Radiology MRI

  Radiology Case Review: The Lasting Imprint of Poliovirus on the Spine and Musculature While widespread vaccination efforts have made acute poliomyelitis a rare encounter in modern clinical practice, radiologists still frequently observe the chronic, lasting footprints of the virus in adult patients. Today, we are reviewing a fascinating and historically significant MRI case that beautifully illustrates the long-term sequelae of polio on both the central nervous system and the musculoskeletal system. The poliovirus has a notorious affinity for the lower motor neurons, specifically targeting the anterior horn cells of the spinal cord. Decades after the initial infection, the resultant damage presents with a very characteristic set of imaging findings. Let’s break down the key features visible in this patient’s scans. 1. Symmetrical Anterior Signal Changes in the Spinal Cord Looking at the axial T2-weighted images of the cervical spine, the pathophysiology of the virus is strikingly...

  Case: Chronic Subdural Hematoma (MRI Characteristics) Imaging Modality:   MRI Brain   Sequences Provided:   Axial T2, Axial FLAIR, Coronal FLAIR, Sagittal (with localization arrows) Radiologic Findings:   The MRI demonstrates a left-sided, crescentic extra-axial fluid collection overlying the cerebral convexity, measuring approximately 7.2 mm in maximum thickness. A critical educational point is best appreciated on the initial   axial T2-weighted image : note the medial displacement and compression of the underlying subarachnoid space. You can clearly visualize the small cortical veins situated at the inner margin of the fluid collection, right against the displaced cortex. This "cortical vein sign" confirms the fluid is entirely within the subdural space, pushing the arachnoid membrane and subarachnoid space inward. When cross-referencing with the   FLAIR sequences   (axial, coronal, and sagittal), the collection does not suppress completely li...

  Case: Spinal Extradural Arachnoid Cyst (Nabors Type IA) Imaging Modality:   MRI Thoracolumbar Spine   Sequences Provided:   Sagittal T2, Axial T2, Sagittal T1 Radiologic Findings:   The MRI demonstrates a well-circumscribed, unilocular cystic lesion located within the posterior extradural space of the lower thoracic spine, at approximately the T11-T12 level. The lesion follows cerebrospinal fluid (CSF) signal characteristics across all pulse sequences, appearing uniformly hyperintense on T2-weighted images and hypointense on T1-weighted images. Spanning approximately 24 mm in craniocaudal dimension, the cyst exerts focal mass effect upon the thecal sac. It causes significant anterior displacement and compression of the distal spinal cord. The axial T2-weighted sequence confirms its posterolateral extradural position, illustrating the resultant flattening of the dural sac. There are no internal septations, complex features, or solid components visible. Impressi...

  In this video I show how we score dementia patients according to the Dementia Protocol. What we look at and how we describe it.   

Wellcome to my new YouTube channel called RP Radiology - Radiant Pixels dedicated to radiology learning.  First case titled  Cavernoma  shows correlation of incidental finding of a Cavernoma on CT Brain with confirmation of this diagnosis on MRI.  See also my previous posts on this subject: Cavernoma - Cavernous Angioma Pontine Cavernoma Multiple Cavernomas  

A patient with a known family history of MELAS (Mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes) presented with new neurological symptoms. On initial CT brain, there was a low-attenuation lesion in the right frontoparietal centrum semiovale that resembled a lacunar infarct. However, a follow-up MRI revealed: • The lesion was hyperintense on DWI, but without corresponding ADC restriction — this indicates vasogenic edema rather than cytotoxic edema, which is not typical for an acute infarction. • There was also evidence of old cortical volume loss in the same hemisphere, in the temporal lobe suggesting previous stroke-like episodes. • Importantly, these lesions do not follow a specific vascular territory. This pattern — recurrent, stroke-like lesions that spare strict vascular distributions and lack classic infarct diffusion restriction — is characteristic of MELAS. The underlying cause is mitochondrial dysfunction leading to metabolic failure and l...