Thursday, September 27, 2007

Hallervorden Spatz Disease-A Rare Case Report

This patient was referred to us for second opinion with clinical features of dystonia and non-specific initial MRI report. On MRI we noted bilaterally symmetric hyperintense signal changes in anterior medial globus pallidus with surrounding hypointensity in the globus pallidus on T2-weighted images. These imaging features are fairly diagnostic of HSD and have been termed the “eye-of-the-tiger” sign.The hyperintensity represents pathologic changes including gliosis, demyelination, neuronal loss, and axonal swelling, and the surrounding hypointensity is due to loss of signal secondary to iron deposition.

Sunday, September 23, 2007

Radiology Quiz-What is the Diagnosis?

This patient presented with complaints of vomitting and abdominal pain. Can you make the diagnosis on the basis of scout film and CT section.

Post your answers in the comments section. Case reported by emergency team of Teleradiology Providers


Dr. Eytan RAZ

Radiology Grand Rounds-XVI

Here is a case of Pineal tumour for the Radiology Grand Rounds submitted by Dr MGK Murthy, Dr Sumer Sethi of Teleradiology Providers. Concept of the Radiology Grand Rounds is available at- Radiology Grand Rounds.

The approach to such cases--
Germinoma and teratoma are two germ cell tumors that can arise from the pineal gland. Germinoma is the most common pineal tumor, accounting for 40-50% of all pineal region tumors and two-thirds of all germ cell tumors. It affects primarily children or young adults and is significantly more common in males. Germinomas have a homogenous appearance on MRI and enhance strongly following contrast administration. Teratoma accounts for 15% of pineal masses and also demonstrates male predominance. These lesions are heterogeneous with calcifications and mixed CSF, lipid and soft tissue areas. Germ cell tumors tend to engulf primary pineal calcifications.
Pineal parenchymal lesions include pineocytoma and pineobalstoma. Pineocytoma is an enhancing lesion that affects adults. This benign entity is characterized by good demarcation, homogeneity, and slow growth. It is noninvasive. Pineoblastoma generally affects children and occurs with approximately equal incidence in males and females. Common characteristics of this malignancy include local invasion, distant CNS spread, heterogeneity, calcification, and marked enhancement. It is important to obtain images of the spine to look for metastases. Parenchymal tumors will have intrinsic calcifications, producing an exploded appearance .
The above case is a lady young and homogenous enhancement hence pineocytoma is possible.
The clinical presentation of a pineal lesion may include obstructive hydrocephalus, Parinaud's syndrome (characterized by palsy of upward gaze, dissociation of light and accommodation, and failure of convergence) caused by compression of the tectum, and endocrine abnormalities ( e.g., precocious puberty) in cases of germ cell tumors. One of the radiologist's main roles is to determine the origin of the lesion. Lesions arising from adjacent regions and extending to the pineal region include CNS lipoma, epidermoid, arachnoid cyst, astrocytoma, and meningioma. Lesions arising from the pineal gland itself include germ cell tumors, pineal parenchymal lesions, pineal cysts, vascular malformations, and metastases.

Tuesday, September 18, 2007

Wednesday, September 12, 2007

Gliomatosis Cerebri-MRI & MRS

Gliomatosis cerebri (infiltrative diffuse astrocytosis) is a rare primary brain tumor. It is commonly characterized by diffuse infiltration of the brain with neoplastic glial cells that affect various areas of the cerebral lobes. Before the advent of MRI, diagnosis was generally not established until autopsy. Typically, gliomatosis cerebri appears as a diffuse, poorly circumscribed, infiltrating non-enhancing lesion that is hyperintense on T2-weighted images and expands the cerebral white matter. The prognosis for gliomatosis cerebri is generally poor, with a median survival time of only 12 months.

Wednesday, September 05, 2007

Arachnoiditis-MRI Findings

MRI is the study of choice for the diagnostic evaluation of arachnoiditis. T1-weighted MRIs may reveal an indistinct or absent cord outline due to the increase in the signal intensity of the surrounding CSF. T2-weighted MRIs may demonstrate CSF loculation and obliteration of the subarachnoid space or irregularly thickened, clumped nerve roots, which occasionally may be misinterpreted as a tethered cord or a thickened filum terminale. With more severe arachnoiditis, progression of nerve root clumping and leptomeningeal adhesions may lead to angular defects in the dural sac. Peripheral adherence of the nerve roots to the walls of the thecal sac produces the so-called featureless, or empty, sac.
Case by-- Teleradiology Providers

Radiology Blog and Sumer Sethi feature in RT Image magazine's 25 most influential list

After eliciting reader nominations and debating for hours, RT Image is proud to present the 2007 roster of radiology’s most powerful people, institutions and organizations. Whether their influence comes in numbers or from the dedication of one, all those on our list demonstrate the drive, character and integrity that deserve the title of “Most Influential.” Check out the number 24th for a mention of yours truly Dr Sumer Sethi and his experience with Rad-Blogging. I am proud that the concept of rad-blogging is now recognized as one of the 25 most influential in the world of Radiology.

Here is the link--

Recognizing radiology’s movers and shakers

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