ADC map differentiation between tumoral and non tumoral tissue

ADC MAP DIFFERENTIATION BETWEEN TUMORAL AND NON TUMORAL TISSUE: -With high cellularity lesion , has a low ADC map value resulting in hypo intense signal. -While in low cellularity lesion such as edema , inflammation , fibrosis , and necrosis shows high ADC map signal.

Neurocutaneous melanosis

Neurocutaneous melanosis in 10-week-old girl. Axial T1-weighted MR image shows increased signal of neuromelanin within the amygdalae bilaterally, along the leptomeningeal surfaces of the brain stem and cerebellum and extending into the pons.

DDx: T1 Leptomeningeal hyperintensity- melanin (neurocutaneous melanosis, metastatic melanoma), blood (subarachnoid hemorrhage), fat (ruptured dermoid).

T2 Leptomeningeal hyperintensity- melanin (neurocutaneous melanosis, metastatic melanoma), hyperoxygenation (general anesthesia/sedation), infection/meningitis, metastatic disease (pineal/posterior fossa).

T1 enhancement- melanin (neurocutaneous melanosis, metastatic melanoma), infection/meningitis, metastatic disease (pineal/posterior fossa).

The current diagnostic criteria for neurocutaneous melanosis are (1) large (>20 cm) or multiple (>3) congenital nevi in association with meningeal melanosis or melanoma, (2) no evidence of meningeal melanoma except in patients in whom cutaneous lesions are histologically benign, and (3) no evidence of cutaneous melanoma except in patients in whom meningeal lesions are histologically benign.

http://imaging.consult.com/image/topic/dx/Brain%20and%20Spine?title=Neurocutaneous%20Melanosis&image=fig5&locator=gr5&pii=S1933-0332(08)70441-5

Neurocutaneous melanosis

Neurocutaneous melanosis in 10-week-old girl. Axial T1-weighted MR image shows increased signal of neuromelanin within the amygdalae bilaterally, along the leptomeningeal surfaces of the brain stem and cerebellum and extending into the pons.

Anencephaly

Coronal ultrasound of the fetal head and upper body shows the absence of the calvarium and brain above the orbits.

http://imaging.consult.com/image/case/dx/Obstetrics%20and%20Gynecology?title=Anencephaly&image=fig2&locator=gr2&pii=S1933-0332(08)70475-0

Chiari Type 1 Malformation

Chiari Type 1 Malformation: A, Sagittal T1 weighted MR image showing caudal protrusion of the cerebellar tonsils below the foramen magnum (Black arrowhead). B, T1 weighted sagittal (Right) and FLAIR sagittal (Left) MR images, showing syrinx (Curved arrows) associated with Chiari 1 malformation in a different patient.

NF2.

Sagittal MR image of the spine demonstrating a T10-11 schwannoma in a patient with NF2.
Axial MR image demonstrating tumors in a patient with NF2 who presented with the classic bilateral eighth cranial nerve schwannomas that occur in this disease.

Discussion:

Neurofibromatosis type 2
-One of the phakomatoses (neuroectodermal disorders with skin and
CNS tumors; other of the more common phakomatoses include tuberous sclerosis, Von-hippel Lindau disease, Sturge-Weber

-Incidence 1:50,000 (much less common than NF-1)
-Autosominal dominant inheritance via chromsome 22 defect

Diagnostic criteria:
-Bilateral vestibular schwanommas are diagnostic
-First degree relative with NF-2 plus unilateral vestibular
schwanomma, meningioma, glioma, scwhanomma, neurofibroma
-Cutaneous manifestations are rare

Radiographic features:
-~100% have cns tumors
-Bilateral vestibular schwanomma is diagnostic
-Other cranial nerve schwanommas
-Meningiomas (can be multiple)
-Non-neoplastic intracranial calcifications (especially
choroid plexus, but can also be cortical)
-Spinal cord schwanommas and ependymomas

http://www.google.com.eg/imgres?imgurl=http://img.medscape.com/fullsize/migrated/522/319/nf522319.fig5.gif&imgrefurl=http://www.medscape.com/viewarticle/522319_4&usg=__7bIYNRkY_Pmcp7PtiS7MG5bYpdA=&h=551&w=400&sz=137&hl=ar&start=9&zoom=1&itbs=1&tbnid=JzdQZhb1WY45KM:&tbnh=133&tbnw=97&prev=/images%3Fq%3DNeurofibromatosis%2Btype%2B2%26hl%3Dar%26sa%3DG%26gbv%3D2%26tbs%3Disch:1

NF2.

Sagittal MR image of the spine demonstrating a T10-11 schwannoma in a patient with NF2.
Axial MR image demonstrating tumors in a patient with NF2 who presented with the classic bilateral eighth cranial nerve schwannomas that occur in this disease.

Discussion:

Neurofibromatosis type 2
-One of the phakomatoses (neuroectodermal disorders with skin and
CNS tumors; other of the more common phakomatoses include tuberous sclerosis, Von-hippel Lindau disease, Sturge-Weber

-Incidence 1:50,000 (much less common than NF-1)
-Autosominal dominant inheritance via chromsome 22 defect

Diagnostic criteria:
-Bilateral vestibular schwanommas are diagnostic
-First degree relative with NF-2 plus unilateral vestibular
schwanomma, meningioma, glioma, scwhanomma, neurofibroma
-Cutaneous manifestations are rare

Radiographic features:
-~100% have cns tumors
-Bilateral vestibular schwanomma is diagnostic
-Other cranial nerve schwanommas
-Meningiomas (can be multiple)
-Non-neoplastic intracranial calcifications (especially
choroid plexus, but can also be cortical)
-Spinal cord schwanommas and ependymomas

http://www.google.com.eg/imgres?imgurl=http://img.medscape.com/fullsize/migrated/522/319/nf522319.fig5.gif&imgrefurl=http://www.medscape.com/viewarticle/522319_4&usg=__7bIYNRkY_Pmcp7PtiS7MG5bYpdA=&h=551&w=400&sz=137&hl=ar&start=9&zoom=1&itbs=1&tbnid=JzdQZhb1WY45KM:&tbnh=133&tbnw=97&prev=/images%3Fq%3DNeurofibromatosis%2Btype%2B2%26hl%3Dar%26sa%3DG%26gbv%3D2%26tbs%3Disch:1

http://e-radiography.net/ibase8/Brain/slides/Brain_tuberous_sclerosis_gadolinium_mr.htm

Glioblastoma Multiforme on CT Scan

http://eradiology.bidmc.harvard.edu/Classics/item.aspx?section=Neuroimaging&labelpk=84a3cf36-44c2-4370-9522-50369eb830e3&pk=672b8da7-2a8d-43a2-a608-7fef8194b9bb

Findings

• The CT scan shows a large oval mass in the right frontal lobe with surrounding edema.
• There is a leftward midline shift and compression of the right lateral and third ventricles.

Discussion

There is a differential for low-attenuation supratentorial lesions on CT as well as for corpus callosum edema. This patient has glioblastoma multiforme, the most common primary brain malignancy in adults (20% of all primary brain tumors). MRI is more sensitive than CT for detecting brain tumors. CT is superior for detecting calcifications within the lesion.

Glioblastoma Multiforme on CT Scan

http://eradiology.bidmc.harvard.edu/Classics/item.aspx?section=Neuroimaging&labelpk=84a3cf36-44c2-4370-9522-50369eb830e3&pk=672b8da7-2a8d-43a2-a608-7fef8194b9bb

Findings

• The CT scan shows a large oval mass in the right frontal lobe with surrounding edema.
• There is a leftward midline shift and compression of the right lateral and third ventricles.

Discussion

There is a differential for low-attenuation supratentorial lesions on CT as well as for corpus callosum edema. This patient has glioblastoma multiforme, the most common primary brain malignancy in adults (20% of all primary brain tumors). MRI is more sensitive than CT for detecting brain tumors. CT is superior for detecting calcifications within the lesion.

eradiology

Epidural Hematoma on CT scans

http://eradiology.bidmc.harvard.edu/Classics/item.aspx?section=Neuroimaging&labelpk=84a3cf36-44c2-4370-9522-50369eb830e3&pk=e56ebea9-dcd1-44d4-9aea-bd6bfe3df54e

Findings

• The CT scans demonstrate a left frontal epidural hematoma.

Discussion

Epidural hematomas arise in the potential space between the dura and the skull and do not cross sutural margins; the bleeding is mostly due to rupture of the middle meningeal artery. The major cause for EDH is trauma and skull fractures are present in 75 to 95 percent of patients. Epidural bleeds produce a bi-convex (lens-shaped) hematoma on CT because the collection is limited by dural attachments at the cranial sutures.

Autosomal Dominant Polycystic Kidney Disease (ADPKD) Complications: Berry Aneurysm on CT Scan, Diverticulitis on BE

Findings

• The CT demonstrates a berry aneurysm off the Circle of Willis.
• The BE demonstrates diverticulosis of the sigmoid with eccentric mass effect due to an intramural diverticular abscess i.e. diverticulitis.

Discussion

ADPKD is one of three major inherited cystic diseases of the kidney. The kidneys become markedly enlarged with cysts. These distort the calyces and renal outline and cause mass effect on surrounding organs. The kidneys are abnormal and frequently show dystrophic calcifications. The liver and pancreas frequently contain cysts. There is an increased incidence of diverticular disease of the colon. There is an increased incidence of cerebral artery aneurysms.

Epidural Hemorrhage

Findings
The CT scans show a lens-shaped, biconvex high attenuation collection in the posterior left parietal lobe exerting mass effect.

Discussion
Acute bleeds present with high attenuation on CT. Epidural hematomas are due to traumatic head injuries which causes bleeding between the inner table of the skull and the dura. The majority are in the temporo-parietal region where a skull fracture causes damage to the middle meningeal artery or one of its branches. EDHs may cross the midline but do not cross suture lines.


http://eradiology.bidmc.harvard.edu/Classics/item.aspx?section=Emergency+Radiology&labelpk=33f0adab-853f-4010-a0e2-0756b3f1eac5&pk=c1634e61-5022-4bf4-8648-111c7af88cc3

Findings
The CT scans demonstrate a left frontal epidural hematoma.

Discussion
Epidural hematomas arise in the potential space between the dura and the skull and do not cross sutural margins; the bleeding is mostly due to rupture of the middle meningeal artery. The major cause for EDH is trauma and skull fractures are present in 75 to 95 percent of patients. Epidural bleeds produce a bi-convex (lens-shaped) hematoma on CT because the collection is limited by dural attachments at the cranial sutures.


http://eradiology.bidmc.harvard.edu/Classics/item.aspx?section=Emergency+Radiology&labelpk=33f0adab-853f-4010-a0e2-0756b3f1eac5&pk=e56ebea9-dcd1-44d4-9aea-bd6bfe3df54e

Coronal and Axial T1-Weighted MRI Scan Showing Right Hippocampal Sclerosis (Arrow)


http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=epi&part=ch3&rendertype=figure&id=ch3.f1

Mammillary bodies

An MRI scan reveals how the mammillary bodies of a sleep apnea patient (right) are smaller than those of a control subject (left).

http:// newsroom.ucla.edu/.../srp-view.aspx?id=24866

Brain memory areas

Counterclockwise, from center: This image shows (1) the location of the mammillary bodies in the head, (2) their position on the underside of the brain, (3) normal mammillary bodies and (4) smaller mammillary bodies in sleep apnea patients.

newsroom.ucla.edu/.../srp-view.aspx?id=24867

Sagittal and coronal US of a grade 2 hemorrhage
Both lateral ventricles are filled with blood, but there is no ventricular dilatation.

http://www.radiologyassistant.nl/en/440c93be7456f

Grade 1 peri ventricular hemorrhage

Sagittal and coronal US of subependymal hemorrhage located in the groove between the thalamus and the nucleus caudatus.

http://www.radiologyassistant.nl/en/440c93be7456f