Saturday, July 31, 2010

Cerebello-pontine Angle Epidermoid-MRI

On T1-weighted images, epidermoids are generally slightly hyperintense or isointense relative to gray matter. The lesions are usually isointense relative to CSF on T2-weighted images, but they may be slightly hyperintense. The center of these lesions usually has an internal architecture with areas of heterogeneity. Enhancement of portions of the rim may be seen after the administration of contrast material. The remainder of the lesion does not enhance. Diffusion-weighted imaging can now be used for these lesions epidermoids have markedly restricted diffusion and, therefore, high signal intensity on the diffusion-weighted trace images.

Friday, July 30, 2010

Venous Angioma-MRI

On contrast-enhanced MRI, the cluster of veins in developmental venous anomalies has a spoke-wheel appearance; the veins are small at the periphery and gradually enlarge as they approach a central draining vein. This appearance has been referred to as caput medusa, or the head of Medusa, because of the serpentine appearance of the curvilinear peripheral draining veins.  These are axial and coronal post contrast images of 13 year old girl with hsitory of absence seizures. Reported by- Teleradiology Providers

CV Junction Potts Spine-MRI

Cervical Pott’s disease is unusual. Furthermore, CVJ tuberculosis has been reported to affect 0.3% to 1% of all Pott’s disease patients. This is a 9year old boy with potts spine with cranial migration of the odontoid process and retropharyngeal abscess. Note the impingement of brainstem with odontoid process.  The occipito-cervical junction, a transitional zone between the skull and the spinal column, serves as the most mobile part of the axial skeleton. Bony abnormalities affecting this complex results in dysfunction of the neural structures by compression along the entire circumference, altering the arterial supply, venous drainage and changing the CSF fluid dynamics.

Saturday, July 24, 2010

Lipomatous Filum terminale

Fat in the filum terminale is not an infrequent occurence, seen in 4 - 6% of individuals , and is especially easily detected on MRI. It is usually an incidental finding of no clinical concern.  There were no related symptoms and no evidence of tethering. The thickened fatty filum terminale seemed to be a developmental anomaly and without clinical significance.

Friday, July 23, 2010

Hairline fractures and Teleradiology

I am not sure if this has been reported before but problem with online reporting is not with complex disorders or with syndromes as our team compromises of senior rads and they are well versed with these situations. Problem possibly is with hairline fractures.

Usually we get no clinical information at all especially in orthopaedic plain films let alone any information on point of tenderness, so we are likely to miss some of the hairline injuries and as soon as we miss any findings we being a teleradiology company cases get bounced back to us very fast and referring physicians think we missed a simple HAIRLINE FRACTURE!

Do you also have similar experiences with reading plain orthropedic films without history?

Thursday, July 22, 2010

Moya Moya Disease-MRI

Moya Moya is a rare idiopathic vasoocclusive disease characterized by progressive irreversible occlusion of main blood vessels to the brain as they enter into the skull. The occlusive process stimulates the development of an extensive network of enlarged basal, transcortical and transdural collateral vessels . In Japanese, Moya Moya means hazy. The disease derives its peculiar name from the angiographic appearance of cerebral vessels in the disease that resembles "puff of smoke". The process of blockage, once it begins tends to continue despite any known medical management unless treated with surgery.

MRI not only reveals areas of infarctions but also allows direct visualization of these collateral vessels as multiple small flow voids at the base of brain and basal ganglia. MR angiography is used to confirm the diagnosis and to see the anatomy of the vessels involved. It typically reveals the narrowing and occlusion of proximal cerebral vessels and extensive collateral flow through the perforating vessels demonstrating the classic puff of smoke appearance.

Our patient is 17 yr old female with history of recurrent seizures. MRI T1 weighted images show extensive collateralization of vessels in region of circle of willis. MRA reveals reduced luminal caliber of left internal carotid artery in petrous, cavernous and supraclinoid segments. Left MCA also shows attenuation of its luminal caliber when compared to its counterpart on right side along with collaterals at the base of the brain and basal gnaglia.

Second Opinion By -Teleradiology Providers

Tuesday, July 13, 2010


Spinal cord hematoma or hematomyelia is an infrequently encountered condition that is the result of several unusual disease processes. The causes of spontaneous, nontraumatic spinal cord hematoma include vascular malformations of the spinal cord (the most common), clotting disorders, inflammatory myelitis, spinal cord tumors, abscess, syringomyelia, and unknown etiologies. Traumatic events, such as spinal cord injury (closed or penetrating), and operative procedures involving the spinal cord also can cause a spinal cord hematoma. Reported by Teleradiology Providers.

Monday, July 12, 2010

Intraventricular Cysticercosis-MRI

Intraventricular infestation of neurocysticercosis is relatively rare, and it is usually associated with multiple sites of ventricular and parenchymal lesions. Intraventricular cysts are typically 1-2 cm in diameter and show surrounding ependymal inflammatory reaction. Note the cystic lesion in IV ventricle with turbulent flow in IV ventricle and ependymal reaction. There was resultant obstructive hydrocephalus.

Allergic Bronchopulmonary Aspergillosis-HRCT

Bronchiectasis and peribronchial thickening are the most common CT findings in ABPA. ABPA typically involves the segmental and subsegmental bronchi, particularly those in the upper lobes. High-attenuating mucoid impaction is a characteristic finding. Mucus plugging of the small airways can be observed on high-resolution CT scans, with resultant centrilobular nodularity and the tree-in-bud sign.

Thursday, July 08, 2010

Osteoid Osteoma-Posterior Element Lumbar Spine

Patient came to us back pain and we noted a small lyic lesion in the junction of the lamina with pars interarticularis along with nidus and suspicion of osteoid osteoma was given which was later confirmed on bone scan.

Reported by Teleradiology Providers

Friday, July 02, 2010

T1 Hyperintense Pineal Tumour

Masses in the pineal region that may demonstrate intrinsic T1 hyperintensity can be following and can be excluded with routine MR imaging techniques. For example, a fat-saturated T1-weighted sequence may exclude a teratoma, dermoid, or lipoma as in our case. A partially thrombosed aneurysm or venous malformation with subacute blood products can be excluded with MR or CT angiography and absence of pulsation artifacts. A hemorrhagic metastasis from a renal, thyroid, or melanoma primary may be excluded by the lack of susceptibility effects on gradient-echo sequences. Melanotic melanomas will also demonstrate susceptibility effects. Also note intrinsic T1 hyperintensity may be a characteristic imaging appearance for a Papillary tumour of the pineal region. In the imaging absence of fat, hemorrhage, melanin, or calcification in a mass of the posterior commissure or pineal region, the diagnosis of a PTPR may be suggested.  This is 50 year old female with headache. Differential of papillary tumour or malignant melanoma was suggested.

Thursday, July 01, 2010

CT Coronary Angiography-3D Images

Few sample 3D images submitted by our Cardiac radiologist Dr Priya Darshan, from Prime Telerad Providers (P) Ltd.

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