Radiology MRI

Coronal T2 showing absent septum pellucidum with characteristic configuration of frontal horns. Also note very thin optic chiasm (arrows). Thin corpus callosum and low fornices. Optic nerves are hypoplastic (not shown). Pituitary has normal appearance in this case. This is a case of Septooptic Dysplasia that is also known as De Morsier Syndrome.

44 years old with clinical symptoms indicating hydrocephalus. CT (not shown) confirmed diagnosis of hydrocephalus. However the question was if this was a Normal Pressure Hydrocephalus or Aqueduct Stenosis? MRI performed on 3T using special thin slice T2 (volume) sequences shows increased flow through foramina of Monroe (arrowhead) as well as Magendie with at the same time no visible flow artifacts in the cerebral aqueduct. Further detail inspection of the aqueduct reveals a thin membrane (arrows) that is responsible for the Aqueduct Stenosis . Also note flattened hypophysis due to bulging of the suprasellar cistern. Increased supratentorial ventricles and stretching of corpus callosum. There is also increased flow in the prepontine cistern that might indicate spontaneous connection between floor of the third ventricle and the interpeduncular cistern. Most likely neurosurgical therapy would be to endoscopically create connection at this place (ventriculocisternostomy).

Note nicely depicted compartmental anatomy of the bilateral frontal Chronic Subdural Hematomas . Subdural space being only a potential anatomic compartment and only visible in case of such fluid collections. Note especially on FLAIR the high signal of fluid collections that is due to high protein content. Also observe the normal subarachnoid space (black - CSF signal) that follows sulci. Fig 769 by Henry Gray from Bartleby.com You can also check my older post:  Chronic Subdural Hematoma

I must admit that I am a strong supporter of open access medical literature . My academic hospital provides doctors with access to subscribed articles from our workstations. Growing number of medical publishers switches from paper to digital only distribution. This is much more efficient in terms of searching for information, storing, as well as more environment friendly. With growing choice of electronic reading devices (PCs, notebooks, tablets, smartphones) it is even more easy and common to read medical literature in electronic form. However the way of accessing articles through hospital computer is still far from optimal. It happens to me that I struggle with a difficult case and find an interesting article in PubMed  that I can not open since the article is restricted by publisher and my hospital has no subscription. Yes I am offered a 30$! per article purchase, and yes I can order this article through my library - but I need this information now! What is more interesting is that

50 years old male with known chronic alcohol abuse. CT showing marked atrophy in the upper vermis. This is a common finding in chronic alcohol abuse. However pay attention when examining the vermis in the sagittal plane as in the midline its appearance might be misleading and mimic atrophy. Therefore examine vermis in parasagittal as well as coronal and axial planes for definite diagnosis.

Note large cystic intrasellar lesion. Enhancing expanded pituitary gland tissue surrounds the cyst. This is called "claw sign" - seen near the pituitary infundibulum. Note that the wall of the cystic lesion is smooth. There are no signs of calcifications. Fluid inside the cyst is homogeneous. Differential diagnosis to Rathke Clef Cyst  are: Cystic Adenoma and Craniopharyngioma. See interesting article concerning differential diagnosis: S.H Choi - Pituitary adenoma, craniopharyngioma, and Rathke cleft cyst involving both intrasellar and suprasellar regions: differentiation using MRI

Before every MRI we screen our patients for possible metal foreign bodies. Those can be implanted due to prior medical procedures as well as accidental. One of the specific inquiry concerns possible metal foreign bodies in the orbit. Sometimes patients work with metal and indicate possibility of being exposed to small projectile metal particles. In such case we check prior CT examinations for possible metal foreign bodies. Note above case of a small piece of metal located medially and superiorly in the left orbit. Here metal seems not to be attached to the globe. However due to risk of metal motion in strong magnetic field of the MRI scanner in a case like this we ask for ophthalmologist consultation. One should review scanogram as well as thin slices of the CT - considering size of foreign body and slice thickness. In case we do not have prior CT we order x-ray of the orbits.