Radiology MRI

Quick radiology Quiz. What can be seen on this sagittal T2 sequence? A. Normal B. Congenital anomaly C. MS D. Do not know, images move too fast! Of course you don't have to answer this quiz. Only remember to include this sequence when trying to diagnose patients with this specific clinical question.

CTA showing large aneurysm at the dorsal upper part of the right Internal Carotid Artery (arrow). There is also an anatomic variant in form of a Persistent Trigeminal Artery (PTA) on the left side which is also showing an aneurysm in its anterior medial part (arrowhead). Note hypoplastic Basilar Artery (long arrow), as another anatomic variant. There are reports in the literature of aneurysms accompanying PTA. This was an incidental finding. Note same findings on the 3D volume reconstructions. (Images are mirrored L-R). Same 3D reconstructions from anterior angle. In this case aneurysms are obvious and easy to find. However it is good to be sure to look for aneurysms in case of this anatomic variant. You might also check my previous post about Persistent Trigeminal Artery . Also, if you like anatomic variants, there is a case of Persistent Hypoglossal Artery .

Unenhanced CT showing large (about 30mm) fishbone dorsally in the larynx . It is located supraglottic. Its oblique trajectory can be seen in the coronary plane. Hyperdense opacity of the fishbone allows for good depiction with CT. There is also surrounding edema around this foreign body. Initial laryngoscopy failed to reveal the fishbone as it was deeply sunk in soft tissues.

T2 and IR images showing Closed-Lip Schizencephaly in this two weeks old neonate located in the inferior parietal lobule region. Note that in this type of Schizencephaly cortex is covering the most medial parts of the cleft and there is no connection with the side ventricle.

Unenhanced CT showing tissue loss after Middle Cerebral Artery MCA infarct involving whole territory of MCA. Note sparring of occipital lobe as well as medial temporal lobe - that belong to Posterior Cerebral Artery PCA territory. Also note medial parts of the frontal lobe that belong to Anterior Cerebral Artery ACA. Above unenhanced CT from the investigation three months prior at acute stage of infarct showing " Dense Vessel Sign " indicating occlusion of the main M1 segment of the MCA on the left side. CT Perfusion study at the time of acute infarct showing: increased Mean Transit Time MTT, decreased Blood Volume BV and decreased Blood Flow BF. Especially the decreased BF - represented by dark blue in the last image indicates infarct that can not be saved. Remember: " Blue is Bad " in CT Perfusion.

Note high signal intensity configuration in the pons that resembles a cross, or as some see it a Hot Cross Bun . This is a sign of MSA -  Multiple System Atrophy . In this case MSA-c variant that involves mainly infratentorial structures. Note extensive atrophy in pons and cerebellum. Above image shows a Hot Cross Bun example - image courtesy of Bakery Jasiek .

T1 sequences showing contrast enhancing aggressive looking tumor in the dorsal parts of the right frontal lobe with extensive edema (last image - FLAIR). Pathology examination revealed Glioblastoma . It is a highly aggressive tumor with poor prognosis. Follow-up revealed recurrence of tumor despite resection, radiotherapy and chemotherapy. One subjective note concerning this case. When I see young patients (40 yrs) with such aggressive tumor I can not stop thinking about all the people I see around me talking on their GSM phones. There has not been, as far as I know, proven correlation between tumor occurrence and extensive use of GSM. And I even do not know if this patient was using handheld phone extensively. There are many theories, among other concerning genetic predisposition and external "vectors" that can stimulate growth of such tumors. But why not "stay on the safe side" and limit lengthy telephone conversations with handheld device. Modern p...