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NERRS Sep 2013 Neuroradiology Case Unknowns
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NERRS Sep 2013 Neuroradiology Case Unknowns

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  • 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
  • 15. NAA Choline Creatine
  • 16. ROI 1 ROI 2 ROI 3 ROI 4 ROI 7 ROI 8 ROI 9
  • 17. ROI 15 ROI 14 ROI 16 ROI 17 ROI 18 ROI 19 ROI 20 ROI 21 ROI 27 ROI 26 ROI 25 ROI 24
  • 18. Asim Mian, MD Assistant Professor of Radiology Boston University School of Medicine Neuroradiologist Boston Medical Center
  • 19. Clinical Information
  • 20.  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
  • 21. Computed Tomography
  • 22. Magnetic Resonance Imaging
  • 23. Post-gadolinium MPRAGE images for surgical planning
  • 24. Post-gadolinium MPRAGE images for surgical planning
  • 25. Cerebral Angiography
  • 26. Right Internal Carotid Artery Injection
  • 27. Left External Carotid Artery Injection
  • 28. Right External Carotid Artery Injection
  • 29. Deepak Takhtani, MD Associate Professor of Radiology University of Massachusetts Medical School Director Neuroradiology Section University of Massachusetts Medical Center
  • 30. Clinical Information
  • 31.  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
  • 32. 2013 2012
  • 33. MRI 2012
  • 34. T1-weighted post-gadolinium
  • 35. T1-weighted post-gadolinium
  • 36. MRI 2013
  • 37. T2-weighted FLAIR
  • 38. T1-weighted post-gadolinium
  • 39. MRI 2013 Pre-operative Study
  • 40. Pre-operative MRI T1-weighted post-gadolinium
  • 41. Based on MR features, surgery was cancelled and a diagnostic Ultrasound was performed
  • 42. Transverse forehead Resting Transverse Forehead Valsalva
  • 43. Color Doppler in resting Color Doppler during Valsalva maneuver
  • 44. Follow up MRI 2013
  • 45. T2-weighted
  • 46. Pre and post-gadolinium T1-weighted
  • 47. Post-gadolinium MPRAGE
  • 48. Pamela W. Schaffer, MD Associate Professor of Radiology Harvard Medical School Associate Director of Neuroradiology Clinical Director MRI Massachusetts General Hospital
  • 49. Clinical Information
  • 50.  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
  • 51. Computed Tomography
  • 52. Magnetic Resonance Imaging
  • 53. T2-weighted Images FLAIR
  • 54. Post-gadolinium T1-weighted Axial Images
  • 55. Post-gadolinium MPRAGE Sagittal and Coronal
  • 56. Post-gadolinium MPRAGE Axial for Surgical Planning
  • 57. Thank You HARVARD MEDICAL SCHOOL