Saturday, November 29, 2008

Spinal Arachnoid Cyst-MRI







Spinal arachnoid cysts are relatively uncommon lesions that may be intradural or extradural with the intradural variety being rare . The majority of intradural spinal arachnoid cysts occur in the thoracic region with only 15% in the cervical region and 5% in the lumbar region . Most are dorsal to the spinal cord (80%). Secondary intradural spinal arachnoid cyst formation is uncommon and is known to occur due to various causes such as trauma, surgery, lumbar puncture, intrathecal injections, arachnoiditis and inflammation.
MRI is useful to assess the size, nature and extent of the cystic lesion as well as the mass effect on the cord and associated signs of meningeal inflammation. Increased CSF signal intensity on T1 weighted images leading to loss of CSF–cord interface is strongly suggestive of the arachnoiditis
Differential diagnosis on imaging includes other intradural cystic lesions like dermoids, epidermoids, hydatidosis and cysticercosis. In a rare case reported by Ciftci et al, multiple intradural cysticercosis were found in the basal cistern, cisterna magna, and cervical subarachnoid space which were isointense with cerebrospinal fluid both on T2 and T1 weighted images Dermoid can be diagnosed by presence of fat and midline in location, epidermoid are bright on spinal difusion where available. Hydatids are better diagnosed by exclusion. Inflammatory etiology with TB can be suggested by sepate, flow signal aberrations and leptomeningeal enhancement apart from brain findings.

Case by Dr MGK Murthy, Sr Consultant Radiologist
Teleradiology Providers

Friday, November 28, 2008

AIIMS November 2008 Fully Solved and Explained


AIIMS November 2008 fully solved and explained with references by famous DAMS faculty, is now available. Book is by peepee publishers. Details here. http://www.damsdelhi.com DAMS as every year has had many selections in AIIMS, with around 40 selections this year.

Monday, November 24, 2008

Sub-acute combined degeneration-MRI












Sub-acute combined degeneration (SCD) is a rare cause of demyelination of the dorsal and lateral columns of the spinal cord and is a neurological complication due to vitamin B12 deficiency. This is a case of SCD of the spinal cord in a 40-year-old man. Magnetic resonance imaging (MRI) of the spine showed intramedullary hyperintensity seen on T2-weighted images in the posterior column of the cervico-dorsal spinal cord, and lateral columns. A diagnosis of SCD of the spinal cord was considered and confirmed by a low serum cobalamin. Detection of lateral tracts involvement by the MRI is uncommon.
Dr.Sumer K Sethi, MD
Sr Consultant Radiologist ,VIMHANS and CEO-Teleradiology Providers

Sunday, November 23, 2008

Radiology Related Link

RadDaily.com is a radiology resource for medical students, technologists, radiology residents and radiologists. The purpose of the website is to provide users with a daily image with a brief desription. The purpose of this site is to provide a single representative image of a disease process and a quick summary of the disease process. The perfect daily refresher to use while waiting for the next case to come or next series to load up in PACS during your busy workday.

Thursday, November 20, 2008

Round Cell Tumour of The Vertebrae-MRI and CT










This is a 2.5yr old child presented with paraparesis and MRI showed osseous destruction with paravertebral and epidural extensive soft tissue component. Note the classically spared intervertebral discs. Initial histopathology suggests a round cell tumour. There is compression of the spinal cord with altered signal intensity suggesting myelomalacia.

Monday, November 17, 2008

Pericallosal Lipoma-MRI




This is a rare congenital lesion characterized by the presence of fatty deposits in inappropriate places in the central nervous system The embryological derangement that leads to the formation of lipomas is still debated; lipomas are variously considered to be the result of mesodermal inclusion due to dysraphism, hyperplasia of normal leptomeningeal fat cells, heterotopia of displaced dermal anlage or derivatives from the embryological meninx primitiva(most accepted theory). Common locations are pericallosal, quadrigeminal cistern, hypothalamic suprasellar and cerebellopontine regions usually asymptomatic but can present with seizures, headache and behavioural disturbances. can be associated with callosal abnormalities. Pericallosal lipoma is usually located within the interhemispheric fissure along the corpus callosum , and on the basis of MR imaging findings in adults and children, these lesions are classified as one of two types . The tubulonodular form is round, more than 2 cm in size, and is usually located at the genu area of the corpus callosum. The second form, on the other hand, is curvilinear; thin and elongated, it is less than 1 cm in diameter and is usually found more posterior to the corpus callosum. The former has ben more associated with callosal anomalies association with pericallosal lipomas include midline defects (cleft lip or palate, median cleft nose, hypertelorism, cerebellar vermis defects, frontal lipomas) and dysraphism (myelomeningocele, encephalocele, anomalies of the cervical spine, cranium bifidium, or other calvarial defects).

Case by Dr MGK Murthy, MD
Sr Consultant Radiologist
Teleradiology Providers

Pericallosal Lipoma-MRI

This is a rare congenital lesion characterized by the presence of fatty deposits in inappropriate places in the central nervous system The embryological derangement that leads to the formation of lipomas is still debated; lipomas are variously considered to be the result of mesodermal inclusion due to dysraphism, hyperplasia of normal leptomeningeal fat cells, heterotopia of displaced dermal anlage or derivatives from the embryological meninx primitiva(most accepted theory). Common locations are pericallosal, quadrigeminal cistern, hypothalamic suprasellar and cerebellopontine regions usually asymptomatic but can present with seizures, headache and behavioural disturbances. can be associated with callosal abnormalities. Pericallosal lipoma is usually located within the interhemispheric fissure along the corpus callosum , and on the basis of MR imaging findings in adults and children, these lesions are classified as one of two types . The tubulonodular form is round, more than 2 cm in size, and is usually located at the genu area of the corpus callosum. The second form, on the other hand, is curvilinear; thin and elongated, it is less than 1 cm in diameter and is usually found more posterior to the corpus callosum. The former has ben more associated with callosal anomalies association with pericallosal lipomas include midline defects (cleft lip or palate, median cleft nose, hypertelorism, cerebellar vermis defects, frontal lipomas) and dysraphism (myelomeningocele, encephalocele, anomalies of the cervical spine, cranium bifidium, or other calvarial defects).

Case by Dr MGK Murthy, MD
Sr Consultant Radiologist
Teleradiology Providers

Sunday, November 16, 2008

Supratentorial Hemangioblastoma-MRI






This tumour originate from the vascular system usually during middle-age and is associated with other diseases such as polycythamia and pancreatic cysts. MR shows typical mural nodule enhancing with areas of restrction on DW with suggestion of bleed on T1.

Case by Dr MGK Murthy, MD
Sr Consultant Radiologist

Tuesday, November 11, 2008

Tuberculosis of Ankle-MRI









These are coronal and sagittal Fat suppressed MR images of a patient with tuberculosis involving the Calcaneum, talus, navicular, cuboid and cueniforms. Other diffeential that was considered was madura foot as it is very common in India.

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

Friday, November 07, 2008

Latest Issue of Internet Journal of Radiology-Table of contents

Original Articles
Incidence And Radiography Of Upper Cervical Spine Injury In Blunt Head Injury In A Rural Hospital Setting - Nazri Aziz Mohd, Mukhtar Alam Ansari, Ibrahim Lufti Shuaib, Ezane Aziz Mohd, Hasnah Hashim.
MR Imaging of Drug-Induced Suicidal Ideation - Donald H. Marks, Mehdi Adineh, Sudeepa Gupta.
A Day In The Life Of A Radiologist - Sumer K. Sethi.
Reviews
Asymptomatic CT Scans: A Health Assessment or a Health Risk? - Jessica Roberts, Shane Keene.
Imaging of Congenital Malformations of Brain: A Pictorial Essay - Shinagare B. Atul, N. K. Patil.
Case Reports
Peripheral Primitive Neuroectodermal Tumor- Imaging Appearance - Shalini Agarwal, Sarita Magu, Sanjay Kumar.
Tuberous sclerosis: MRI findings - Sapna Singh, Veena Chowdhury, Gyan Chand.
Uterine AVM - Sapna Singh, Veena Chowdhury, Gyan Chand.
Vaginal Leiomyoma: A rare cause of Menometrorrhagia - Shalini Agarwal, Rohtas K. Yadav, Krishna Sangwan, Pushpa Dahiya.
Lymphoplasmacyte-rich Meningioma Mimicking Tubercular Meningitis: A Case Report - RR Pandey, Prafful Khurana, Sumer Sethi, Sunil Suneja, Jaya Shankar.
Colonic Atresia: An Unusual Cause of Intestinal Obstruction in a Neonate - Manphool Singhal, O.P. Tiwari, Kushaljit Singh Sodhi.
Recovering The Appropriateness of Ordering Outpatient Diagnostic Imaging for Acute Care: Should there be clearer guidelines for physicians? - Heather N. Perkins, Shane Keene.
Syntelencephaly, a lesser known variant of holoprosencephal - G. Khandelwal, G. Bathla, R. Jain, P. Sharma, V. Maller.
Hiatal Hernia: An Uncommon Presentation of Chest Pain - Loabet Amiri, Raja Shekhar R. Sappati Biyyani.
Idiopathic Rectosigmoid Megacolon Presenting As A Giant Palpable Abdominal Mass: Report Of A Case - Bilal Battal, Veysel Akgun, Nail Ersoz, Fatih Ors, Mustafa Tasar.
Congenital neuroblastoma: A Case Report - Arif Nelliyulla Parambath, VR Rajendran, CK Vasu.
Abdominal Gossypiboma (Textilioma) - Mohamed El Fortia, Maroua Bendaoud, Sumer Sethi.
A pulled muscle," - Aortic Dissection - Anjali Bhagra, Nishant Anand, M. Fernanda Bellolio.
Amoebic liver abscess with sympathetic empyema thoracis: A Case Report And Review Of Literature - Godwin I. Ogbole, Abiodun O. Adeyinka.
Letters
Tesla MRI is better: Size does matter - Philip W. Chao.

Thursday, November 06, 2008

Multicentric Glioblastoma Multiforme-MRI








The actual incidence of true multicentric glioblastoma multiforme (GBM) varies between 2.4 and 4.9% of all GBMs. True multicentric tumors are described as widespread lesions in different lobes or hemispheres, which cannot be explained by spreading along the cerebrospinal fluid or blood pathways. We present here a case of multicentric GBM identified with MRI. This is a 73 yr old man, Look at the spread across the corpus callosum and along the white matter tracts in the posterior limb of the internal capsule and into cerebral peduncle.

Wednesday, November 05, 2008

Temporal Bone Fracture-CT













These are the high resolution CT images through the temporal bone of a case of RTA who presented with CSF ottorhea following the injury. CT images reveal hemomastoid and hemotympanum along with fracture through the mastoid extending to the cranial cavity and tegmen tympani.

Pineal Region Germinoma-MRI












These are Post Gadolinium MRI images of pineal region region germinoma with homogenous post gd enhancement. Also note the characteristic enhancing seeding in the infundibular recess of third ventricle. Pituitary gland is inferiorly displaced.

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

Distal Facial Neuroma-A Rare Case Report





The presentation of facial nerve neuroma tends to be insidious and depends on the location and extent of the lesion. Slowly progressive or sudden facial weakness, often preceded by facial twitching, is a common presenting complain. Bone-targeted high-resolution CT of the temporal bone is believed to be superior to MRI. Enlargement of the facial nerve suggests involvement of a neoplastic process.4 MRI is complementary, providing information about the nerve itself. Abnormal enhancement indicates the presence of the tumor. High-resolution CT should be performed first to visualize the facial canal followed by MRI to demonstrate the actual tumor. In this case of insidious facila nerve palsy we see mass in the external auditory canal, hypotympanum and descending facial nerve canal.

Corpus Callosum Agenesis-MRI






These are the MRI images of a child with corpus calllosum agenesis, note that the proximal part of the corpus callosum inculding the genu and proximal body are seen, distal part is not seen. Also note the interhemispheric cyst.

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

Epidermoid Tumour- Suprasellar location-CT


Here is a case of epidermoid tumour in the suprasellar location and it appeared bright on DWI.


Dr.Sumer K Sethi, MD
Sr Consultant Radiologist ,VIMHANS and CEO-Teleradiology Providers
Editor-in-chief, The Internet Journal of Radiology
Director, DAMS (Delhi Academy of Medical Sciences)

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