWI +, no fever
- Contusions - trauma
-
Subdural collection with enhancement of the rim
- Subdural empyema
- -correlate with patient's clinical status to exclude hematoma
-
Edema in the temporal lobes or involvement of inferior frontal lobe and opposite insula
HSV 1 infection
-
bilateral insular and temporal lobe involvement
Think HHV 6
-
DDx: Leptomeningeal enhancement
- Meningitis
- Tumor
- Sarcoidosis
-
DDx: Basilar Leptomeningeal Enhancement
- TB
- Sarcoid
- Metastases
- Lymphoma
-
Imaging findings of different types of meningitis
- •Aseptic (viral): few imaging findings, early dilation of temporal horns
- •Bacterial: mild enhancement, obliteration of CSF spaces
- •Fungal/TB: thick exudates often at base of brain
-
Acute vs Chronic meningitis means what type of infections?
- acute (viral, bacterial)
- chronic (fungal, TB)
-
Diffuse cystic lesions in the brain without edema
Cysticercosis
- •Agent: Taenia solium (pork tapeworm)
- •Hematogenous spread
- •Involves: parenchyma, ventricles, CSF
- •Early: Mild inflammatory response (unenhancing)
- •Late: larval death, profound inflammatory response cyst, mural nodule
-
Progressive atrophy of the brain and diffuse white matter abnormalities
HIV encephalitis
-
Progressive atrophy of the brain and focal white matter abnormalities
Progressive Multifocal Leukoencephalopathy
-
Meningeal enhancement including lat vents, gelatinous pseudocysts in VR spaces (T2 hyperintense)
Cryptococcal infection in AIDS
-
Ovoid-finger like WM lesions arranged perpendicular to the lateral ventricles, usually symmetric
Multiple sclerosis
"Dawson's fingers"
-
Locations other than periventricular WM to find MS
- spinal cord
- middle cerebellar penduncle
-
Area of low density on CT and low signal on T1 MR with a rim of enhancement only on one side of the lesion
Tumefactive MS
-
Assymetric WM lesions shortly after viral infection or vaccination
ADEM (acute disseminated encephalomyelitis)
-
Posterior WM demyelination with thin rim of enhancement indicated rim of demyel.
Adrenoleukodystrophy
-
Subcortical T2 hyperintense lesions on WM with vent enlargement
Krabbe DZ
-
Tigroid appearance with extensive involvement of entire WM, with prominent cerebellar involvement
Metachromatic Leukodystrophy
-
Large head–Generalized white matter abnormality–Elevated N-acetyl aspartate (NAA) on MR spectroscopy
Canavan's DZ
-
DDx: Vascular causes of WM dz
- Vasculitis (e.g., Systemic Lupus Erythematosus) - young female typically not periventricular
- Lacunar Infarctions - older patients, HTN, dementia
- Vascular Malformations
-
Hyperintense T2 signal in pons, rapid sodium correction causes
Central pontine myelinolysis
-
Older patient with diffuse, symmetric WM hyperintensity on T1
Methotrexate
-
Corpus callosal and WM abnormality with history of trauma
Diffuse axonal injury
-
DDx: Intramedullary spinal lesions
- •Syrinx
- •Spinal cord tumors
- –Glioma/Astrocytoma
- –Pilocytic astrocytoma
- –Ependymoma
- –Hemangioblastoma
- –Metastases
- •Trauma
- •Demyelinating disease
- •Granulomatous disease (SARCOID)
- •Myelitis (inflammatory, vasculitis)
- •Dural Venous Fistula
-
DDx: cyst in the spinal cord without enhancment or nodular component
Chiari I with a central cord syrinx
-
DDx: cyst within the spinal cord with solid enhancing component
"HEMP MET"
- smaller nodular component - ependymoma - more focal, curvilinear nodular enhancement
- myxopappillary ependymoma - larger, usually at level of filum terminale can extend to cervical cord
- pilocyticastrocytoma - larger enhancing nodular component
- met
-
DDx: Focal signal abn in spinal cord with circumscribed enhancement
- Metastasis
- Ependymoma
- Hemangioblastoma(without associated cyst)
- Cavernoma(without prior hemorrhage)
- Demyelinatingdisease
- Sarcoid
-
DDx: Focal signal abn with ring enhancement in spinal cord
- Metastasis
- Ependymoma (typically more solidly enhancing)
- Demyelinating disease(typically more diffusely enhancing)
- Sarcoid
- Lymphoma
-
DDx: Focal signal abn with diffuse fuzzy enhancement in spinal cord
- Metastasis
- Demyelinating DZ
- Sarcoid
- Lymphoma
- Glioma, Astrocytoma
-
DDx: Diffuse signal abn in the spinal cord with multiple focal and ill-defined areas of enhancement
- Metastases
- Demyelinating dz
- Sarcoid
- Lymphoma
- ADEM
- Lupus vasculitis
- Glioma, Astrocytoma
-
DDx: Diffuse signal abn in the spinal cord without contrast enhancement
- Demyelinating Dz
- Sarcoid
- Lymphoma
- ADEM
- Lupus vaculitis
- Glioma, Astrocytoma
- Spinal cord infarct
-
Flow voids on T2WI on surface of cord and punctate enhancement
Spinal dural AVF
-
Intradural extramedullary spinal lesions
- •Tumors
- –Myxopapillary ependymoma
- –Neurofibroma
- –Schwannoma - ring enhancing
- –Meningioma - avid enhance, may Ca2+
- –Metastases - multiple
- –Dermoid/Epidermoid
- •Vascular lesions
- •Arachnoid cyst
- •Lipomas
- Disc herniation - ring enhancment, doesn't enlarge neural foramen
-
DDx: Multiple rounded contrast enhancing lesions through out the subarachnoid space.
Drop mets vs neurofibromas
-
Lesions which have drop mets in or around the cord
- Germinoma
- Pinealblastoma
- Pilocyticastrocytoma
- Ependymoma
-
DDx: Heterogenous mass in cord; high on T1 and T2; no enhancment
- Complex lipoma
- Melanoma
- Dermoid
- Cavernoma
-
Common mets to spine
- –Breast
- –Prostate
- –Lung
- –kidney
-
osteoblastic mets
- –Prostate
- –Breast
- –Carcinoid
- –Ovarian
- –TCC
- –lymphoma
-
Decreased density in the spine
- 1. Osteoporosis (central lucency)
- 2. Paget’s (thickened cortex)
- 3. Osteomalacia
- 4. Multiple myeloma (punched out, striations)
-
Increased density in the spine (ivory verteberal body)
- 1. Paget’s
- 2. Lymphoma
- 3. Infection
- 4. Metastasis
- 5. hemangioma (striated)
-
Posterior vertebral body scalloping
- 1. Congenital
- •OI
- •Mucopolysaccharidoses
- •Achondroplasia
- 2. Dural ectasia
- •Neurofibromatosis
- •Ehlers-Danlos
- •Marfan’s
- 3. Increased central canal pressure
- •Syrinx
- •Spinal canal tumors
-
DDx: Brain mass, general
- •Hemorrhage
- •Infection / Inflammation
- •Vascular: Infarction, Vascular Malformation
- •Trauma
- •Tumor: Primary, Metastasis, Lymphoma, Reaction to treatment
- •Demyelination
- •Congenital
-
DDx: Supratentorial Mass
- •Gliomas: Astrocytoma, Anaplastic Astrocytoma, Glioblastoma (GBM), Oligodendroglioma-Ca2+
- •Lymphoma
- •Metastasis
- •Meningioma
- •Seizure lesions: Ganglioglioma, Pleomorphic Xanthroastrocytoma
- •Other: Epidermoid, Arachnoid cyst
-
DDx: Infratentorial Mass
- •Medulloblastoma
- •Ependymoma
- •Brainstem Glioma
- •Cerebellar Glioma
- •Hemangioblastoma
- •Metastasis
-
DDx: Parasellar brain lesions
- "CRAMP"
- •Craniopharyngioma
- •Rathke’s Cleft Cyst
- •Aneurysm
- •Meningioma
- •Pituitary Adenoma
- OTHERS:
- •Ectopic Pituitary
- •Germinoma
- •Optic Nerve Glioma
- •Hypothalamic Glioma
- •Metastasis
- •Hamartoma of the Tuber Cinereum
- •Others: Dermoid, Arachnoid Cyst
-
DDx: Pineal region tumors
- •Germ Cell: Germinoma, Teratoma, Embrynal, Choriocarcinoma, Yolk Sac
- •Pineal Cell: Pineocytoma, Pineoblastoma
- •Others neoplasms: Metastasis, Astrocytoma, Ependymoma, Meningioma, Lymphoma
- •Others: Pineal Cyst, Lipoma, Arachnoid Cyst, Dermoid, AVM
-
DDx: Intraventricular tumors
- •Central Neurocytoma
- •Choroid Plexus Papilloma
- •Colloid Cyst
- •Giant Cell Astrocytoma
- •Ependymoma
- •Meningioma/ Metastases
- •Subependymoma
-
DDx: Cerebellopontine angle lesions
- •Acoustic Schwannoma
- •Meningioma
- •Epidermoid
- •Arachnoid Cyst
- •Others: Metastasis, Other Schwannomas, Aneurysm
-
DDx: Skull base lesions
- •Chondrosarcoma
- •Chordoma
- •Nasopharyngeal Carcinoma
- •Metastasis
- •Others: Glomus Tumor, Schwannoma, Myeloma, Lymphoma
-
DDx: Potential abnormalities on angio of the aorta/great vessels on angio
- trauma, dissection, vasculitides
- Atherosclerotic disease proximal great vessels
- subclavian steal
- Takayasu’s arteritis
-
DDx: Vascular related conditions seen on angio of the neck
- •Stenosis
- -atherosclerosis
- -fibromuscular disease
- -dissection
- •Tumors
- -Carotid body tumor - embolize preop
- •Trauma
-
DDx: Reasons for doing selective ECA angio
- "NEAT"
- •Neoplasms - glomus jugulare, angiofibroma, meningioma
- •Epistaxis
- •Arteriovenous malformations
- •Trauma - indirect CCF (carotid-cavernous fistula)
-
If shown coronal/frontal view of an ECA injection, they are trying to show you what?
IMAX - probably for epistaxis
-
Two intracranial views on angio
- •Internal carotid artery injection
- •Vertebral artery injection
-
DDx: ICA conditions seen on angio
- Trauma
- -CCF (direct)
- Aneurysms
- Vessel stenosis/occlusions
- -atherosclerosis
- -vasculitis
- -vasospasm
- -embolic
- Arteriovenous malformations
- Tumors
-
DDx: Infants angio of head neck
- •Occlusions
- •moya moya
- •Vein Of Galen malformations
-
How to sort out severe hydrocephalus from hydranenchepahly?
Thin rim of cortex should still be seen in hydrocephauls, sometimes best seen on MR
-
Small unilateral cerebral hemisphere
Dyke-Davidoff-Mason syndrome
-
"Undivided front of the brain"
Holoprosencephaly
-
DDx: Cystic disorders of the posterior fossa
- •Dandy-Walker Complex
- -Malformation - upturned torcula, enlarged PF
- -Variant
- •Mega Cisterna Magna - normal PF size, but cystic
- •Arachnoid Cyst - mass effect cyst in PF, but no real upturned torcula, hydrocephalus
-
guitar pick 4th ventricle
rhombencephalosynapsis
- fusion of the cerebellar hemishperes
- usually get hydrocephalus
-
which territory ischemic stroke can be treated with surgical resection?
- PICA territory
- cerebellar hemisphere can be resected
- o/w can cause hydro and is life threatening
-
DDx: Common ocular lesions
- •Tumors
- -metastasis
- -melanoma
- -retinoblastoma (child, Ca2+)
- •Retinal detachment
- •Infection
- •Inflammatory
- •Trauma
-
Shrunken possibly calcified globe that doesn't function
Pthisis bulbi
-
Punctate Ca2+, posterior globe
drusen
-
DDx: Leukocoria
- •Retinoblastoma - doesn't have to be Ca2+, also look at pineal gland to assess for trilateral lesion
- •Primary Hyperplastic Vitreous
- •Coat’s Disease - small b/l globes with increased density
- •Retinopathy of Prematurity - linear calc posterior globe, small globes
-
DDx: Extraocular muscle lesions
- •Grave’s disease - IMSLO progression usually, can be unilateral, fat clean
- •Pseudotumor - usual MT involvement, fat dirty
- •Lymphoma
- •Metastasis
- •Granulomatousdisease
- •Infection
- •Carotid cavernous fistula
-
Most important features in differentiating graves from pseudotumor?
- Clean or dirty intraconal fat
- Painful or not
- Pseudotumor - painful, dirty fat
- Graves - non-painful, clean fat
-
DDx: Optic nerve enlargement
- •Optic-nerve glioma - NF1
- •Optic-nerve meningioma - tram track Ca2+
- •Optic neuritis - enhancement
- •Increased intracranial pressure
- •Pseudotumor
- •Graves’ disease
- •Lymphoma, leukemia, meningeal carcinomatosis
-
DDx: Well defined intraconal mass not involving the optic nerve
- –cavernous hemangioma
- –neurofibroma (CN III-V)
- –pseudotumor
- –venous varix
-
DDx: Ill defined Intraconal Mass not Involving Optic Nerve
- –Lymphoma
- –Metastasis
- –Pseudotumor
- –Infection
- –Lymphangioma, venous varix, capillary hemangioma
-
DDx: Extraconal mass in an adult
- •Adjacent structure
- –Infection, inflammatory, or tumor
- –Lacrimal Gland
- •Lymphoma
- •Metastasis
- •Pseudotumor
- •Granulomatous Disease
-
DDx: Extraconal mass in a child
"CaLL RN"
• Capillary Hemangioma - •Langerhans Cell Histiocytosis (LCH or EG)
- •Lymphangioma
- •Rhabdomyosarcoma
- •Neuroblastoma
-
DDx: Lacrimal gland enlargement
"ELDer GraM"
- –Benign Adenomas (50%)
- –Carcinomas (50%)
- •Lymphoid lesions
- –Lymphoma
- –Benign Hyperplasia
- –Pseudotumor
- –Sjogren’s
- •Dermoid
- •GranulomatousDiseases
- –Wegener’s
- –Sarcoid
- •Metastasis
|
|
