1. Rafeeque A. Bhadelia, MD
Associate Professor of Radiology
Harvard Medical School
Clinical Director, Neuroradiology
Beth Israel Deaconess Medical Center
HARVARD
MEDICAL
SCHOOL
Unknown Cases

2. Alexander Lin, PhD
Instructor in Radiology
Harvard Medical School
Clinical Spectroscopist
Center for Clinical Spectroscopy
Brigham and Women’s Hospital

3. HARVARD
MEDICAL
SCHOOL
MR Spectroscopy in a Patient with
Suspected Brain Tumor

4. Clinical Information

5.  37-year-old right-handed man with history of
Asperger's syndrome and hypertension
 Seven days prior to hospital admission, he began
to notice right sided numbness and twitching
and bitemporal headaches
 Patient gave history of travelling to Botswana
 Neurological examination was unremarkable
 Laboratory examinations of blood and CSF were
unremarkable

6. Subcortical hyperdense masses in the left fronto-parietal lobes
with surrounding hypodensities extending to basal ganglia

7. FLAIR: Well defined hyperintense lesions in the left fronto-parietal lobes with
hyperintensities in left basal ganglia, splenium of corpus callosum and left cerebellum

8. T1-weighted Post-gadolinium images show homogenously enhancing well defined
lesions in left fronto-parietal lobes and enhancement in left cerebellum

9. ADC
Diffusion
ASL
Diffusion trace and ADC images show slow (restricted) diffusion in the well
defined enhancing left fronto-parietal lesions
ASL show mild to moderate increased perfusion in left fronto-parietal lesions

10. Dynamic Susceptibility Contrast (DSC) Perfusion
images show minimally increased rCBV and rCBF in left
fronto-parietal lesions
rCBF
rCBV

11. Differential Diagnosis
 Glioblastoma Multiforme
 Metastasis
 Lymphoma
 Tumefactive Multiple Sclerosis
 Subacute Infarcts

12. Creatine
2D- CSI (PROBE: TE=144, Section=10mm, NEX=1
NAA Choline

13. ROI 4ROI 2 ROI 3

14. ROI 5 ROI 7
ROI 9ROI 8
ROI 14 ROI 15
ROI 12
ROI 13

16. NAA
Choline Creatine

17. ROI 1 ROI 2
ROI 3 ROI 4
ROI 7 ROI 8 ROI 9

18. ROI
15
ROI
14
ROI
16
ROI
17
ROI
18
ROI
19
ROI
20
ROI
21
ROI
27
ROI
26
ROI
25
ROI
24

19. Asim Mian, MD
Assistant Professor of Radiology
Boston University School of Medicine
Neuroradiologist
Boston Medical Center

20. Clinical Information

21.  59-year-old male with the history of a slow
growing bony tumor of his right calvarium
 The mass has grown over several years
 No similar masses elsewhere
 No associated neurological symptoms or pain
 Medical consultation for cosmetic reasons

22. Computed Tomography

25. Magnetic Resonance Imaging

26. Post-gadolinium MPRAGE images for surgical planning

27. Post-gadolinium MPRAGE images for surgical planning

29. Cerebral Angiography

30. Right Internal Carotid Artery Injection

31. Left External Carotid Artery Injection

32. Right External Carotid Artery Injection

33. Deepak Takhtani, MD
Associate Professor of Radiology
University of Massachusetts Medical School
Director
Neuroradiology Section
University of Massachusetts Medical Center

34. Clinical Information

35.  65-year-old female, with a past medical history
significant for obesity, hypertension, and multiple
sclerosis
 A routine follow-up MRI for multiple sclerosis
at an outside facility revealed a new dumbbell-
shaped mass in the frontal area on the left
 Patient referred for biopsy with differential
diagnosis of plasmacytoma, lymphoma, or dural
based metastasis

36. 2013
2012

37. MRI 2012

38. T1-weighted post-gadolinium

39. T1-weighted post-gadolinium

40. MRI 2013

41. T2-weighted FLAIR

42. T1-weighted post-gadolinium

44. MRI 2013
Pre-operative Study

45. Pre-operative MRI T1-weighted post-gadolinium

47. Based on MR features,
surgery was cancelled and a
diagnostic Ultrasound was
performed

48. Transverse forehead
Resting
Transverse Forehead Valsalva

49. Color Doppler in resting
Color Doppler during Valsalva maneuver

50. Follow up MRI 2013

51. T2-weighted

52. Pre and post-gadolinium T1-weighted

53. Post-gadolinium MPRAGE

54. Pamela W. Schaffer, MD
Associate Professor of Radiology
Harvard Medical School
Associate Director of Neuroradiology Clinical
Director MRI
Massachusetts General Hospital

55. Clinical Information

56.  25-year old right handed man with complaints of
cranial defect left side of his head for three years
 For the past 6 months he has had headaches in the
area of indentation, decreased hearing and
occasional visual problems
 No history of fever, weight loss, systemic illness or
trauma

57. Computed Tomography

62. Magnetic Resonance Imaging

64. T2-weighted Images FLAIR

65. Post-gadolinium T1-weighted Axial Images

66. Post-gadolinium MPRAGE Sagittal and Coronal

67. Post-gadolinium MPRAGE Axial for Surgical Planning

68. Thank You
HARVARD
MEDICAL
SCHOOL