Thursday, August 28, 2008

Tuberculosis-The Mimic

This is 31 yr old female who presented acute complaints, inhomogenously enhancing pathology was seen in the cerebllar vermis and a MRI diagnosis of neoplastic etiology was made. Patient underwent surgery and histopathologically turned out to be tubercular infection. Yet another reminder to the fact that TB can mimic any pathology, should be included in differential in endemic areas.


These are post Gd MRI images of an infant showing intense ependymal enhancement and hydrocephalus consistent with ventricultis. Abscess formation is also noted in the left frontal and right temporo-parietal region. Abscess is seen as differential bright signal on DWI.
Case by --

Right Sided Aortic Arch

These are usually asymptomatic Unless they cause encircling vascular ring like pulmonary sling etc.

Tuesday, August 26, 2008

New Website for Information on Hydatid Cyst Sonography

Here is a new information website by Dr Elfortia (President - Meditrranean & African Society of Ultrasound (MASU)President - Libyan Society of Ultrasound in Medicine & Biology (LSUMB).Misurata Teaching Hospital, Department of Radiology) and Dr Sumer Sethi (Consultant Radiologist, Vimhans, CEO-Teleradiology Providers Blog - Sumer's Radiology Site Editor-in-chief,The Internet Journal of Radiology, Director DAMS (Delhi Academy of Medical Sciences) for latest updates on the radiology of hydatid cyst. Hydatid Cyst
All readers are welcome to send their experiences on Radiology of hydatid cyst and they will be included on the website with due credit to them.

Thursday, August 21, 2008

Early Stroke-CT finding

NCCT done on the day reveals obscuration of the outline of lentiform nucleus, which is a early sign of infarction. CT repeated next day confirms the right MCA territiry infarct.

Wednesday, August 20, 2008

Cryptococcal Meningitis-MRI

Cryptococcal organisms spread from the basal cisterns through the Virchow-Robin spaces to the basal ganglia, internal capsule, thalamus, and brainstem.The production of voluminous mucoid material may enlarge the perivascular spaces. MRI is more sensitive than CT scanning in demonstrating abnormalities such as dilated perivascular spaces. These manifest on T2-weighted MRIs as punctate, hyperintense, round or oval lesions that are usually smaller than 3 mm. This is 40 yr old man with altered sensorium clinically suspected meningitis. Cyptococcal infection was suggested and confirmed microbiologically.

Dr.Sumer K Sethi, MD
Sr Consultant Radiologist ,VIMHANS and CEO-Teleradiology Providers

Tuesday, August 19, 2008

MR-PET Imaging is feasible

In a paper by Heinz-Peter W. Schlemmer et al in Radiology 2008;248:1028-1035 authors concluded " MR/PET data enabled accurate coregistration of morphologic and multifunctional information. Simultaneous MR/PET imaging is feasible in humans, opening up new possibilities for the emerging field of molecular imaging. "
Looks like hybrid imaging is going to feel like science fiction soon.

Hyperdense MCA sign-Hyperacute Stroke

Axial CT images demonstrate increased linear attenuation within the left middle cerebral artery. Hyperacute stroke was suspected. MRI was done and diffusion weighted MRI confirms left MCA territory infarct.

Monday, August 18, 2008

Carotid Stenosis-MRA

These are MRA images showing significant atherosclerotic narrowing of the left proximal internal carotid artery.

Thursday, August 14, 2008

Outsourcing Radiology Services

"The internet, affordable high performance computers, the wide adoption of digital imaging, and picture archiving and communication systems (PACS) have propelled radiology into the digital era. Amy Davis has discussed pros and cons of the radiology services outsourcing in this article in BMJ, taking on issues like diagnostic clarity and cost effectiveness."
Read the full article here-

Wednesday, August 13, 2008

Carcinoma Stomach with Krukenberg Secondaries

Radiology Quiz-Try your radiology skills!!

These are some cases seen in a single day presented to you as a quiz.

Case 1
Post contrast axial T1weighted image. Recurrent Haemangiopericytoma (Histopathologically proven)

Case 2
FLAIR image of early herpes encephalitis (patient presented with seizure and fever and improved with acyclovir)

Case 3
Lipoma of corpus callosum

Case 4
FLAIR sulcal hyperintensity may indicate exudates/SAH. CSF revealed lymphocytosis. Diagnosis-meningitis

Case 5
T1 fat sat image, craniopharyngioma. 12 yr old boy with T1hyperintense sellar-supraellar mass.

Monday, August 11, 2008

Growing Fracture

This is T2 weighted MR images of child with history of head injury and reveals post injury gliosis in the left parietal region and leptomeningeal cyst also called as the Growing Fracture.

Dr.Sumer K Sethi, MD
Sr Consultant Radiologist ,VIMHANS and CEO-Teleradiology Providers

Friday, August 08, 2008

Arachnoid Cyst-MRI

Arachnoid cysts represent benign cysts that occur in the cerebrospinal axis in relation to the arachnoid membrane and do not communicate with the ventricular system. They usually contain clear, colorless fluid that is most likely normal cerebrospinal fluid, but they rarely contain xanthochromic fluid. Most are developmental anomalies. On MRI, arachnoid cysts appear as well-defined nonenhancing intracranial masses that are isointense to CSF.

Dr.Sumer K Sethi, MD

Sr Consultant Radiologist ,VIMHANS and CEO-Teleradiology Providers

Coronal Diffusion Weighted Imaging

Coronal DW-EPI can more easily demarcate ischemia in the brainstem and/or cerebellum than axial scans when susceptibility artifacts are present as in this case wherein axial DW scan was read as equivocal while coronal DWI confirms the acute infarction. Coronal scans also demonstrate the site and direction of the pyramidal tract and its anatomical correlation with the lesions.

Dr.Sumer K Sethi, MD
Sr Consultant Radiologist ,VIMHANS and CEO-Teleradiology Providers

Thursday, August 07, 2008

Glomus Jugulare Tumour-MRI

This is a classical case of glomus jugulare seen on MRI. The images to this case are courtesy Dr PK Sachdeva, Sr Consultant Neurosurgeon.

Sigmoid Sinus Thrombosis with Mastoiditis

Cerebral venous thrombosis often presents with hemorrhagic infarction in areas atypical for arterial vascular distribution. Magnetic resonance venography (MRV) in conjunction with conventional MRI can accurately diagnose cerebral venous thrombosis. In this case of a 14 yr old child who presenterd fever, headache, vomitting MRI and MRV were done. On MRI fluid signal in the left mastoid sinus is noted suggesting mastoiditis. Involvement of the sinus due to adjacent infectious process is a known cause for venous sinus thrombosis. Also noted in left temporoparietal haemorrhagic infarction. High signal is noted in the sinus on conventional MR images and diagnosis was confirmed on MRV.

Dr.Sumer K Sethi, MD
Consultant Radiologist ,VIMHANS and CEO-Teleradiology Providers

Basal Ganglia Calcification-Differential Diagnosis


Birth anoxia

Idiopathic (most common) bilateral and symmetrical

Toxoplasmosis / CMV - usually not limited to basal ganglia

Hypoparathyroidism / pseudohypoparathyroidism

Fahr syndrome

Cockayne syndrome

Cortical Lipoma

This is a patient with seizure disorder. On MRI a T1 hyperintense lesion was noted in the left frontal region with associated cortical dysplasia. Signal suppresion was noted on Fat-sat T1 weighted images. Fat density on confirmed on CT scan.

Intracranial lipomas are rare lesions, assumed to be resulting from abnormal persistence and maldifferentiation of the meninx primitiva. The majority of the lesions occur at or near midline, mostly in the pericallosal cistern. Other locations include the quadrigeminal/superior cerebellar, suprasellar/interpeduncular, cerebellopontine angle, and sylvian cisterns.

Anterior Cerebral Artery Infarct

These are diffusion weighted MRI images of ACA territory relativel fresh infarct. Acute infarct shows differential bright signal on DWI.

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