tag:blogger.com,1999:blog-13384797287798594452024-03-14T18:36:14.743+01:00Radiology MRINeuroradiology, Radiology, Anatomy, MRI and CT Cases - for Medical ProfessionalsRobert Prejshttp://www.blogger.com/profile/17634722289004416123noreply@blogger.comBlogger200125tag:blogger.com,1999:blog-1338479728779859445.post-70588853623700581062023-12-17T15:12:00.000+01:002023-12-17T15:12:57.158+01:00X-mas presents from AI<p>I asked ChatGPT-4: "Can you make me an image of a simulated Lego set of an MRI Scanner. Show it in foreground with its box behind." </p><p>This is what I got: </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiSQizI25Q7XcwKBR2BHd2aajbVxpx734zcaabCvBwI4V9QxxTQXbGRR4mOlnBXYxvA65Z7vRMo1HaYGqCsooAc14rBWDjheUXc_SQxpeiD5hxa-VZ29wP58jXQSRVBh97Egk_N40Y6JDFBKfbnXuZ8AR3lA1VasC16Zqg6JVN0LVvXMOoexEgwxUV9Cl3A/s1024/231217%20Dalle%20Lego%20MRI%20Scanner.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1024" data-original-width="1024" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiSQizI25Q7XcwKBR2BHd2aajbVxpx734zcaabCvBwI4V9QxxTQXbGRR4mOlnBXYxvA65Z7vRMo1HaYGqCsooAc14rBWDjheUXc_SQxpeiD5hxa-VZ29wP58jXQSRVBh97Egk_N40Y6JDFBKfbnXuZ8AR3lA1VasC16Zqg6JVN0LVvXMOoexEgwxUV9Cl3A/w640-h640/231217%20Dalle%20Lego%20MRI%20Scanner.png" width="640" /></a></div><p>This image was generated by AI called Dall-E that is subdivision of ChatGPT. It looks pretty impressive! It would certainly be a great present for X-mas!</p><p>I was inspired to make this prompt after seeing the image below that i found on X, that also looks like generated by AI. </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhLVykcjj0_yt4hgzZDOS1tpEqODXRWkdHaW39cNKUux2zrJEcCequERKbisIhpuyF5PgPgHwlr1u9-kC70oJjzJzLsyKIR-tQgYCYrcOJwyfqVvPAEmkOsQKYo_0UN5_vbyK7aNpx008YTaAeK7fdKltQRzVohGLipo118x4K7KabDvJFj1CTxmkC2AOTO/s1792/231217%20Simulated%20Lego%20Scaner%20from%20X.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1024" data-original-width="1792" height="366" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhLVykcjj0_yt4hgzZDOS1tpEqODXRWkdHaW39cNKUux2zrJEcCequERKbisIhpuyF5PgPgHwlr1u9-kC70oJjzJzLsyKIR-tQgYCYrcOJwyfqVvPAEmkOsQKYo_0UN5_vbyK7aNpx008YTaAeK7fdKltQRzVohGLipo118x4K7KabDvJFj1CTxmkC2AOTO/w640-h366/231217%20Simulated%20Lego%20Scaner%20from%20X.jpeg" width="640" /></a></div><br /><p>I think capabilities of AI in the field of Radiology are pretty impressive! </p><p>But honestly I was even more impressed when I asked ChatGPT to spot the difference between two images I took in my garden. It did the great job and this is quite promising example of how can AI be used in Radiology. See the images for yourself first and spot the difference: </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgeUNLjIwnELqeoUh0P-PpgMIbJaw_gxSJPU4oeczvA0zAd110IJ9WVz1hry3HAY3wZJPS9HX4sQQDHgaPS_po2rB1HQ8vSp_ZA2Q4ufr05apGJq9YYEto365AbMx4BLg8Mf-msbXU_LFUxhjMa3A2eXfSobITrFwHNaSK6hhgVkgmJhHZCIl27SQxdfWGA/s1349/Spot%20the%20difference%20Sarenka.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1349" data-original-width="1231" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgeUNLjIwnELqeoUh0P-PpgMIbJaw_gxSJPU4oeczvA0zAd110IJ9WVz1hry3HAY3wZJPS9HX4sQQDHgaPS_po2rB1HQ8vSp_ZA2Q4ufr05apGJq9YYEto365AbMx4BLg8Mf-msbXU_LFUxhjMa3A2eXfSobITrFwHNaSK6hhgVkgmJhHZCIl27SQxdfWGA/w584-h640/Spot%20the%20difference%20Sarenka.png" width="584" /></a></div><br /><p>And now look at result of AI analysis:</p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh1wZ7vJ1wd-mrHzJlb-mIEiP8tc8DRwhkBj-PBEguYuF5ip3W8cVPpvheLp1__UG8yDi8TRfvY_1JKxJxWQklDEc7Rb4AnlFj3t3MoVC32zgJcYuQjnMHxiMYE154V3S7_N0mdF0FXGol19Eny41zEZMvvuCNCE0FdW2fPUDKt1Mg07rh6DH4BXCFnTGrS/s1728/Chat%20GPT%204%20comparison.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1728" data-original-width="1612" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh1wZ7vJ1wd-mrHzJlb-mIEiP8tc8DRwhkBj-PBEguYuF5ip3W8cVPpvheLp1__UG8yDi8TRfvY_1JKxJxWQklDEc7Rb4AnlFj3t3MoVC32zgJcYuQjnMHxiMYE154V3S7_N0mdF0FXGol19Eny41zEZMvvuCNCE0FdW2fPUDKt1Mg07rh6DH4BXCFnTGrS/w598-h640/Chat%20GPT%204%20comparison.png" width="598" /></a></div><br /><div class="separator" style="clear: both; text-align: left;"><br /></div><div class="separator" style="clear: both; text-align: center;"><span style="text-align: left;">As a fun task I asked AI to make me an image of a cat sitting on top of aquarium - something I'm used to see in my office. Here is what I got:</span></div><div class="separator" style="clear: both; text-align: center;"><span style="text-align: left;"><br /></span></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgCcP9ENozlX4zzZu24vm3ycLesx0z5IX-AIiexi95yc4ciXzqJtzgusUnKtspeRakTHr2Re3nDHbhe7DmVrbi13MIi1QqznRQ_NJC541EBJGwst_-xEJdwy0GsWNEvsQybaCwks0CxvB0QDHPdwXDVH3AEYv9opdtAdsKXgjjYg4__IXtKbnIStki2GXle/s1024/IMG_0523.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1024" data-original-width="1024" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgCcP9ENozlX4zzZu24vm3ycLesx0z5IX-AIiexi95yc4ciXzqJtzgusUnKtspeRakTHr2Re3nDHbhe7DmVrbi13MIi1QqznRQ_NJC541EBJGwst_-xEJdwy0GsWNEvsQybaCwks0CxvB0QDHPdwXDVH3AEYv9opdtAdsKXgjjYg4__IXtKbnIStki2GXle/w640-h640/IMG_0523.jpeg" width="640" /></a></div><br /><p>I think it's very nice. Finally I asked AI to generate a picture of a radiologist sitting in a dark room in front of many monitors. This is what I got:</p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi6Hojp5Il27Al1SC0dSN6Pxe9crs4W9K_4jljx-FIZFxEV7wNliCrewto401k0svVQnQhwRbJ_DZsTYlh_8SsuqYa0I-LOdT_HkENW5ouFqeckmAiTDG4jLjAjwq859d8w8QLvI4wPSuiidmunmBlzxcUdS7w4Luq64j8toqD7PPrR-YOxYprm9uSRJLrP/s1024/DALL%C2%B7E%202023-11-24%2019.29.17%20-%20A%20radiologist,%20of%20Asian%20descent%20and%20male%20gender,%20sitting%20in%20a%20dark%20room%20in%20front%20of%20a%20computer%20and%20multiple%20screens.%20The%20screens%20display%20various%20radio.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1024" data-original-width="1024" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi6Hojp5Il27Al1SC0dSN6Pxe9crs4W9K_4jljx-FIZFxEV7wNliCrewto401k0svVQnQhwRbJ_DZsTYlh_8SsuqYa0I-LOdT_HkENW5ouFqeckmAiTDG4jLjAjwq859d8w8QLvI4wPSuiidmunmBlzxcUdS7w4Luq64j8toqD7PPrR-YOxYprm9uSRJLrP/w640-h640/DALL%C2%B7E%202023-11-24%2019.29.17%20-%20A%20radiologist,%20of%20Asian%20descent%20and%20male%20gender,%20sitting%20in%20a%20dark%20room%20in%20front%20of%20a%20computer%20and%20multiple%20screens.%20The%20screens%20display%20various%20radio.jpeg" width="640" /></a></div><br /><p>In summary: AI is still in its early stages but developing fast and certainly will have a future helping us Radiologists. </p>Robert Prejshttp://www.blogger.com/profile/17634722289004416123noreply@blogger.comtag:blogger.com,1999:blog-1338479728779859445.post-91584849786147624222023-11-26T20:06:00.000+01:002023-11-26T20:06:29.002+01:00Non-Ketotic Hyperglycemic Hemichorea - Diabetic Striatopathy<p>Non-Ketotic Hyperglycemic Hemichorea (NKHH), also known as Diabetic Striatopathy, is a rare neurological disorder predominantly observed in patients (mostly Asian elderly women) with uncontrolled diabetes, usually type 2. It is characterized by involuntary, irregular, and unpredictable movements, primarily affecting one side of the body (hemichorea). The condition is linked to hyperglycemia without ketosis and often involves alterations in the basal ganglia's striatum (comprising the caudate nucleus and putamen).</p><p>A 49-year-old Caucasian male with a history of type 1 diabetes presented with characteristic symptoms of hemichorea. This case is particularly noteworthy given the patient's background, as NKHH predominantly affects older individuals with type 2 diabetes.</p><p>Radiological Findings: CT and MRI Analysis</p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg9u1vbBHR3bK06EawQcmlk-LA6ZnDGByc30r343KJOQ5QluOG-AHEtkJZzDdpbyTssvhYGBR1mMCcAD-VXsPHRNlds5t3fw5p2HheN6c8vqoSEiHhOYiVb7P7-K4YQY3j8T1vg4z48K95WEbObsYbn9jyBG-GOef6wzQoDH3rXVmrTSkebTHQeJlGMyz11/s2427/Non-ketotic%20hyperglycaemic%20hemichorea%20diabetic%20striatopathy%201.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1308" data-original-width="2427" height="344" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg9u1vbBHR3bK06EawQcmlk-LA6ZnDGByc30r343KJOQ5QluOG-AHEtkJZzDdpbyTssvhYGBR1mMCcAD-VXsPHRNlds5t3fw5p2HheN6c8vqoSEiHhOYiVb7P7-K4YQY3j8T1vg4z48K95WEbObsYbn9jyBG-GOef6wzQoDH3rXVmrTSkebTHQeJlGMyz11/w640-h344/Non-ketotic%20hyperglycaemic%20hemichorea%20diabetic%20striatopathy%201.jpg" width="640" /></a></div><p>Image 1: Initial CT and MRI</p><p>The first CT scan, performed without contrast, revealed <b>diffusely increased signal intensity in the putamen</b>, more pronounced on the right. The subsequent MRI, conducted without contrast, showed elevated T1 signal intensity in the posterior part of the right putamen, likely indicating methemoglobin presence. Accompanying these findings were slight edema around the right putamen and minimal diffusion restriction.</p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEinbT9kT1Hm098mNyC3_jhQ86MuFgSIWSWhdVjdHBI8sfdZ70ygB9OzlLQbcPg-H2NDBWgFwBncUqLq_9a84MaS80IPPRS9yoL7BtY3_IBfKsQnLiftBAdx9NoI-zUCr-JV-qKwgHayBnMtKSfokcrfkz39KwSqSEGs5eYylh6k7uQ1OitxCiDSN0b68kLo/s2439/Non-ketotic%20hyperglycaemic%20hemichorea%20diabetic%20striatopathy%202.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1294" data-original-width="2439" height="340" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEinbT9kT1Hm098mNyC3_jhQ86MuFgSIWSWhdVjdHBI8sfdZ70ygB9OzlLQbcPg-H2NDBWgFwBncUqLq_9a84MaS80IPPRS9yoL7BtY3_IBfKsQnLiftBAdx9NoI-zUCr-JV-qKwgHayBnMtKSfokcrfkz39KwSqSEGs5eYylh6k7uQ1OitxCiDSN0b68kLo/w640-h340/Non-ketotic%20hyperglycaemic%20hemichorea%20diabetic%20striatopathy%202.jpg" width="640" /></a></div><p>Image 2: One-Year Follow-Up MRI</p><p>A follow-up study conducted a year later (top row) presented a remarkable resolution of the condition. Comparison with the original MRI (bottom row) highlighted the resolution of edema and the emergence of low signal in the right putamen on Susceptibility Weighted Imaging (SWI), suggestive of hemosiderin deposition (most right top row).</p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEja71UzAhlg9pcQC7_gZLhOtycWRKXuO6n1t9oOV3OqPAE2vvPyj5pvRwYEWUA4o_oAiWj-li4wsZDemq9LBPraEQKFEOVV1WJJy-RC7R9PBvN462AgCaG1Knd5MPMx8LJQInlQPjRM1aI-VEd-r7o1X0hGT5wXarZUvbkRSH_zKvwdtrFzNeHqtKvzDBJ_/s2515/Non-ketotic%20hyperglycaemic%20hemichorea%20diabetic%20striatopathy%203.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1298" data-original-width="2515" height="330" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEja71UzAhlg9pcQC7_gZLhOtycWRKXuO6n1t9oOV3OqPAE2vvPyj5pvRwYEWUA4o_oAiWj-li4wsZDemq9LBPraEQKFEOVV1WJJy-RC7R9PBvN462AgCaG1Knd5MPMx8LJQInlQPjRM1aI-VEd-r7o1X0hGT5wXarZUvbkRSH_zKvwdtrFzNeHqtKvzDBJ_/w640-h330/Non-ketotic%20hyperglycaemic%20hemichorea%20diabetic%20striatopathy%203.jpg" width="640" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjwLawmbkZSVwcHsJeRYC1DIcCJiTOUim0ZnzFaAwjdBDNtoppXM6Wb4WTANtGo1YNSC6UgFoYC3KUwqVcQJYnFr9lPCKOJUPFt3xCQvCcdTHika2PVc7H68aJHTYUUT8qpZmhHdw-MYY7OFKaWWTyV9YSeYDkVpyfLxtrOF4Mw6uEnBd7kUhStB2-dqLCa/s2525/Non-ketotic%20hyperglycaemic%20hemichorea%20diabetic%20striatopathy%204.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1293" data-original-width="2525" height="328" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjwLawmbkZSVwcHsJeRYC1DIcCJiTOUim0ZnzFaAwjdBDNtoppXM6Wb4WTANtGo1YNSC6UgFoYC3KUwqVcQJYnFr9lPCKOJUPFt3xCQvCcdTHika2PVc7H68aJHTYUUT8qpZmhHdw-MYY7OFKaWWTyV9YSeYDkVpyfLxtrOF4Mw6uEnBd7kUhStB2-dqLCa/w640-h328/Non-ketotic%20hyperglycaemic%20hemichorea%20diabetic%20striatopathy%204.jpg" width="640" /></a></div><p>Images 3 and 4: Additional Sequence Comparisons</p><p>Further comparative sequences reinforced the initial observations and provided a comprehensive view of the patient's response to treatment.</p><p><b>Key Insights and Take-Home Message</b></p><p>This case underscores the importance of meticulous radiological examination in patients presenting with hemichorea, particularly in those with a history of diabetes. The distinct radiological feature to note is the <b>diffusely increased density in the putamen on CT scans</b>, which may not present as an obvious hemorrhage. Early recognition of these signs, coupled with the specific clinical history, can prompt a suspicion of Diabetic Striatopathy, facilitating timely intervention and management.</p><div><br /></div>Robert Prejshttp://www.blogger.com/profile/17634722289004416123noreply@blogger.comtag:blogger.com,1999:blog-1338479728779859445.post-33344857869135586372023-10-10T14:17:00.000+02:002023-10-10T14:17:06.117+02:00Anomalous ossicle between laminae C2 and C3<p> </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj5FFcVLZnamFFCBDSYxqqsXyrzzv7VdxCySMjxQj8SMf0b0lo-8LMyGnD8-Upp5wiNLKPiv8RZt_AoNXphcOLHA9eBeSk6chFLkSQ2h7f1xyhoxn7nqEyUUFEQ5U55kOeUdsIIUsd7qGSumtgmDEHq9-WHkT0ou_pQ0yI5JrdDUadsFba7EKNNUWx-Yvk_/s2429/Anomalous%20ossicle%20between%20laminae%20C2%20and%20C3.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1336" data-original-width="2429" height="352" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj5FFcVLZnamFFCBDSYxqqsXyrzzv7VdxCySMjxQj8SMf0b0lo-8LMyGnD8-Upp5wiNLKPiv8RZt_AoNXphcOLHA9eBeSk6chFLkSQ2h7f1xyhoxn7nqEyUUFEQ5U55kOeUdsIIUsd7qGSumtgmDEHq9-WHkT0ou_pQ0yI5JrdDUadsFba7EKNNUWx-Yvk_/w640-h352/Anomalous%20ossicle%20between%20laminae%20C2%20and%20C3.jpg" width="640" /></a></div><br /><p></p><p>There are many congenital anomalies of the spine. One rare is this one spotted as incidental finding on MRI of the Cervical Spine of a 64 years old patient. Reporting radiologist pointed skeletal anomaly in form of an ossicle between laminae of C2 and C3 on the right side causing slight impression on the posterior part of the dural sack, recommending further analysis with CT of the Cervical Spine. The CT has confirmed what looks like an anomalous ossicle between laminae C2 and C3. The ossicle has its own cortex and there are some depressions in the laminae due to its presence. </p><p><br /></p><p>Similar anomalous ossicle is described in T. Keats - Atlas of Normal Roentgen Variants 7th edition, Figure 3-69, page 215. </p>Robert Prejshttp://www.blogger.com/profile/17634722289004416123noreply@blogger.comtag:blogger.com,1999:blog-1338479728779859445.post-11862021544916090752022-12-21T17:18:00.000+01:002022-12-21T17:18:04.937+01:00AI vs Human<p> </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjwvNEawRs17lwW_BXuB3kASF4FyRKTZ9kjE2XNd22oJ6BzKQuGnXaqPatwrfLaG2UHuZ1pK7Npe9_nrWnNlyhdCBvk6E3AvzGC1q6nhWsJbb1nEjDL9fe718UdvJ_eM316tOeSjsjeYDhdIUbkhT-ZesJQA1UzsW-tcFlvkzDbHOW1qTOgD43aesesEQ/s1316/AI%20vs%20Human.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1316" data-original-width="1058" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjwvNEawRs17lwW_BXuB3kASF4FyRKTZ9kjE2XNd22oJ6BzKQuGnXaqPatwrfLaG2UHuZ1pK7Npe9_nrWnNlyhdCBvk6E3AvzGC1q6nhWsJbb1nEjDL9fe718UdvJ_eM316tOeSjsjeYDhdIUbkhT-ZesJQA1UzsW-tcFlvkzDbHOW1qTOgD43aesesEQ/w514-h640/AI%20vs%20Human.jpg" width="514" /></a></div><br /><p></p><p><span style="font-family: verdana;">As a funny post here example of counting spinal levels by AI (Artificial Intelligence - purple) vs Human (me - orange). :)</span></p>Robert Prejshttp://www.blogger.com/profile/17634722289004416123noreply@blogger.comtag:blogger.com,1999:blog-1338479728779859445.post-84965619449482202242022-10-11T12:06:00.000+02:002022-10-11T12:06:06.860+02:00Small Vestibular Schwannoma<p><span style="font-family: verdana;">Remember my old post about anatomy of the Internal Acoustic Canal (ICA). I mentioned that to me it looks like "<a href="https://radiologymri.blogspot.com/2011/01/monkey-looking-at-cerebellum.html" target="_blank">Monkey Looking at Cerebellum</a>" in cross section. Mouth of the monkey being Vestibular Nerve and upper eye being 7th nerve (Facial Nerve) (7-UP!) and lower eye being Cochlear Nerve. </span></p><p><span style="font-family: verdana;">Today I came across this exam showing a Small Vestibular Schwannoma (VS) deep in the Internal Acoustic Canal. </span></p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgCo0Gu3HJ_UTl-PqcIguhol9bvnuMzIfsD1Yynb1g5Q_4dPh4q2e6NDLhaLOxepRKUrM2SP0vMq-qZ_rnEEU3G6m977yPmCqU_mARxF7y1sI6UKd7SjXF6626ooWMLfLsJSqYvwhW9fvLP3pKjdHnTDE2LxDSOSM41E6OO3VHVDNRGGAJcLfffkFemUw/s2431/vestibularisschwannom%201%20small.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1264" data-original-width="2431" height="332" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgCo0Gu3HJ_UTl-PqcIguhol9bvnuMzIfsD1Yynb1g5Q_4dPh4q2e6NDLhaLOxepRKUrM2SP0vMq-qZ_rnEEU3G6m977yPmCqU_mARxF7y1sI6UKd7SjXF6626ooWMLfLsJSqYvwhW9fvLP3pKjdHnTDE2LxDSOSM41E6OO3VHVDNRGGAJcLfffkFemUw/w640-h332/vestibularisschwannom%201%20small.jpg" width="640" /></a></div><br /><span style="font-family: verdana;">Note that the VS is located in the "mouth" of the monkey. </span><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgQJ71A4DcIz5cSQ7ubi2dPAAFNS5iR_hk9hLKv03DUSZcebyq14nf1PFYmazmp-a7zO6843aAUOuf2Hf6FjJfoCem7v_zPhpnsjbFZQiSzncHE7hfYAeWOftmGhNevkFAzDKpCzAkXQ3HQZgWpFmRWqnNEH6tE4hChPGJ-cN50HavhA1T99jO-npTADw/s2476/vestibularisschwannom%202%20small.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1312" data-original-width="2476" height="340" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgQJ71A4DcIz5cSQ7ubi2dPAAFNS5iR_hk9hLKv03DUSZcebyq14nf1PFYmazmp-a7zO6843aAUOuf2Hf6FjJfoCem7v_zPhpnsjbFZQiSzncHE7hfYAeWOftmGhNevkFAzDKpCzAkXQ3HQZgWpFmRWqnNEH6tE4hChPGJ-cN50HavhA1T99jO-npTADw/w640-h340/vestibularisschwannom%202%20small.jpg" width="640" /></a></div><p><span style="font-family: verdana;">This is a section just next to the VS showing a bit "sad face of the monkey". :(</span></p>Robert Prejshttp://www.blogger.com/profile/17634722289004416123noreply@blogger.comtag:blogger.com,1999:blog-1338479728779859445.post-65884331234618000002022-09-13T09:23:00.000+02:002022-09-13T09:23:15.244+02:00Multiple Cavernomas in KRIT-1 Gene Mutation<p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjZBwYeq4BGVKdwkXSKOXIw_2I7f1yrMa6mYgzbnxKDwoqW-yB7jIVsXfvp18GUAZiqbcb0dc6BmQzKt1dVVvBRfETiOqWOus1GteZuhtJLfZbC7H5Qjq0phG6Rrv0XWl7aiPi5P0Q13fPMLam2tLO-2ZZjrQCxhK1iJQMihdH_2zh5wahEfgH2LqM-oA/s2553/Multiple%20Cavernomas%20in%20KRIT-1%20%20Gene%20Mutation%201.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="911" data-original-width="2553" height="228" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjZBwYeq4BGVKdwkXSKOXIw_2I7f1yrMa6mYgzbnxKDwoqW-yB7jIVsXfvp18GUAZiqbcb0dc6BmQzKt1dVVvBRfETiOqWOus1GteZuhtJLfZbC7H5Qjq0phG6Rrv0XWl7aiPi5P0Q13fPMLam2tLO-2ZZjrQCxhK1iJQMihdH_2zh5wahEfgH2LqM-oA/w640-h228/Multiple%20Cavernomas%20in%20KRIT-1%20%20Gene%20Mutation%201.jpg" width="640" /></a></div> <div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjGu3d9ZJoSwFIPUfgMtGzEn18bkLOAnhxeGete_spwtkSwEsu7JY2ev3ZxHRAkW81Vf9-EZaob8QrWFLPBFeoiAX378iJZ70yXHn2RHvOPS1sCO1CwHQuqJIeQ38582TU5npr5NoMt_NoUnHRcVODkNmRmq8VKmTRqH2KRK0mU-5ah5CQHEjcYChPvrg/s2544/Multiple%20Cavernomas%20in%20KRIT-1%20%20Gene%20Mutation%202.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="827" data-original-width="2544" height="208" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjGu3d9ZJoSwFIPUfgMtGzEn18bkLOAnhxeGete_spwtkSwEsu7JY2ev3ZxHRAkW81Vf9-EZaob8QrWFLPBFeoiAX378iJZ70yXHn2RHvOPS1sCO1CwHQuqJIeQ38582TU5npr5NoMt_NoUnHRcVODkNmRmq8VKmTRqH2KRK0mU-5ah5CQHEjcYChPvrg/w640-h208/Multiple%20Cavernomas%20in%20KRIT-1%20%20Gene%20Mutation%202.jpg" width="640" /></a></div><br /><span style="font-family: verdana;">A person with known in family KRIT-1 gene mutation shows multiple (uncountable number) cavernous malformations (cavernomas) on the SWI sequence (most to the left on both images). The largest one located temporo-occipital in the right hemisphere (to the left on the images) is visible on T2 sequence and hardly noticeable on T1 without and with Gd contrast. Other multiple cavernomas are hard to spot on other sequences. Same situation in the posterior fossa. </span><p></p><p><span style="font-family: verdana;">According to the literature: </span></p><p><span style="font-family: verdana;"><i>"The KRIT1 gene (also known as CCM1) provides instructions for making a protein that strengthens the interactions between cells that form blood vessels and limits leakage from the vessels." </i> </span><span style="font-family: verdana;"><a href="https://medlineplus.gov/genetics/gene/krit1/">https://medlineplus.gov/genetics/gene/krit1/</a></span></p><p><span style="font-family: verdana;"><i>"Mutations in Krev1 interaction trapped gene 1 (KRIT1) cause cerebral cavernous malformation, an autosomal dominant disease featuring malformation of cerebral capillaries resulting in cerebral hemorrhage, strokes, and seizures."</i> <a href="https://pubmed.ncbi.nlm.nih.gov/12140362/">https://pubmed.ncbi.nlm.nih.gov/12140362/</a></span></p><p><span style="font-family: verdana;">Please note how important is the SWI sequence showing the vascular malformations (hemosiderin) the best. The second best sequence to look at the cavernous malformation structure is high quality T2 sequence - best on 3T MRI. </span></p><p><span style="font-family: verdana;"><br /></span></p><p><span style="font-family: verdana;"><br /></span></p>Robert Prejshttp://www.blogger.com/profile/17634722289004416123noreply@blogger.comtag:blogger.com,1999:blog-1338479728779859445.post-37952803037123907572022-08-14T12:31:00.002+02:002022-08-14T12:32:44.101+02:00Brain Degenerative Diseases and Gut Flora<p> </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEji9mVB94m8f-jY5D5MOjiPX6hs4007lIGMiHJbtK1Y2w5LMhsbFa5HR1nCsj2sc9xxCIuJcm8uBNEh4colxCkyvgp090wKrP9GzYfZwhphuIt5vORDtqJYLPUs52q2RG4u0UJcMia0651bWosKmvAo-L-OsSatID7d2UeBu0ELaIPS5cKtSPObdOqGVg/s1021/Aging%20CT%20hippocampi.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="953" data-original-width="1021" height="374" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEji9mVB94m8f-jY5D5MOjiPX6hs4007lIGMiHJbtK1Y2w5LMhsbFa5HR1nCsj2sc9xxCIuJcm8uBNEh4colxCkyvgp090wKrP9GzYfZwhphuIt5vORDtqJYLPUs52q2RG4u0UJcMia0651bWosKmvAo-L-OsSatID7d2UeBu0ELaIPS5cKtSPObdOqGVg/w400-h374/Aging%20CT%20hippocampi.jpg" width="400" /></a></div><div style="text-align: center;">Coronal CT of 86 years old showing moderate atrophy i hippocampi - MTA 2.</div><p></p><p><span style="font-family: verdana;"><br /></span></p><p><span style="font-family: verdana;">Interesting articles indicate complex relation between our gut flora and neurodegenerative diseases. Especially in Alzheimer Dementia (AD).</span></p><p><span style="font-family: verdana;"><a href="https://www.mdpi.com/2076-2607/9/11/2281/htm" target="_blank">Gut Microbiota Regulation and Their Implication in the Development of Neurodegenerative Disease - Peilin Sun, Et al.</a></span></p><p><span style="font-family: verdana;"><a href="https://www.frontiersin.org/articles/10.3389/fneur.2022.900048/full" target="_blank">Downregulation of Neurofilament Light Chain Expression in Human Neuronal-Glial Cell Co-Cultures by a Microbiome-Derived Lipopolysaccharide-Induced miRNA-30b-5p - Aileen I. Pogue, Et al.</a></span></p><span style="font-family: verdana;"><i>*(citations from above articles in cursive font)</i><br /><br /><br />Studies indicate that anaerobic bacteria producing toxins cause brain inflammation that disrupts fragile neural connections in the elderly. My private theory is that hygiene of the mouth plays important role. Environmental factors of the modern civilisation, food preservatives and destruction of natural gut flora plays important role. Also fact that people live longer allows more time for neurodegenerative diseases to develop. <br /><br /><br /><i>One major class of microbiome-derived neurotoxin is the Gram-negative bacteria-derived lipoprotein glycoconjugate lipopolysaccharide (LPS) that has been reported by several independent research groups to reside within the brain cells and CNS tissues of aged patients affected with AD and in AD murine models (10–15). Many different variations of LPS are derived from different human microbiome-resident Gram-negative bacteria; for example, species such as the anaerobic bacterium Bacteroides fragilis are capable of secreting particularly pro-inflammatory and neurotoxic forms of LPS, such as BF-LPS, which penetrate physiological barriers, including brain cell plasma membranes (8–18). Importantly, Aβ peptides, one neuropathological hallmark for AD, have recently been shown to further support the translocation of LPS into neurons, probably via transient channel formation through the neuronal plasma membrane (6–12).<br /></i><br /><br /><br />About important role of gut bacteria:<br /><br /><br /><i>In recent years, human gut microbiota have become one of the most promising areas of microorganism research; meanwhile, the inter-relation between the gut microbiota and various human diseases is a primary focus. As is demonstrated by the accumulating evidence, the gastrointestinal tract and central nervous system interact through the gut–brain axis, which includes neuronal, immune-mediated and metabolite-mediated pathways. Additionally, recent progress from both preclinical and clinical studies indicated that gut microbiota play a pivotal role in gut–brain interactions, whereas the imbalance of the gut microbiota composition may be associated with the pathogenesis of neurological diseases (particularly neurodegenerative diseases), the underlying mechanism of which is insufficiently studied. This review aims to highlight the relationship between gut microbiota and neurodegenerative diseases, and to contribute to our understanding of the function of gut microbiota in neurodegeneration, as well as their relevant mechanisms. <br /><br /><br /><br />Aging in humans is reportedly also related to significant shifts in the composition of gut microbiota, and the loss of microbial diversity was also evident in the aging gut. In addition, a striking alteration of microbiota composition was observed in the gastrointestinal tracts of elderly patients suffering from neurodegeneration [29]. Hence, researchers hypothesized that the alteration of human gut microbiota might well be one of the causes, or at least one of the contributing factors, of neurodegenerative diseases.<br /><br /><br />Currently, the prevalence of neurodegenerative disease is rapidly rising. Although genetic susceptibility is a major risk factor of neurodegenerative diseases, environmental factors throughout one’s lifetime also exert a great influence on the onset, development and eventual severity of such diseases.</i><br /><br /><br /><br /><i>According to a recent comparative study, human AD patients had a decreased microbial diversity, compared to both healthy controls and patients with merely mild cognitive impairments (MCI).<br /><br /><br /><br />Moreover, intestinal bacteria can also secrete a large number of lipopolysaccharide (LPS) and amyloid proteins. On one hand, these substances can directly enter the brain through the intestinal and blood–brain barriers. On the other hand, they can also induce a series of inflammatory reactions and increase the permeability of these barriers [39]. Additionally, the microbial amyloid protein produced by gut microbiota can also interact with the Toll-like receptor TLR2 to induce the activation of pro-inflammatory mediators such as interleukin (IL-17A, IL22), subsequently inducing an immune response and stimulating the production of the amyloid protein in the brain neurons [40].</i><br /><br /><br /><br />Important role plays intestinal epithelium being a major barrier for the penetration of our organism by harmful bacteria and their toxins.<br /><br /><br />Antibiotics in food destroy natural bacteria flora that has protective function.<br /><br /><br /><i>Indigenous microbiota in the intestinal tract is the first line of defense against invading exogenous pathogens [54]. Specifically, the beneficial microorganism species contribute to the prevention of intestinal infection through mechanisms such as altering the pH value of the intestinal microenvironment, secreting anti-bacterial substances, and directly competing for adhesion sites or nutrition on the epithelium surface [55,56,57]. In clinical scenarios, antibiotics-related diarrhea occurs mostly when the treatment with antibiotics starts to substantially disrupt the natural balance between the intestinal microbiota subpopulations and leads to the proliferation of harmful bacterial types (e.g., Clostridium difficile).</i><br /><br /><br /><br />Important role is played by probiotics:<br /><i>Additionally, Lactobacillus GG (a probiotic species) significantly shortened the disease course of infectious diarrhea in infants and children [59]. Both results suggested that certain types of gut microbiota might have played a substantial role in the systematic reaction against gut-mediated infection.</i><br /><br /><br /><br />Importance of the main bacteria in our mouth - Lactobacillus salivarius - present in our saliva:<br /><i>Specifically, Lactobacillus salivarius and Bifidobacterium breve are considered important bacteria species that contribute to the stabilization of the immune system.</i><br /><br /><br /><br />Important role play vitamins that are necessary for our good bacteria to thieve. <br /><br /><br />There are even hypothesis that bacteria can be the cause for multiple sclerosis (MS):<br /><i>Bacteria is occasionally capable of passing through the blood–brain barrier, or the blood–cerebrospinal fluid barrier, to enter the central nervous system, the mechanisms of which include trans-cellular infiltration, paracellular entering, or via the infected leukocytes [130]. Branton et al. [131] detected the existence of bacteria in the brain tissue of multiple sclerosis (MS) patients and discovered that Proteobacteria were the dominant flora in the cerebral white matter of female MS patients, a phenomenon that is reportedly associated with the expression of inflammation-related genes in patients’ brains.</i><br /><br /><br /><br />Importance of good mouth hygiene - chronic gingival inflammation stimulates growth of harmful bacteria:<br /><i>Studies also found that Porphyromonas gingivalis, a primary pathogen of chronic periodontitis, existed in the brain tissue of patients with Alzheimer’s disease.</i><br /><br /><br /><br />Now we know why our dogs eat poop 💩🐶:<br /><i>Fecal Microbiota Transplantation (FMT) - FMT refers to the transplantation of feces containing gut microbiota from healthy donors to recipients with dysbacteriosis, by means of an enema or nasogastric, nasointestinal, or endoscopic approaches, aiming to restore the normal diversity and functionality of the gut microbiome [157,158]. This method is currently considered an effective treatment for the recurrent infection of Clostridium difficile.</i></span>Robert Prejshttp://www.blogger.com/profile/17634722289004416123noreply@blogger.comtag:blogger.com,1999:blog-1338479728779859445.post-23372495838274212012022-07-25T09:06:00.001+02:002022-07-25T09:07:47.815+02:00Large Colloid Cyst in Cavum Vergae<p> </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh_76Pwwt87iD0Wfb6WxkfKCYL1fNEdLMCEPHcTKuYWSBUMKY6YeXI1wNVLjcNPYflsykmbWqSZ8saBTrZC7xDDP8lBx5lU2tQSXgvsMk0dqzVmOTIIcrVEYd0DJFqZyTzEUWijQv3WoUuUsLzZH50_PRYzaJh1i3Q8NCLJGEaVKY8F7Q1_D9eTIV5QKw/s2503/Large%20Colloid%20Cyst%20in%20Cavum%20Vergae.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1336" data-original-width="2503" height="342" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh_76Pwwt87iD0Wfb6WxkfKCYL1fNEdLMCEPHcTKuYWSBUMKY6YeXI1wNVLjcNPYflsykmbWqSZ8saBTrZC7xDDP8lBx5lU2tQSXgvsMk0dqzVmOTIIcrVEYd0DJFqZyTzEUWijQv3WoUuUsLzZH50_PRYzaJh1i3Q8NCLJGEaVKY8F7Q1_D9eTIV5QKw/w640-h342/Large%20Colloid%20Cyst%20in%20Cavum%20Vergae.jpg" width="640" /></a></div><p>Large Colloid Cyst in the roof of the Third Ventricle in Cavum Vergae - posteriorly in the Third Ventricle. As usual there is no enhancement. CT with contrast shows higher attenuation due to cholesterol component of the fluid (mucin) in the cyst. Note higher than CSF signal on FLAIR and T2. There is no hydrocephalus and no oedema. You can compare it to other <a href="https://radiologymri.blogspot.com/2020/05/large-colloid-cyst.html" target="_blank">Large Colloid Cyst</a> expanding more anteriorly and the most typical in size and location <a href="https://radiologymri.blogspot.com/2010/10/colloid-cyst.html">Colloid Cyst</a> - in the roof of the Third Ventricle near Foramina Monroi. Note small "dots" on the superior aspect of the Colloid Cyst representing Internal Cerebral Veins - that are not compromised. </p>Robert Prejshttp://www.blogger.com/profile/17634722289004416123noreply@blogger.comtag:blogger.com,1999:blog-1338479728779859445.post-62164254015374332362020-06-16T15:11:00.001+02:002020-06-16T15:11:08.732+02:00MRI Tractography - Brain Tumor<br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgksz3jqgTrAmJAqZYU2t_VJXvVdfpUPdUtX_tPCNDvBQFWK8KwvfhTpdLsQLYQi2MZuaIpIPOZzQp3bZmaKa3bYibdBRheb9TirbmiXkLc6ke1wgSlRTUpZ3cLz232ogLjkx5oAtFeeVIC/s1518/Tractography+tumor+brain.PNG" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1116" data-original-width="1518" height="470" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgksz3jqgTrAmJAqZYU2t_VJXvVdfpUPdUtX_tPCNDvBQFWK8KwvfhTpdLsQLYQi2MZuaIpIPOZzQp3bZmaKa3bYibdBRheb9TirbmiXkLc6ke1wgSlRTUpZ3cLz232ogLjkx5oAtFeeVIC/w640-h470/Tractography+tumor+brain.PNG" width="640" /></a></div><div class="separator" style="clear: both; text-align: left;"><br /></div><div class="separator" style="clear: both; text-align: left;">Recently when reporting a brain MRI of a patient after tumor operation I came across beautiful functional and <b>MRI Tractography</b> images showing corticospinal tracts relation to the brain tumor in the frontal lobe. The interpretation of this study was that most ventral parts of the corticospinal tracts are located near tumor's dorsal part and the arcuate fasciculus was unaffected. Of course there were more images showing the arcuate fasciculus in more detail. The exam also included functional (fMRI) study showing motoric and speech locations. I'm not expert in this field but I wanted to show you that we are moving closer to using such functional studies in daily practice. </div>Robert Prejshttp://www.blogger.com/profile/17634722289004416123noreply@blogger.comtag:blogger.com,1999:blog-1338479728779859445.post-65745512455560905212020-06-16T14:50:00.000+02:002020-06-16T14:50:26.366+02:00Music Staff on MRI Lumbar Spine - fun<br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgR4j-y-QG7k7iFSiZRbcz14AOyXJdJdqJkhnoH846rF0McLD-pZZVCpQiZ43eOroxkloJsY3gHSZm0MHAUFYeNp8mdFGkQldhsyZPe7_liXf219qEbd389ic8fH-w6wfHCAmWIgqgR32ZN/s2450/Music+Staff+on+MRI+Lumbar+Spine.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1053" data-original-width="2450" height="276" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgR4j-y-QG7k7iFSiZRbcz14AOyXJdJdqJkhnoH846rF0McLD-pZZVCpQiZ43eOroxkloJsY3gHSZm0MHAUFYeNp8mdFGkQldhsyZPe7_liXf219qEbd389ic8fH-w6wfHCAmWIgqgR32ZN/w640-h276/Music+Staff+on+MRI+Lumbar+Spine.jpg" width="640" /></a></div><div class="separator" style="clear: both; text-align: left;"><br /></div><div class="separator" style="clear: both; text-align: left;">As a new hobby project I recently took on some digital piano and synthesizer training. Part of it is to learn to read the notes. <b>And somehow I keep on seeing five lines of staff even om MRI images :) !</b> This localizer incidentally even shows <a href="https://en.wikipedia.org/wiki/Staff_(music)" target="_blank">the grand staff</a>. :) </div><div class="separator" style="clear: both; text-align: left;"><br /></div><div class="separator" style="clear: both; text-align: left;">You can see a little <b>annular tear</b> in a place of previous disk herniation. </div><div class="separator" style="clear: both; text-align: left;"><br /></div><div class="separator" style="clear: both; text-align: left;">The <b>numbering of lumbar levels</b> is often a matter of discussion. Previous exam has called the lowest lumbar vertebra as L5. I used the same numbering but in fact the vertebra that is called L5 on this image is a transitional vertebra that is partially sacral vertebra - so it could be called S1. I made a note on my report for the clinician that in case of operation it is important to correlate the level of operation with <b>fluoroscopy</b>. </div><div class="separator" style="clear: both; text-align: left;"><br /></div><div class="separator" style="clear: both; text-align: left;">For correct numbering of spinal lumbar levels I look for proximal parts of ribs 12 on sagittal images and count from what I assume as L5 upwards. When I have the whole spine or CT, especially with coronal images, then the life is much easier. Also previous x-rays can be helpful. Sometimes we see hypoplastic 13th ribs or simply 11 thoracic vertebra. There are a lot of normal anatomic variants. </div>Robert Prejshttp://www.blogger.com/profile/17634722289004416123noreply@blogger.comtag:blogger.com,1999:blog-1338479728779859445.post-88686444011473562142020-05-27T15:49:00.002+02:002020-05-27T16:00:09.440+02:00Large Colloid Cyst<br /><br /><div class="separator" style="clear: both; text-align: center;"><img border="0" data-original-height="1143" data-original-width="2988" height="244" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg35UGYRprYsfLf7XWOLEqAy7smSKGnTnWwZPCdM5shkyp71_RpXj3v0zeNbkUFe4QOeEHoWbl_0eKHhgsYnwM8S1lqO9-fvIK7zwUCUh-0oHpUuRsTmwGrxpkCYBxgd-RGHj8yf2QXAuFn/w640-h244/Colloid+Cyst+Foramen+Monroe+32y+CT+before+operation.png" style="text-align: left;" width="640" /></div><div class="separator" style="clear: both; text-align: left;"><br /></div><div class="separator" style="clear: both; text-align: left;">37 years old patient presenting with hydrocephalus caused by unusually large <b>Colloid Cyst (CC)</b> at the typical location in the region of foramina Monroe. CC have characteristic appearance as thin-walled cyst in this location filled with rather homogenous high density content (cholesterol and proteins) on non-contrast CT. This one is rather large. For "usual" size Colloid Cyst see <a href="https://radiologymri.blogspot.com/2010/10/colloid-cyst.html" target="_blank">this other case</a>. CC can grow and obstruct foramina Monroe causing hydrocephalus - as in this case. Therefore neurosurgeons often recommend follow-up of CC that do not cause hydrocephalus or operate cases like this one. </div><div class="separator" style="clear: both; text-align: left;"><br /></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><img border="0" data-original-height="1111" data-original-width="4073" height="174" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh_UkNLtU6QG8V2t_Swg5TUraMiogOn15PXYICySoR1vK92hGBH5yQcStqZQ-G1Jaj4q2vNP_AND85mwudooGU0PHeKBKfBz8iwNtMg0Uc8zddH7VMl2u2Tu_eQl8Qy4-O445LmwuBeB9p0/w640-h174/Colloid+Cyst+Foramen+Monroe+32y+CT+after+operation.png" style="text-align: left;" width="640" /></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: left;">Patient has been operated (new images on the left) with successful removal of the CC and reduction of the hydrocephalus. Operation using endoscope and only small trepanation frontally (not shown). Note how nicely the sulci are seen now after operation compared with pre-operative images. </div>Robert Prejshttp://www.blogger.com/profile/17634722289004416123noreply@blogger.comtag:blogger.com,1999:blog-1338479728779859445.post-84219578314919939402020-05-15T13:57:00.003+02:002020-05-27T15:53:26.918+02:00Ventriculus Terminalis - Fifth Ventricle <br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhx9Re6DyMAxre607I1RngyoibPExiZ9PG1dr2UXOAuPJ_JMCIOQgAocj_Jjf8NpU5jlNxVl8wiCrI3yKWuNTqGCRylq49SVntfVkwOzpxCYAoaw0r3DgZS0KsA7E0UQZ8ZHJ6O2PGFbjyZ/" style="margin-left: auto; margin-right: auto;"><img alt="ventriculus terminalis - fifth ventricle ax" border="0" data-original-height="851" data-original-width="2519" height="216" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhx9Re6DyMAxre607I1RngyoibPExiZ9PG1dr2UXOAuPJ_JMCIOQgAocj_Jjf8NpU5jlNxVl8wiCrI3yKWuNTqGCRylq49SVntfVkwOzpxCYAoaw0r3DgZS0KsA7E0UQZ8ZHJ6O2PGFbjyZ/w640-h216/ventriculus+terminalis+-+fifth+ventricle+ax.jpg" title="ventriculus terminalis - fifth ventricle ax" width="640" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">sag T2, ax T2, ax T1 C+, ax T1 C+ FS<br /></td></tr></tbody></table><br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjn5sAyKNL5GaITsqqkLXFie4xMytej2gcp6R9EhmzaeOXrwXE4_gNVsu7UzcMMU6qGKFkzDQ7qFCQS1HqaoiYAEC1Ye01pge_NXYN57hXKx5x2xlYV9iUEBuDIqXgw1b1E09XnIzRuoWFs/" style="margin-left: auto; margin-right: auto;"><img alt="ventriculus terminalis - fifth ventricle sag" border="0" data-original-height="1141" data-original-width="2464" height="296" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjn5sAyKNL5GaITsqqkLXFie4xMytej2gcp6R9EhmzaeOXrwXE4_gNVsu7UzcMMU6qGKFkzDQ7qFCQS1HqaoiYAEC1Ye01pge_NXYN57hXKx5x2xlYV9iUEBuDIqXgw1b1E09XnIzRuoWFs/w640-h296/ventriculus+terminalis+-+fifth+ventricle+sag.jpg" title="ventriculus terminalis - fifth ventricle sag" width="640" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">sag T2, T1 C-, T1 C+, T1 C+ FS<br /></td></tr></tbody></table><div><br /></div><div>As additional finding at MRI of Lumbar spine an oval cystic lesion with thin well demarcated wall without contrast enhancement located in conus medullaris. This is a <b>ventriculus terminalis</b> also known as <b>fifth ventricle</b>. It represents developmental remnant and is believed to have no clinical significance. It has typical location and lack of enhancement differentiates it from other cystic lesions in the spine as for example hemangioblastoma. </div><div><br /></div><div>See also this interesting article:</div><div><a href="https://www.nature.com/articles/3101712" target="_blank">G. Liccardo - Fifth ventricle: an unusual cystic lesion of the conus medullaris</a> </div>Robert Prejshttp://www.blogger.com/profile/17634722289004416123noreply@blogger.comtag:blogger.com,1999:blog-1338479728779859445.post-50626427676968113692020-04-28T12:06:00.000+02:002020-04-28T12:06:08.516+02:00CT Pelvimetry - BäckenmätningBelow is a short summary of the <b>protocol for Pelvimetry</b> (Bäckenmätning in Swedish).<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi0J1H-3ahTNw_LEMhbSbnBsEhonbGYzDOjuAat53mXX1cWr3QZ6sLh-4cIwuqh4tYRxwancy44_bNoUM452X-463FN8QdrOcbvct1aSNWg4wvzNcB0dvVcOqdzSt_DYFSyhj6Jlvvrdjvj/s1600/Backenmatning.+MIP.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1089" data-original-width="1395" height="498" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi0J1H-3ahTNw_LEMhbSbnBsEhonbGYzDOjuAat53mXX1cWr3QZ6sLh-4cIwuqh4tYRxwancy44_bNoUM452X-463FN8QdrOcbvct1aSNWg4wvzNcB0dvVcOqdzSt_DYFSyhj6Jlvvrdjvj/s640/Backenmatning.+MIP.png" width="640" /></a></div>
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First a thick MIP is reconstructed on the scanner that covers whole pelvis. A line is drawn on the scanner that is later used for <b>calibration</b> on PACS workstation.<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhAkG7UmW8EqL63o3NthHxOYfAdPzP6-Wx5W784dtAB5OwtemEn3lFtb05zzQvPOlv-2hQeSfXgsKJTN2wiCeEH6ZCpB5qOMZZ-2p03DhmyV6pZKKWad2P90kO5EH78_82fF-AY1uo_900Z/s1600/B%25C3%25A4ckenm%25C3%25A4tning+MIP+Kalibrering.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="992" data-original-width="1373" height="462" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhAkG7UmW8EqL63o3NthHxOYfAdPzP6-Wx5W784dtAB5OwtemEn3lFtb05zzQvPOlv-2hQeSfXgsKJTN2wiCeEH6ZCpB5qOMZZ-2p03DhmyV6pZKKWad2P90kO5EH78_82fF-AY1uo_900Z/s640/B%25C3%25A4ckenm%25C3%25A4tning+MIP+Kalibrering.jpg" width="640" /></a></div>
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Calibration of the previously measured line.<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjJ_HUsk-l1AUXCDbyjusvwFOWJUsH263mN60Nt6ogCQq8S4xNBb_o4cDSiy1rUTJdMHXQCKJ-lShKZZ9uXMzHX3zQr2VPpV3D8rUnVGGTGKR_qpHmaLpm4Ad_GBo_wdwz_7k5hErDKe_fa/s1600/B%25C3%25A4ckenm%25C3%25A4tning+MIP+Transversal+Intertubar.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1089" data-original-width="1592" height="436" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjJ_HUsk-l1AUXCDbyjusvwFOWJUsH263mN60Nt6ogCQq8S4xNBb_o4cDSiy1rUTJdMHXQCKJ-lShKZZ9uXMzHX3zQr2VPpV3D8rUnVGGTGKR_qpHmaLpm4Ad_GBo_wdwz_7k5hErDKe_fa/s640/B%25C3%25A4ckenm%25C3%25A4tning+MIP+Transversal+Intertubar.jpg" width="640" /></a></div>
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On the above MIP the <b>Transversal Inlet Diameter</b> (Transverstingångsmått) is measured as the largest transversal distance in the pelvic inlet. As well as <b>Intertubar Diameter</b> (Intertubaravstånd) as distance between <b>ischial tubers</b>.<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjfU2gxKFA943XIhWpyEMjyd9zr28jCHYMoYrIghPRhilmADOxCZa4IbgGtkvr3Lew4MdFCof-XYTgcTkKYmQn0ZmSswvoeaS9B0OGUFvxpqrOUlW6BBKWUTq6PKPpfM2dU540qUR7Hkbhb/s1600/B%25C3%25A4ckenm%25C3%25A4tning+Sag.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="795" data-original-width="1600" height="318" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjfU2gxKFA943XIhWpyEMjyd9zr28jCHYMoYrIghPRhilmADOxCZa4IbgGtkvr3Lew4MdFCof-XYTgcTkKYmQn0ZmSswvoeaS9B0OGUFvxpqrOUlW6BBKWUTq6PKPpfM2dU540qUR7Hkbhb/s640/B%25C3%25A4ckenm%25C3%25A4tning+Sag.jpg" width="640" /></a></div>
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On sagittal reconstruction measure <b>Sagittal Inlet Diameter</b> (Sagittellt ingångsmått) as shortest distance between posterior part of symphysis pubis and promontorium (S1). As well as <b>Sagittal Outlet Diameter</b> (Sagittellt utgångsmått) as shortest distance between posterior part of symphysis pubis and <b>fist mobile joint between sacrum and coccyx</b>.<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg0leO-ZDUY52NQiuEpTGLDI6hkHVzqFQHJCBJTqHD1KEBTf8WqVhHpta-pdmMg4GKYtJMjIj6dDiCferJytddgF6ZVBeOwJZ23WcVqTEwK72PzuTy4R2M4o1eln9ZHjpznB532hTzyhnug/s1600/B%25C3%25A4ckenm%25C3%25A4tning+Interspinal.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="861" data-original-width="1530" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg0leO-ZDUY52NQiuEpTGLDI6hkHVzqFQHJCBJTqHD1KEBTf8WqVhHpta-pdmMg4GKYtJMjIj6dDiCferJytddgF6ZVBeOwJZ23WcVqTEwK72PzuTy4R2M4o1eln9ZHjpznB532hTzyhnug/s640/B%25C3%25A4ckenm%25C3%25A4tning+Interspinal.jpg" width="640" /></a></div>
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On axial reconstruction (see topogram for level) measure <b>Interspinal Diameter</b> (Interspinal avstånd) as shortest distance between ischial spines.<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgnH2fRpWi3kr3Tr0EshGFr0-1Kc8R6ah3h_qm3UE-NiDO7JKH4Zyo3ejivbCpfOzacRNerHvIb9uJ4kSMr21l3qW4UFzPfnNsINGyh85eavuuKm4JpcMN4OmL4EhiZb6uuz1GCHmsvF2H2/s1600/B%25C3%25A4ckenm%25C3%25A4tning+exampel+utl%25C3%25A5tande.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="566" data-original-width="1600" height="226" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgnH2fRpWi3kr3Tr0EshGFr0-1Kc8R6ah3h_qm3UE-NiDO7JKH4Zyo3ejivbCpfOzacRNerHvIb9uJ4kSMr21l3qW4UFzPfnNsINGyh85eavuuKm4JpcMN4OmL4EhiZb6uuz1GCHmsvF2H2/s640/B%25C3%25A4ckenm%25C3%25A4tning+exampel+utl%25C3%25A5tande.jpg" width="640" /></a></div>
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In your final report group the measurements in two groups:<br />
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<b>Sagittal Inlet Diameter</b><br />
<b>Transversal Inlet Diameter</b><br />
<b><br /></b>
<b>Sagittal Outlet Diameter</b><br />
<b>Interspinal Diameter</b><br />
<b>Intertubar Diameter</b><br />
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<i>Some obstetrics departments like to see the summation of the values for the inlet and outlet measurements. </i><br />
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Below some more examples:<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj28_niPmuIWCaeLmIg3yscIY8tOXpgeu2XTDzeXr8Jwm8s3GQj3P3pFh5PJm0AUW9CvE94vbsqPhrE7az72PikvzWMyXwCAcrJd8iGd7S0SCRqFkAor1B70EG3H9VxWiuTqaaRD7_uFszR/s1600/B%25C3%25A4ckenm%25C3%25A4tning+Sag+Ing%25C3%25A5ng.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1047" data-original-width="1600" height="418" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj28_niPmuIWCaeLmIg3yscIY8tOXpgeu2XTDzeXr8Jwm8s3GQj3P3pFh5PJm0AUW9CvE94vbsqPhrE7az72PikvzWMyXwCAcrJd8iGd7S0SCRqFkAor1B70EG3H9VxWiuTqaaRD7_uFszR/s640/B%25C3%25A4ckenm%25C3%25A4tning+Sag+Ing%25C3%25A5ng.jpg" width="640" /></a></div>
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<b>Sagittal Inlet Diameter</b> - note the shortest distance to measure.<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgP0BNRjfSwrbuRilnwaPABEBqPOSXDPQOsrp7KYOZMLU2-SdCg6rdtKBG97o0R_xd4MZduBLRR5M1UvOvcFiHeFaOzRoz-aXTTH-k5pd3ir0SlH0BETxMaBB04yTaX_3aE9IlRrwbjBoTi/s1600/B%25C3%25A4ckenm%25C3%25A4tning+MIP+Tra+Ing%25C3%25A5ng.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1087" data-original-width="1600" height="434" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgP0BNRjfSwrbuRilnwaPABEBqPOSXDPQOsrp7KYOZMLU2-SdCg6rdtKBG97o0R_xd4MZduBLRR5M1UvOvcFiHeFaOzRoz-aXTTH-k5pd3ir0SlH0BETxMaBB04yTaX_3aE9IlRrwbjBoTi/s640/B%25C3%25A4ckenm%25C3%25A4tning+MIP+Tra+Ing%25C3%25A5ng.jpg" width="640" /></a></div>
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Pelvic MIP showing <b>Transversal Inlet Diameter</b> measurement.<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgawaFacfwYSQamqPU3CTx5-cQh1NYCWkUix_n4fVLl-Tsi7GMhBMHjFQi3VaFUNUcFAMluEUqhHd2ZrTWWwQp16E1WwXwP-_OnCAjWUqxiqwxNZn3Pg3ljk7w5Ma5UZZrIV1C17sOR_2sz/s1600/B%25C3%25A4ckenm%25C3%25A4tning+Sag+Utg%25C3%25A5ng.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1064" data-original-width="1600" height="424" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgawaFacfwYSQamqPU3CTx5-cQh1NYCWkUix_n4fVLl-Tsi7GMhBMHjFQi3VaFUNUcFAMluEUqhHd2ZrTWWwQp16E1WwXwP-_OnCAjWUqxiqwxNZn3Pg3ljk7w5Ma5UZZrIV1C17sOR_2sz/s640/B%25C3%25A4ckenm%25C3%25A4tning+Sag+Utg%25C3%25A5ng.jpg" width="640" /></a></div>
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Sagittal reconstruction for <b>Sagittal Outlet Diameter</b> - measure the shortest between posterior part of symphysis pubis and <b>fist mobile joint between sacrum and coccyx</b>.<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhX4OArpNP7lf_RLynC2BnqDYiGhSLWL-bBGFIhLTdpR6TaE7iQBb8tDbuHAtAlbTStB7k7IBIhoP86Gh7OZcOk1KW20IY-dwc7VPb0O2JX7IbVCxWkRGCdlGUII_DFPuAWrxN2oTkxCe6r/s1600/B%25C3%25A4ckenm%25C3%25A4tning+Ax+intersinal.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1034" data-original-width="1600" height="412" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhX4OArpNP7lf_RLynC2BnqDYiGhSLWL-bBGFIhLTdpR6TaE7iQBb8tDbuHAtAlbTStB7k7IBIhoP86Gh7OZcOk1KW20IY-dwc7VPb0O2JX7IbVCxWkRGCdlGUII_DFPuAWrxN2oTkxCe6r/s640/B%25C3%25A4ckenm%25C3%25A4tning+Ax+intersinal.jpg" width="640" /></a></div>
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Axial reconstruction for <b>Interspinal Diameter</b> - again measure the shortest distance between <b>ischial spines</b>.<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh6KgC-TXIFLb9ZAFj48OKX9GPxVmxLIVQsvO0zJS7n-dxSRVCZYn7XaWKGgvBSI1cEFBxOU5rQO-kYnLz_NS2cxVmCDIHbyohbmJYWccjhYKaKpb5QmxwUhuoLFsDdYhd0ufH8fXT0-Wha/s1600/B%25C3%25A4ckenm%25C3%25A4tning+MIP+Intertubar.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1145" data-original-width="1600" height="456" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh6KgC-TXIFLb9ZAFj48OKX9GPxVmxLIVQsvO0zJS7n-dxSRVCZYn7XaWKGgvBSI1cEFBxOU5rQO-kYnLz_NS2cxVmCDIHbyohbmJYWccjhYKaKpb5QmxwUhuoLFsDdYhd0ufH8fXT0-Wha/s640/B%25C3%25A4ckenm%25C3%25A4tning+MIP+Intertubar.jpg" width="640" /></a></div>
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On MIP measure <b>Intertubar Diameter</b> - measure from the central parts of the <b>ischial tubers</b>.<br />
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Your final report could look like this (if you report in Swedish :)<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhuuIx7vyLCIE42c7kfM6O3WGmKyBy3lZxA-IFS8SX9oW83XVRQbfkn6S-i21oJZ6Ad-gJO-nHXCmUv4Z618Zv3mbES1bpValeaV6co_nnvvp0hvIaQ1Pm9YY_TnimYw1xtc_dyHTwEvURb/s1600/B%25C3%25A4ckenm%25C3%25A4tning+Utl%25C3%25A5tande.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1091" data-original-width="1600" height="436" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhuuIx7vyLCIE42c7kfM6O3WGmKyBy3lZxA-IFS8SX9oW83XVRQbfkn6S-i21oJZ6Ad-gJO-nHXCmUv4Z618Zv3mbES1bpValeaV6co_nnvvp0hvIaQ1Pm9YY_TnimYw1xtc_dyHTwEvURb/s640/B%25C3%25A4ckenm%25C3%25A4tning+Utl%25C3%25A5tande.jpg" width="640" /></a></div>
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<i><span style="color: red;">With Great Thanks for lending me the images to Dr. Rahideh Azadeh - radiology resident in Sweden!</span></i>Robert Prejshttp://www.blogger.com/profile/17634722289004416123noreply@blogger.comtag:blogger.com,1999:blog-1338479728779859445.post-9479485888960046122020-04-28T10:18:00.001+02:002020-04-28T12:06:52.053+02:00Brain infarctions in Covid-19Case 1.<br />
Healthy 57 years old male, military (fighter-jet) pilot, presented with speech problems after Covid-19 infection:<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhxIV9Ze1bGEzry9H-XkPwVwfBHdXHnA3Yhg5OL30m1p0TNxAV2pMFSRIwVgE_rX-7GGwE2YtukmUwTvrgfA3ZF6R116I6uuShyphenhyphen9gENqKkw0ndX8RihyJSN7tXiE2rLKXy6or-5FBe4ps1F/s1600/Covid+Infarcts+temporooccipital+57y+M+stridspilot+1.PNG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="479" data-original-width="1600" height="190" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhxIV9Ze1bGEzry9H-XkPwVwfBHdXHnA3Yhg5OL30m1p0TNxAV2pMFSRIwVgE_rX-7GGwE2YtukmUwTvrgfA3ZF6R116I6uuShyphenhyphen9gENqKkw0ndX8RihyJSN7tXiE2rLKXy6or-5FBe4ps1F/s640/Covid+Infarcts+temporooccipital+57y+M+stridspilot+1.PNG" width="640" /></a></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi47Ft9fhnvBw9PMy9b06S1pd2cH0aoxhW_FW8e6wd_QlItvJQFoZySXS57KUKXAMiKLF07_xkixYtB849o3WhXjVX5gKwYMh7sqtUi7o6acuSzWeobmAidvVq2nqDjfzG_jA-jTt5N4pnu/s1600/Covid+Infarcts+temporooccipital+57y+M+stridspilot+2.PNG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="475" data-original-width="1600" height="188" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi47Ft9fhnvBw9PMy9b06S1pd2cH0aoxhW_FW8e6wd_QlItvJQFoZySXS57KUKXAMiKLF07_xkixYtB849o3WhXjVX5gKwYMh7sqtUi7o6acuSzWeobmAidvVq2nqDjfzG_jA-jTt5N4pnu/s640/Covid+Infarcts+temporooccipital+57y+M+stridspilot+2.PNG" width="640" /></a></div>
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MRI shows acute infarctions in the temporo-occipital regions on the left most likely of small embolic nature. Rather unexpected finding in this age and at this location in otherwise healthy person.<br />
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Case 2.<br />
67 years old male presented with expressive aphasia. Unknown Covis-19 status:<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh2bohpPrCzpG2TgjiHKNnWi6EJwfz0YtG_GMJJMZB6m5OH17sM5Bqb3oQKyXPNwzDBQTbNYjLtA-WXIyrl3D8ua9pHhPczbF1gKX1elBQOtorDjpGm6FSxtM3-mFL7I2aHKcsG_6_HQDbG/s1600/Large+infarct+temporooccipital+67y+M+expressive+aphasia+1.PNG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="469" data-original-width="1600" height="186" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh2bohpPrCzpG2TgjiHKNnWi6EJwfz0YtG_GMJJMZB6m5OH17sM5Bqb3oQKyXPNwzDBQTbNYjLtA-WXIyrl3D8ua9pHhPczbF1gKX1elBQOtorDjpGm6FSxtM3-mFL7I2aHKcsG_6_HQDbG/s640/Large+infarct+temporooccipital+67y+M+expressive+aphasia+1.PNG" width="640" /></a></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgQFNLr6hLzFkGHmVWCGiBa798fNQb6A4ipvwghMmtc3KOECOYY5NkZ6dQL2mv8xZJkVNFG-2Y9jvbN9bYD5Oo8OkHCB9Predyuj-JDH-Np1TXLdREjP3cPsXnk5NN-SD0Hq54eq9Yubh3L/s1600/Large+infarct+temporooccipital+67y+M+expressive+aphasia+2.PNG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="472" data-original-width="1600" height="188" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgQFNLr6hLzFkGHmVWCGiBa798fNQb6A4ipvwghMmtc3KOECOYY5NkZ6dQL2mv8xZJkVNFG-2Y9jvbN9bYD5Oo8OkHCB9Predyuj-JDH-Np1TXLdREjP3cPsXnk5NN-SD0Hq54eq9Yubh3L/s640/Large+infarct+temporooccipital+67y+M+expressive+aphasia+2.PNG" width="640" /></a></div>
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MRI shows extensive cortical and subcortical as well as periventricular infarctions in temporo-occipital regions on the left.<br />
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Some doctors observe increased number of brain infarctions in especially younger age group of patients with Covid-19. There are hypothesis that virus is causing increase risk for both cerebral and cardiac infarctions.Robert Prejshttp://www.blogger.com/profile/17634722289004416123noreply@blogger.comtag:blogger.com,1999:blog-1338479728779859445.post-61195735023138323102020-04-28T10:00:00.000+02:002020-04-28T12:06:39.486+02:00Covid-19 Pneumonia CasesBelow some cases with Covid-19 pneumonia.<br />
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88 years old male:<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhLn9UTs3mRtVe08nW7dm4y53ej_HP7lBRieOyEvRwbD1Orswe_Ucb0cxcBvgqMjk-voK9UGdMhu6G3UjstyQ4x0OnFgTI02F_cfgfyzJ1Xaulu-amADYHrRCT8N8fhXqAdy20g5Rwide8B/s1600/88y+M+Viral+Pneumonia+01.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1185" data-original-width="1380" height="547" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhLn9UTs3mRtVe08nW7dm4y53ej_HP7lBRieOyEvRwbD1Orswe_Ucb0cxcBvgqMjk-voK9UGdMhu6G3UjstyQ4x0OnFgTI02F_cfgfyzJ1Xaulu-amADYHrRCT8N8fhXqAdy20g5Rwide8B/s640/88y+M+Viral+Pneumonia+01.png" width="640" /></a></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhj9L521uXk7i7rhZGosPiCFWsD3kBO5DqD5yhbUlBFriV-IBN6p0GBvBhVl2QJGZGfNNESq2hfha8W473NF3kuyPW1xqo6jvm9ZD-1Xcx_tg_i308Kes156uqSb9P9C7eho-BU3YlVwlPH/s1600/88y+M+Viral+Pneumonia+02.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1260" data-original-width="1261" height="638" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhj9L521uXk7i7rhZGosPiCFWsD3kBO5DqD5yhbUlBFriV-IBN6p0GBvBhVl2QJGZGfNNESq2hfha8W473NF3kuyPW1xqo6jvm9ZD-1Xcx_tg_i308Kes156uqSb9P9C7eho-BU3YlVwlPH/s640/88y+M+Viral+Pneumonia+02.png" width="640" /></a></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhfPorbutNWF_VOBMKRKmxiGv6YP6N3fFbjETR36Oif5C3LSKiyYc8H_QnZxyzNJo6QAi5kYfC_AI4-73i_19HjGn6G5vDp15z24sv_wAfPan6CS_aNtTzo1-XIj0LnF4Q-vmwN6qCRdIMN/s1600/88y+M+Viral+Pneumonia+03.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1106" data-original-width="1316" height="536" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhfPorbutNWF_VOBMKRKmxiGv6YP6N3fFbjETR36Oif5C3LSKiyYc8H_QnZxyzNJo6QAi5kYfC_AI4-73i_19HjGn6G5vDp15z24sv_wAfPan6CS_aNtTzo1-XIj0LnF4Q-vmwN6qCRdIMN/s640/88y+M+Viral+Pneumonia+03.png" width="640" /></a></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi6d8Ol9qr8Wnyi5r6HFz_sPwCRwd4cQb6UAYLdjH3oiJ4vDrn3q3CiDqy7Vfsi1lKGcSzTj22HL2KR9T3jVe9YdMQ9efwXZo5b-udtK5e9M3xWuF3NzpZUUhaexNRJPkBUU2DlT9qfxKDV/s1600/88y+M+Viral+Pneumonia+04.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1132" data-original-width="1428" height="506" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi6d8Ol9qr8Wnyi5r6HFz_sPwCRwd4cQb6UAYLdjH3oiJ4vDrn3q3CiDqy7Vfsi1lKGcSzTj22HL2KR9T3jVe9YdMQ9efwXZo5b-udtK5e9M3xWuF3NzpZUUhaexNRJPkBUU2DlT9qfxKDV/s640/88y+M+Viral+Pneumonia+04.png" width="640" /></a></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiBGtkobXa5PqXzUz-Kdwi5iKi4gmhEO9z_qGf3I7Dl8P1EEzfqcPtMZUqBOLzILlcl0CKHIovVbyslct3gZKN4idUOLz4KfcMeYJKgP50zGyLHFr3_qIoNTBNZ89_d2AJEEWFrEoaI3Bfc/s1600/88y+M+Viral+Pneumonia+05.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1188" data-original-width="1376" height="552" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiBGtkobXa5PqXzUz-Kdwi5iKi4gmhEO9z_qGf3I7Dl8P1EEzfqcPtMZUqBOLzILlcl0CKHIovVbyslct3gZKN4idUOLz4KfcMeYJKgP50zGyLHFr3_qIoNTBNZ89_d2AJEEWFrEoaI3Bfc/s640/88y+M+Viral+Pneumonia+05.png" width="640" /></a></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg13sEIwqIH67GyPT4Izbq1ccyyxQ8EOzwt6zqujxbQhqXsqABo1qbEiRI7hD_bc03vejyqovaImHJnRLLrTRDnUsI6XrtWkuoSLM2VELaqq78H56YoMnlJYsID-AVLwoRyraUmKyAKCkIT/s1600/88y+M+Viral+Pneumonia+06+thick.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1136" data-original-width="1383" height="524" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg13sEIwqIH67GyPT4Izbq1ccyyxQ8EOzwt6zqujxbQhqXsqABo1qbEiRI7hD_bc03vejyqovaImHJnRLLrTRDnUsI6XrtWkuoSLM2VELaqq78H56YoMnlJYsID-AVLwoRyraUmKyAKCkIT/s640/88y+M+Viral+Pneumonia+06+thick.png" width="640" /></a></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgniOzlv6xFb7zH0x7H_hYCOyQag3ObWXvKex5_QJYoL3YeYVVSFBkx00rwkmBg_3KtDR9kPMyKsxDLgRRP9bmltlL0ks6kLsaIZy1W8WVDgzAFWpLNkXJfjutlRQEZ0aRt2S3tIsbLiPAm/s1600/88y+M+Viral+Pneumonia+07+scout.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1255" data-original-width="1525" height="526" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgniOzlv6xFb7zH0x7H_hYCOyQag3ObWXvKex5_QJYoL3YeYVVSFBkx00rwkmBg_3KtDR9kPMyKsxDLgRRP9bmltlL0ks6kLsaIZy1W8WVDgzAFWpLNkXJfjutlRQEZ0aRt2S3tIsbLiPAm/s640/88y+M+Viral+Pneumonia+07+scout.png" width="640" /></a></div>
Not much was seen on the scout image.<br />
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Severe Covid-19 pneumonia:<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhFoTpURVQl8ZK6L1Eq78KMfy07exktxwN4Xor-15Aq7hyiJ56vEw8wj1UgBrNtg1m2YAXBPMouwXWnB_SFDSN0m0CUlCnUgF8Wdc1623eTCK5-OcltVg3GDlfT1eSl5waKfV29TeDv1RWi/s1600/200318+Pneumonia+CT+1.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1211" data-original-width="1292" height="598" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhFoTpURVQl8ZK6L1Eq78KMfy07exktxwN4Xor-15Aq7hyiJ56vEw8wj1UgBrNtg1m2YAXBPMouwXWnB_SFDSN0m0CUlCnUgF8Wdc1623eTCK5-OcltVg3GDlfT1eSl5waKfV29TeDv1RWi/s640/200318+Pneumonia+CT+1.png" width="640" /></a></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh_zUGGeiXR7QOsnY8Hsc9t9c1btMzq7Kg_1qGKd6zcipz6nJuY12zzRMYjy_Bj8MTgDYd4zJannmi1ySvWjYCqti7Q1ryZAGgE9zPT-6Uu51-8Z_68JwF86FAB-TwmHlSkeRI2uucyLB-8/s1600/200318+Pneumonia+CT+2.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1218" data-original-width="1292" height="602" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh_zUGGeiXR7QOsnY8Hsc9t9c1btMzq7Kg_1qGKd6zcipz6nJuY12zzRMYjy_Bj8MTgDYd4zJannmi1ySvWjYCqti7Q1ryZAGgE9zPT-6Uu51-8Z_68JwF86FAB-TwmHlSkeRI2uucyLB-8/s640/200318+Pneumonia+CT+2.png" width="640" /></a></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjAttWdA35YhnTFbSNE2pOSgJtunFa1d29XiIoiPwv_n8LCNJKuJkZiTbHaKbSDsMgpxabKVdBH0uKyCJzlOkOZie95hlqkBjXcRUmFRfP79TdK0T57sFw82gemlrgRWa5a1Vb33Z3f5Mx8/s1600/200318+Pneumonia+CT+3.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1295" data-original-width="1133" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjAttWdA35YhnTFbSNE2pOSgJtunFa1d29XiIoiPwv_n8LCNJKuJkZiTbHaKbSDsMgpxabKVdBH0uKyCJzlOkOZie95hlqkBjXcRUmFRfP79TdK0T57sFw82gemlrgRWa5a1Vb33Z3f5Mx8/s640/200318+Pneumonia+CT+3.png" width="558" /></a></div>
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28 years old male with Down syndrome, died 2 days later:<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh9_-eaTr9YbL3QoGpY0J5hhfue8OnlYZuW954ec28TRBQiFHMqaKC-HmbczSXuGCGzdcG8cNEq1A8cDrIpSK72UiLlT8kXZZ5JYPvoEOBIviiSch0y3POEZU-G9mINbFpOcbFj9SeE428y/s1600/Covid+28y+Male+Downd+died+2+days+later+ax+CT.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1206" data-original-width="1421" height="542" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh9_-eaTr9YbL3QoGpY0J5hhfue8OnlYZuW954ec28TRBQiFHMqaKC-HmbczSXuGCGzdcG8cNEq1A8cDrIpSK72UiLlT8kXZZ5JYPvoEOBIviiSch0y3POEZU-G9mINbFpOcbFj9SeE428y/s640/Covid+28y+Male+Downd+died+2+days+later+ax+CT.png" width="640" /></a></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjQ-m3XYNtav3gnzCHrMhoDIEmgHqJTXPRuu1NqJuk4MjDr6X9ONo08MIKkE8GW-IWJalV6PHZP49VeF8Qx76XogR1lyKOeZ8NIAXvBzSCn18hWaGGfAD8ZWuz5SOXwpRawmqKrsZvVGyHZ/s1600/Covid+28y+Male+Downd+died+2+days+later+sag+CT.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1156" data-original-width="1172" height="630" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjQ-m3XYNtav3gnzCHrMhoDIEmgHqJTXPRuu1NqJuk4MjDr6X9ONo08MIKkE8GW-IWJalV6PHZP49VeF8Qx76XogR1lyKOeZ8NIAXvBzSCn18hWaGGfAD8ZWuz5SOXwpRawmqKrsZvVGyHZ/s640/Covid+28y+Male+Downd+died+2+days+later+sag+CT.png" width="640" /></a></div>
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79 years old male Covid-19 basal pneumonia, died 10 days later:<br />
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62 years old male progress 5 days later (left image):<br />
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48 years old male:<br />
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As you can see most cases present with diffuse "ground-glass" opacities in both lungs with some predilection to basal and dorsal fields. Pleural effusion is not common. Consolidations can be seen but not often. There is a tendency to progression of changes in time.Robert Prejshttp://www.blogger.com/profile/17634722289004416123noreply@blogger.comtag:blogger.com,1999:blog-1338479728779859445.post-8360691317572118722020-03-27T15:20:00.000+01:002020-04-28T12:06:24.122+02:00Viral PneumoniaThis is just a refresher of how lungs look like in cases of a severe viral pneumonia. Findings on both X-ray and CT are nonspecific for COVID-19 but those are the findings we can see. The important factor is <b>progression of the lung changes</b> and <b>diffuse distribution</b> in both lungs. There is some predilection for the <b>peripheral and lower parts</b> of the lungs. Opacities are more diffused of type <b>"ground glass"</b> compared to more dense in bacterial pneumonia. <b>Increased interstitial pattern</b> can be seen. The end result in severe cases is <b>diffuse lung edema or ARDS</b> that leads to death.<br />
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85 years old patient with heart failure. Note diffuse, mostly interstitial opacities in both lungs especially in the right upper lobe and apical segment of the left lower lobe.<br />
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57 years old patient, shortly on respirator that died with cause of death officially announced as heart failure. Note diffuse predominantly interstitial "ground-glass" opacities most prominent in the left upper lobe.<br />
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Same 57 years old patient later on showing advanced diffuse pneumonia in both lungs. In such cases lungs are filled with fluid. The oxygenation capacity is markedly reduced.<br />
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<i>I do not have official confirmation of COVID-19 in those two patients. I reported those cases in the early stages of COVID-19 pandemy when not all patients were screened for virus. In both cases onset of symptoms and death in second case were rapid. I do not have follow-up on the first patient.</i>Robert Prejshttp://www.blogger.com/profile/17634722289004416123noreply@blogger.comtag:blogger.com,1999:blog-1338479728779859445.post-47327649875168860392020-03-11T11:12:00.001+01:002020-03-17T07:58:57.150+01:00STR COVID-19 Position Statement - March 10, 2020STR - Society of Thoracic Radiology just published a video about radiological findings of COVID-19. Here is a link to this video: <a href="https://veritastv.org/programs/covid-19">https://veritastv.org/programs/covid-19</a><br />
Here are some important points:<br />
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Complex RNA virus from SARS family that easily mutates. Causes respiratory distress requiring Intensive Care.<br />
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WHO hoping that it will burn out in July like SARS. That's why isolation is important.<br />
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However it is more serious than SARS - data per 2020-03-10.<br />
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It plateaus in China but goes up in Europe as for 2020-03-10.<br />
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Now watch the video: <a href="https://veritastv.org/programs/covid-19">https://veritastv.org/programs/covid-19</a><br />
<br />
Check also those excellent YouTube channels:<br />
Ninja Nerd Science <a href="https://youtu.be/PWzbArPgo-o">https://youtu.be/PWzbArPgo-o</a><br />
MedCram <a href="https://youtu.be/9vMXSkKLg2I">https://youtu.be/9vMXSkKLg2I</a><br />
<br />Robert Prejshttp://www.blogger.com/profile/17634722289004416123noreply@blogger.comtag:blogger.com,1999:blog-1338479728779859445.post-68542986148329340822019-12-04T13:56:00.001+01:002019-12-04T14:41:35.368+01:002 small abscesses<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiOUHbfDkkb1UvJH1bAYVosJuj4R0caPsURxNR0lgmh-eL3dNBeYnyvMF8l99UMv7hBC-Xsp67Z7tH5h7b1hSyWdOlpvYkXiuKQELW4NFxEqSNfqRYrlaSTXTGQqIpU8K-tfalMp2Fz2CrM/s1600/2+small+abscess+CTC+1+month+earlier.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="588" data-original-width="1600" height="234" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiOUHbfDkkb1UvJH1bAYVosJuj4R0caPsURxNR0lgmh-eL3dNBeYnyvMF8l99UMv7hBC-Xsp67Z7tH5h7b1hSyWdOlpvYkXiuKQELW4NFxEqSNfqRYrlaSTXTGQqIpU8K-tfalMp2Fz2CrM/s640/2+small+abscess+CTC+1+month+earlier.JPG" width="640" /></a></div>
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Immunocompromised patient presents with ring-enhancing subcortical expansivities with perifocal oedema. MRI was performed (not shown) suggesting 2 small abscesses. Patient was set on antibiotics.<br />
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Control MRI after one month shows on axial T1 without- and with contrast slightly decreased size of ring enhancing expansivities.<br />
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Both small abscesses are still enhancing.<br />
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There is still perifocal <b>vasogenic edema</b> seen on axial FLAIR and T2 weighted sequences. Note <b>on T2 a well defined low signal rim</b> of the abscesses.<br />
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Diffusion weighted imaging showing central diffusion restriction (high signal on DWI and low on ADC-map).<br />
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Numerous pathologic entities show as ring-enhancing lesions therefore it is important to include patient's history in evaluation. Here the biggest clue is restricted diffusion. However hemorrhage can also show restricted diffusion due to high protein content as well as rim of hemosiderin on T2.<br />
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You can also check my other cases related to this topic:<br />
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<a href="https://radiologymri.blogspot.com/2010/12/abscess-and-subdural-empyema.html" target="_blank">Abscess and Subdural Empyema</a><br />
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<a href="https://radiologymri.blogspot.com/2009/10/diffusion-weighted-imaging-mri.html" target="_blank">Diffusion Weighted Imaging - MRI</a><br />
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<a href="https://radiologymri.blogspot.com/2010/03/late-subacute-hemorrhage-on-dwi.html" target="_blank">Late Subacute Hemorrhage on DWI</a><br />
<br />Robert Prejshttp://www.blogger.com/profile/17634722289004416123noreply@blogger.comtag:blogger.com,1999:blog-1338479728779859445.post-68111523911469669062019-12-04T11:36:00.002+01:002022-09-20T08:42:13.169+02:00101 years old brain - normal aging<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEihuNZQH39PRprl6WFQn3PvkHS9Zu6vf8SmhC6oQHXutFf7NLymdWbRhPPFlCLwMb9s1DSkuIaTLWYGhmpxWUh4U_s-4kq9cfzBc45DZ8p2kdn3JzqPxpDfjEoCdxpozskg5NlOg6TRlAwA/s1600/Brain+101+years+old.JPG" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="620" data-original-width="1600" height="246" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEihuNZQH39PRprl6WFQn3PvkHS9Zu6vf8SmhC6oQHXutFf7NLymdWbRhPPFlCLwMb9s1DSkuIaTLWYGhmpxWUh4U_s-4kq9cfzBc45DZ8p2kdn3JzqPxpDfjEoCdxpozskg5NlOg6TRlAwA/s640/Brain+101+years+old.JPG" width="640" /></a></div>
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Yes, as you can see in the title this (female) person is 101 years old. I wanted to show those images as an example of "successful aging". There is some cortical atrophy (GCA 2), some temporal atrophy (MTA 1 right and 2-3 left) as well as some central atrophy and slight atrophy in corpus callosum. Brainstem and cerebellum show no significant signs of atrophy. There is an old lacunar infarction medially in the left thalamus and some ischemic changes in the anterior parts of the left internal capsule but without signs of extensive microvascular disease. By simply looking at the brain I would estimate the age at about 80. BTW. It is known that the atrophy tends to progress in logarithmic and nonlinear fashion - meaning that you see more progression of atrophy in advanced age compared to less change in the younger ages - as a general rule of aging. However of course there are exceptions to this rule.</span><div><span style="font-family: verdana;"><br /></span></div><div><span style="font-family: verdana;">Update with another example of s.k. "normal aging". This is a brain CT of a 96 years old person. There are some white matter degenerative changes but there is not much atrophy. See image below. </span><br /><div><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjIFAe8Yz166wd79vJfuATT0CBekqLNKkYQzzOEcYsTi7m566PyQexAQBXyP6r7pVWB1BF9tKpX0PaDQ6VhlstlBNyux6nPFjCKjoJwALcxsMAHJmY1cxaNLxJt5DxMbe34jrdPBPvz1GQUZXDCSm4o5aMakpWLUlOtwOJ5yU-6cYzsiZ4cJ55hkyPBNg/s1899/Nomral%20Brain%20at%2096%20y%20-%20no%20atrophy.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="836" data-original-width="1899" height="282" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjIFAe8Yz166wd79vJfuATT0CBekqLNKkYQzzOEcYsTi7m566PyQexAQBXyP6r7pVWB1BF9tKpX0PaDQ6VhlstlBNyux6nPFjCKjoJwALcxsMAHJmY1cxaNLxJt5DxMbe34jrdPBPvz1GQUZXDCSm4o5aMakpWLUlOtwOJ5yU-6cYzsiZ4cJ55hkyPBNg/w640-h282/Nomral%20Brain%20at%2096%20y%20-%20no%20atrophy.jpg" width="640" /></a></div><br /><div><br /></div></div>Robert Prejshttp://www.blogger.com/profile/17634722289004416123noreply@blogger.comtag:blogger.com,1999:blog-1338479728779859445.post-78349564100432962622019-11-24T10:55:00.000+01:002019-11-25T11:15:21.818+01:00Cytotoxic Lesions Of the Corpus Callosum (CLOCCs)<div class="separator" style="clear: both; text-align: center;">
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45 years old patient on antiepileptic (lamotrigine) and antidepressant medication. Presents with unspecific neurological symptoms. MRI without contrast shows diffusely demarcated oval lesion with edema in splenium of corpus callosum.<br />
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Diffusion weighted imaging shows restricted diffusion with high signal on DWI and low on ADC corresponding with <b>cytotoxic edema</b>. However location is not specific for infarction. Given the history of treatment together with appearance of the lesion the <b>Cytotoxic Lesions Of the Corpus Callosum (CLOCCs) </b>was presumed to be the most likely diagnosis. CLOCCs do no enhance. Medication was stopped and follow up scan was scheduled.<br />
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Control scan 1 month later was performed without and with contrast and as expected no contrast enhancement was seen. The lesion has decreased in size. Patient symptoms have resolved.<br />
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Reduction of edema in the lesion is well seen on T2 sequence.<br />
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<i>As a side note: the control scan was performed on 1.5T vs 3.0T MRI scanner for initial exam - that does not influence the depiction - only gives slightly different appearance of the brain structures. </i><br />
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No diffusion restriction was noted on the control scan - compared with initial MRI.<br />
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CLOCCS present with cytotoxic edema in the splenium of corpus callosum. It can be caused by metabolic disturbance (electrolyte imbalance, etc.), infections, but also by drugs and toxins: chemotherapy, antidepressants, antiepileptics, etc.<br />
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Also known as: transient lesions of the splenium of corpus callosum, mild encephalitis/encephalopathy with a reversible isolated SCC lesion (MERS), reversible splenial lesions and reversible splenial lesion syndrome (RESLES).<br />
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Take home message is when you see cytotoxic edema "strange looking infarct-like" lesion in the splenium think about patient's medical history especially for medication. </div>
<br />Robert Prejshttp://www.blogger.com/profile/17634722289004416123noreply@blogger.comtag:blogger.com,1999:blog-1338479728779859445.post-58906090565358427072019-10-31T08:50:00.000+01:002019-10-31T08:50:08.505+01:00Calcified Thoracic Disc Herniation<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiejFiQbu6m2pNWmtQlz-sAUTX7iFTg_NjZhqXkvvwRJScq0oypUYSJg3dl_9-wmRbKdU1b-WlGl5uh1c-NkGXVEUmrEYe0kWiTga-sMFnHg13LZHSjYqErtpsrUQrzefKg5WIZAiFzjX-B/s1600/Calcified+Thoracic+Disc+Herniation+CT.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1071" data-original-width="1579" height="434" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiejFiQbu6m2pNWmtQlz-sAUTX7iFTg_NjZhqXkvvwRJScq0oypUYSJg3dl_9-wmRbKdU1b-WlGl5uh1c-NkGXVEUmrEYe0kWiTga-sMFnHg13LZHSjYqErtpsrUQrzefKg5WIZAiFzjX-B/s640/Calcified+Thoracic+Disc+Herniation+CT.JPG" width="640" /></a></div>
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Large left sided paramedian calcified thoracic disk herniation. Note calcifications also present anteriorly in the annulus fibrosus at this level that has reduced disk height. CT was performed 5 years prior.<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhEy6gfR4nJIsrbUc6IaMow4qqhXu3o8hmrBBfkTwG0-fn_u97Z4hjJ2_9cxcVNxrw3zbO5EVGobIqEU2fdIe2jg4XvW807cV5Tti0U0LcbMdNKpzcshbfujsudInKjLjyOlXzEIORe8rSf/s1600/Calcified+Thoracic+Disc+Herniation+MR.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1071" data-original-width="1435" height="476" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhEy6gfR4nJIsrbUc6IaMow4qqhXu3o8hmrBBfkTwG0-fn_u97Z4hjJ2_9cxcVNxrw3zbO5EVGobIqEU2fdIe2jg4XvW807cV5Tti0U0LcbMdNKpzcshbfujsudInKjLjyOlXzEIORe8rSf/s640/Calcified+Thoracic+Disc+Herniation+MR.JPG" width="640" /></a></div>
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Current MR (sag STIR and axial T2) showing mostly unchanged disk herniation with low signal on both sequences, but fortunately without spinal stenosis - visible spinal fluid around medulla. The slightly high signal in medulla on sag is an artifact. Calcified thoracic disk herniations pose problem for surgeons when are causing spinal stenosis and requiring operation. <b>It is common that thoracic disk herniations calcify.</b> Should not be confused with meningioma. Thoracic spine being part of thoracic cage is more rigid and stable than more flexible cervical and lumbar spine - so the herniations tend to progress less than on other spinal levels.Robert Prejshttp://www.blogger.com/profile/17634722289004416123noreply@blogger.comtag:blogger.com,1999:blog-1338479728779859445.post-27420458132623444192019-10-28T10:44:00.000+01:002019-10-28T10:46:35.976+01:00Sinus Thrombosis - 9 days old neonate - MRI<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhg9XK4qRNNEDwfxCOZUS8GtIZTLNqk7TEZVemfXcSvQfj_iNnvaPozcl-1PQKcnZ54ZfxTel_BX2Uvrl0s6A1YniF1tUF6xUlprTa6HbABPzmvhnS0cxjGtngBBBQUXU42HbM1vXR-74n7/s1600/Sinus+Thrombosis+T1+9+days+old+neonate.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="640" data-original-width="1600" height="252" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhg9XK4qRNNEDwfxCOZUS8GtIZTLNqk7TEZVemfXcSvQfj_iNnvaPozcl-1PQKcnZ54ZfxTel_BX2Uvrl0s6A1YniF1tUF6xUlprTa6HbABPzmvhnS0cxjGtngBBBQUXU42HbM1vXR-74n7/s640/Sinus+Thrombosis+T1+9+days+old+neonate.JPG" width="640" /></a></div>
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9 days old neonate. Mother known with sinus thrombosis during pregnancy. This is T1 without contrast showing high signal of methemoglobine in sinus rectus, superior sagittal sinus and cavernous sinus - representing massive blood clots of sinus thrombosis.<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhwkmyy9x2jAuYiT7SYzYDA7flEc6LWVkLU8zy59NWsDxKMuhvBAtkQH1DOc6yWNhrUvWmsFuh4tPGZnoFFAqoJoE19gRE3T7UsRRjOFsyYnQzuW7pgdlMg0otKcLDBIkXysxI2-sb84DMv/s1600/Sinus+Thrombosis+SWI+T2+MRV+ToF+9+days+old+neonate.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="482" data-original-width="1600" height="192" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhwkmyy9x2jAuYiT7SYzYDA7flEc6LWVkLU8zy59NWsDxKMuhvBAtkQH1DOc6yWNhrUvWmsFuh4tPGZnoFFAqoJoE19gRE3T7UsRRjOFsyYnQzuW7pgdlMg0otKcLDBIkXysxI2-sb84DMv/s640/Sinus+Thrombosis+SWI+T2+MRV+ToF+9+days+old+neonate.JPG" width="640" /></a></div>
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SWI sequence is showing low signal of hemosiderine deposits in central veins. T2 sequence is showing clot filled occipital part of sagittal sinus. ToF MRV (flow based venous angio) shows corresponding flow defects, same on MRV MiP reconstruction.<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhZIU00y7CTPzqInko31HETt4ISgbueHailCW7GZd0vU_K4DxvSjBr3t9gFxx-H9D_StKJtI4oLfsvjXaMjkMXB71TaEUnLK4qTHbcjRjIXtq1p8lhPFuavBEpWURbUho5Xvh9ZuV9C6Hdn/s1600/Sinus+Thrombosis+DWI+9+days+old+neonate.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="938" data-original-width="1502" height="396" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhZIU00y7CTPzqInko31HETt4ISgbueHailCW7GZd0vU_K4DxvSjBr3t9gFxx-H9D_StKJtI4oLfsvjXaMjkMXB71TaEUnLK4qTHbcjRjIXtq1p8lhPFuavBEpWURbUho5Xvh9ZuV9C6Hdn/s640/Sinus+Thrombosis+DWI+9+days+old+neonate.JPG" width="640" /></a></div>
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DWI and ADC-map showing ischemia in the basal ganglia, corpus callosum and corona radiata frontally. Those ischemic changes can be reversible in case of sinus thrombosis (venous infarcts). Major risk are the possible brain hemorrhages - that are fortunately not present in this case.<br />
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Teaching point is to look very carefully at non-contrast T1 of neonate for possible high signal changes representing methemoglobine products, not only in dural sinus but also in the subarachnoidal spaces for possible partus related subdural hematomas (SDH).<br />
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You can check my post about <a href="https://radiologymri.blogspot.com/2010/12/intracranial-hemorrhage-on-mri.html" target="_blank">Intracranial Hemorrhage on MRI</a>Robert Prejshttp://www.blogger.com/profile/17634722289004416123noreply@blogger.comtag:blogger.com,1999:blog-1338479728779859445.post-16363315496954629572019-10-27T18:07:00.000+01:002019-10-28T11:16:32.305+01:00Active MS plaques on DWI<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh9M0bU0J08qMaZmik3rIOrNUO95yv2y4OvAZc8_JETnHQsULrho-kSZrTMGJ-uov5RxwSZ1en7v-2S3CSlyUxpL7Rs75vEXibL8rB4BMh7FhtozMiqLCmnrKT43Mp2lYe47MK7TN945cHz/s1600/MS+DWI+-+b1000+ADC.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1081" data-original-width="1519" height="454" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh9M0bU0J08qMaZmik3rIOrNUO95yv2y4OvAZc8_JETnHQsULrho-kSZrTMGJ-uov5RxwSZ1en7v-2S3CSlyUxpL7Rs75vEXibL8rB4BMh7FhtozMiqLCmnrKT43Mp2lYe47MK7TN945cHz/s640/MS+DWI+-+b1000+ADC.JPG" width="640" /></a></div>
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This is MS patient with contrast enhancing plaque. Note on DWI sequence high signal as well as high on ADC - therefore no restriction but bright on DWI. DWI gives a clue to active plaques.<br />
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MS plaques showing highest signal on DWI are most suspect for activity - in my opinion. Therefore look at DWI (b1000) when reporting brain MRI of MS patients.Robert Prejshttp://www.blogger.com/profile/17634722289004416123noreply@blogger.comtag:blogger.com,1999:blog-1338479728779859445.post-5344309650060828452018-09-26T15:43:00.000+02:002019-10-28T11:17:32.508+01:00CLIPPERS - Chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEguns3bU44FbntN8pnP3F_6Y-_Z0U-fxzJCjQoAfdYvRRqijseRXvKCGYccFYjCEi5ox5zFduFpzGK1q545z-G4yff3Z26POnygJib1vmczGeTN_1I4SB6cWMIi5LUmULhYY5qlnqMzC6rb/s1600/CLIPPERS+1.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1031" data-original-width="1515" height="433" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEguns3bU44FbntN8pnP3F_6Y-_Z0U-fxzJCjQoAfdYvRRqijseRXvKCGYccFYjCEi5ox5zFduFpzGK1q545z-G4yff3Z26POnygJib1vmczGeTN_1I4SB6cWMIi5LUmULhYY5qlnqMzC6rb/s640/CLIPPERS+1.JPG" width="640" /></a></div>
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T1 GD+ sequences show multiple punctate and linear enhancing lesions in pons and medulla oblongata representing perivascular enhancing lymphatic tissue.<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiiBuG-8QSsDXtjIiVFwhUvd0DCXTY0VMpmvHe_oCgi7M_Wyo-qHJpowdhMVy7EBrCe2wFuyht0Q9sgz54MTUPdmkGPkobL0rJhxIYnL4EjRCP_R6C_B7IzvhNrBja3FUcTxFQliHTrRVFU/s1600/CLIPPERS+2.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1003" data-original-width="1505" height="425" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiiBuG-8QSsDXtjIiVFwhUvd0DCXTY0VMpmvHe_oCgi7M_Wyo-qHJpowdhMVy7EBrCe2wFuyht0Q9sgz54MTUPdmkGPkobL0rJhxIYnL4EjRCP_R6C_B7IzvhNrBja3FUcTxFQliHTrRVFU/s640/CLIPPERS+2.JPG" width="640" /></a></div>
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Enhancing punctate lesions are also present in corona radiata on both sides. FLAIR sequence showing corresponding white matter lesions that however present no significant oedema.<br />
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Findings represent <b>CLIPPERS - Chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids</b>. Rare entity caused by infiltration of the brain with inflammatory cells in perivascular areas, mostly found in brainstem.<br />
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More comprehensive description of <a href="https://radiopaedia.org/articles/chronic-lymphocytic-inflammation-with-pontine-perivascular-enhancement-responsive-to-steroids-clippers" target="_blank">CLIPPERS in Radiopaedia</a><br />
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<br />Robert Prejshttp://www.blogger.com/profile/17634722289004416123noreply@blogger.comtag:blogger.com,1999:blog-1338479728779859445.post-84327794022258027482017-03-04T11:17:00.000+01:002020-03-11T15:59:23.836+01:00Huntington Disease<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgFldAZWqwJhJ66wGmW_gJyCXZvgBZyo0suUk_b8yiNSr8_3BOpH15pO9L1T9N229xB6hEvrtwZp_inS7NXSQ1loUxGWU8HXohsvgEX_ozI2Z_r1RZIdRNKGQzsr8KHiy1shcmRCLWiFrBj/s1600/Huntington+consanguinity+child+10y+FLAIR+tra+T2+cor.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: "verdana" , sans-serif;"><img border="0" height="428" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgFldAZWqwJhJ66wGmW_gJyCXZvgBZyo0suUk_b8yiNSr8_3BOpH15pO9L1T9N229xB6hEvrtwZp_inS7NXSQ1loUxGWU8HXohsvgEX_ozI2Z_r1RZIdRNKGQzsr8KHiy1shcmRCLWiFrBj/s640/Huntington+consanguinity+child+10y+FLAIR+tra+T2+cor.JPG" width="640" /></span></a></div>
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<span style="font-family: "verdana" , sans-serif;">10 years old boy from parents being cousins to each other presents with progressive rigidity and dystonia. Initial MR showing significant bilateral atrophy in caudate nuclei and putamina with high signal on FLAIR and T2 consistent with gliosis.</span><br />
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<span style="font-family: "verdana" , sans-serif;">Note striking symmetric atrophy of the putamina and caudate nuclei on T2 and IR.</span><br />
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<span style="font-family: "verdana" , sans-serif;">Huntington disease (HD) is also known as Huntington chorea. HD is an autosomal dominant chronic hereditary neurodegenerative disorder with complete penetrance [Osborn]. </span><br />
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<span style="font-family: "verdana" , sans-serif;">Aggregates of huntingtin protein accumulate in axonal terminals, which eventually leads to the death of medium spiny neurons. Autopsy shows generalized cerebral atrophy with an average of 30% reduction in brain weight. Both the cortex and hemispheric WM are affected. The most characteristic gross abnormality is volume loss with rarefaction of the caudate nucleus, putamen, and globus pallidus [Osborn]. </span><br />
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<span style="font-family: "verdana" , sans-serif;">Microscopically, HD features neuronal loss with huntingtin nuclear inclusions, astrocytic gliosis, and iron accumulation. The changes are most severe in the basal ganglia but can also be seen in other regions of the brain, including the cerebellum [Osborn].</span><br />
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<span style="font-family: "verdana" , sans-serif;">Juvenile-onset HD is initially characterized by rigidity and dystonia, much more than by chorea [Osborn].</span><br />
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<br />Robert Prejshttp://www.blogger.com/profile/17634722289004416123noreply@blogger.com