Radiology MRI

  Welcome back to the blog. In our latest case presentation on Radiant Pixels , we explore a fascinating neuroradiological riddle involving a 70-year-old patient. This case perfectly demonstrates how a familiar vascular pathology can completely mask a hidden, underlying mechanical issue. The Contradictory Imaging Findings At first glance, the brain MRI presents a highly complex, multi-compartment constellation of findings: Bilateral Chronic Subdural Hematomas (CSDHs): Measuring 3–4 mm both supra- and infratentorial, showing persistent enhancement one year after prior surgical evacuation via bilateral frontoparietal trepanation holes. Chronic Dural Venous Sinus Thrombosis (CVST): A clear void of contrast enhancement centrally within the right sigmoid sinus and jugular foramen region, accompanied by a distended right jugular vein. Diffuse Pachymeningeal Enhancement: Striking, smooth, generalized dural enhancement visible on post-gadolinium T1 sequences. Pituitary Hyperemia: Upwar...

  What do you do when a routine brain CT for non-specific headaches reveals striking, dense, bilateral calcifications, but the clinical exam is completely unremarkable? In our latest teaching case on RP Radiology - Radiant Pixels , we break down a fascinating case of a 40-year-old patient whose neuroimaging keys open a door to a completely unexpected systemic diagnosis. The Imaging Dilemma: Symmetrical but Atypical When encountering prominent, symmetrical intracranial mineralization on a non-contrast CT, the classic reflex is to think of Fahr’s disease (primary familial brain calcification). However, this case reminds us why location is everything in neuroradiology. While Fahr's characteristically targets the deep gray matter, this patient's basal ganglia, thalami, and dentate nuclei were completely pristine. The dense calcifications were strictly restricted to the cortical and subcortical regions of the bilateral occipital lobes. To investigate further, we performed an MRI, w...

  An absent posterior pituitary bright spot on MRI is a classic neuroradiology finding, but it always demands a deeper look. In the latest case breakdown on the Radiant Pixels YouTube channel, we review a compelling case of a 30-year-old patient presenting with clinical diabetes insipidus. When evaluating central diabetes insipidus, the MRI protocol must be meticulous. This case beautifully demonstrates how to systematically evaluate the adenohypophysis, neurohypophysis, and the pituitary stalk to differentiate between structural, congenital, and inflammatory pathologies. Key sequences highlighted in the video include: Coronal T2-weighted images to evaluate local anatomy and the optic chiasm. Sagittal T1-weighted images (pre-contrast) to check for the normal intrinsic high signal intensity of the posterior pituitary. Dynamic post-gadolinium T1 images (sagittal and coronal) to assess enhancement patterns and track pathology. Major Teaching Points Covered in the Video 1. The Abse...

  In this case presentation, we review the imaging findings of a 50-year-old male presenting with balance issues, visual disturbances, and general fatigue. While aqueductal stenosis is often associated with pediatric populations, adult-onset presentation due to an ependymal web is a critical diagnostic entity to recognize. Check out the full breakdown and see the high-resolution sequences in the video below: Key Imaging Findings Ventriculomegaly: The ventricular system is widened supratentorially, with an Evans' index of 0.36 . The temporal horns and cerebral sulci remain within normal limits. Secondary Signs of Hydrocephalus: Notable upward expansion of the corpus callosum and very faint transependymal leakage (interstitial edema). The Web: High-resolution multiplanar reconstruction (MPR) and sagittal FLAIR sequences reveal a thin membrane localized to the lower one-third of the aqueduct . Caliber Mismatch: The aqueduct measures approximately 4 mm at the level of the superior ...

  When evaluating neuroimaging for epilepsy, finding a clear culprit is always a breakthrough. But what happens when the images reveal a more complex story—a "double whammy" of potential epileptogenic foci? In the upcoming video on Radiant Pixels , we dive into a fascinating, longitudinal case of an epilepsy patient followed over a 12-year period (from age 30 to 42). This case beautifully illustrates classic mesial temporal sclerosis (MTS) while presenting an intriguing secondary structural pathology that poses a classic chicken-and-egg dilemma. The Primary Suspect: Mesial Temporal Sclerosis (MTS) The journey begins with a look back at the patient's scans from 12 years ago. On the coronal sequences—specifically using an inversion recovery sequence highly sensitive to anatomical structures—we see the definitive hallmarks of mesial temporal sclerosis : Volume Loss: Clear, asymmetric atrophy of the left hippocampus. Hyperintensity: Markedly increased signal intensity on t...

  A new case presentation is now live on the Radiant Pixels YouTube channel. In this session, we walk through an excellent example of a normal vascular anatomical variant that frequently catches the eye during routine scans: a Developmental Venous Anomaly (DVA) located in the cerebellum. When evaluating a suspected DVA, a systematic, multi-sequence approach is essential to confirm the diagnosis and rule out complications. Here is a brief summary of the key diagnostic imaging points highlighted in the video: Non-Enhanced CT: The anomaly may initially present as a subtle high-density structure, prompting further MR investigation. Standard MRI (T1, T2, FLAIR): Look for a tubular structure exhibiting the classic "caput medusae" configuration—a cluster of small branching vessels. These typically show a low signal on T2 and FLAIR. Crucially, the surrounding brain parenchyma should appear anatomically normal, lacking any signs of gliosis, volume loss, or old infarctions. Time-of-...

  Welcome back to the blog. Following up on my previous posts, Monkey looking at cerebellum and Small  Vestibular Schwannoma , I have just published a new companion video on the Radiant Pixels YouTube channel that brings these concepts to life. If you are looking to sharpen your diagnostic skills regarding internal acoustic canal pathology and anatomy, this case presentation is for you. What to Expect in the New Video In this latest upload, I walk through a classic presentation of a 75-year-old patient experiencing left-sided hearing loss. We review the imaging step-by-step, starting with the thin-slice T2 sequences that are highly sensitive for evaluating the internal acoustic canals, all the way through to the contrast-enhanced T1 coronal slices. Key highlights of the case include: Identifying a normal vascular AICA-loop at the level of the porus acusticus and understanding when to note it for the clinician. Locating and measuring a small 5 mm by 3 mm dark structure plugge...

  Evolution of Hemorrhagic Infarctions on MRI Welcome to another intriguing radiology case study. In our latest release on the Radiant Pixels YouTube channel, we dive into a comparative MRI analysis of an 80-year-old patient, examining scans taken five months apart. This case provides a fantastic look at the evolution of subacute infarctions and the often-perplexing behavior of contrast-enhancing areas over time. The Initial Findings and the Mystery Enhancement The baseline exam reveals distinct areas of tissue loss and gliosis, accompanied by contrast enhancement in the medial parts of the right occipital lobe. We also observe similar, smaller contrast-enhancing areas in the right lateral frontal lobe, specifically at the level of the inferior frontal gyrus. The initial radiological report strongly suggested these locations were indicative of subacute to old infarctions within the posterior cerebral artery territory. However, the persistent contrast enhancement presented a specif...

  I have just uploaded a new video case to the   Radiat Pixels   YouTube channel, highlighting a fascinating and critical late complication of oncological treatment that every radiologist should keep on their radar. Case Overview In this week's video, we review the neuroimaging follow-up of a 33-year-old patient. The clinical timeline is key here: this patient underwent surgical resection and subsequent therapy for a medulloblastoma during childhood. Crucially, a follow-up control exam performed when the patient was 19 years old was completely clear, showing no signs of tumor recurrence and no vascular abnormalities. Now, at 33 years of age, the latest follow-up imaging reveals the distinct development of a new cavernous malformation. The Core Teaching Point The primary takeaway from this case is a vital reminder for long-term follow-up imaging:   Cavernomas can be radiation-induced. Radiation-induced cavernous malformations (RICMs) are a well-documented, delayed com...

  New on Radiant Pixels : Spotting an MVNT in a Suspected Epilepsy Case Welcome to   Radiant Pixels , my brand-new YouTube channel dedicated to fascinating radiological cases and imaging insights! In our latest video, we are diving deep into a compelling neuroimaging workup of an adult patient being investigated for a possible epilepsy focus. The Case Breakdown Initial investigations started with a standard CT scan, which was entirely negative. However, the MRI painted a much more detailed and intriguing picture. During the read, we isolated a very specific lesion with the following characteristics: Location:   Juxtacortically adjacent to the right gyrus cinguli. Morphology:   A distinct, micro-bubbly and nodular appearance. Edema:   Absolutely no perifocal edema present. Vascularity & Enhancement:   No pathological vessels and zero contrast enhancement. The Diagnosis For radiologists, these specific imaging hallmarks—particularly the juxtacortical bubb...

Welcome back to the blog! I am expanding the ways we explore radiology together with the launch of my new YouTube channel,   Radiant Pixels . To kick things off, the latest video features a classic but highly educational case of a   Pituitary Macroadenoma   (a benign tumor measuring >1 cm). In this visual walkthrough, we focus on the crucial anatomical landmarks and how to systematically assess the tumor's boundaries on MRI. The main teaching points covered in the video include: The Optic Chiasm:   Assessing for superior extension and chiasmal compression, which is vital for correlating with visual field deficits like bitemporal hemianopsia. The Cavernous Sinus:   Evaluating the degree of lateral invasion and understanding the implications for the internal carotid artery and adjacent cranial nerves. Normal Pituitary Remnants:   Identifying the displaced, compressed normal gland tissue to properly differentiate the adenoma from other sellar and parasellar...

  Following our previous discussion on the clinical presentation of Chronic Subdural Hematoma (cSDH) and its appearance on CT, today we're going a step further. We'll utilize specific MRI sequences and CT correlation to gain a more detailed understanding of the signal characteristics of cSDH and, crucially, to properly visualize the anatomy of the subdural space, which is typically just a potential space but becomes strikingly apparent in this pathology. All the images we'll examine today are from the same patient, providing a comprehensive, multi-modal overview of their diagnosis. Expanding the Potential Space: The T1 Signal Characteristics We begin our detailed look with an enlarged axial T1-weighted image. T1 sequences are excellent for anatomical detail and can sometimes help characterize fluid based on its protein content and hemorrhagic degradation products. In this image, you can clearly see a fluid collection expanding along the cerebral convexity. The key takeaway ...

  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...

  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...

  T2 sequences showing right sided paramedian disk herniation at L5-S1 level compressing right nerve root S1 in the lateral recess. No spinal stenosis. See my YouTube Short Video

  A case of a young patient with incidental finding of an intra-dural extra-spinal Schwannoma. Tumor enhances mostly in the periphery, is well defined and shows high signal on T2 sequences. Tumor compresses conus. Note fine outcome on the control study 6 months after operation (on the right) with no residue tumor and fine remodelling of the conus.  See also my YouTube Short . 

  Young patient diagnosed with vitamin B12 deficiency showing classical inverted V sign in the posterior part of the cervical spinal cord that indicates Subacute Combined Degeneration of the spinal cord.  See also my YouTube Short :

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). 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. Radiological Findings: CT and MRI Analysis Image 1: Initial CT and MRI The first CT scan, performed without contrast, revealed diffusely increased signal intensity in the putamen , more pronounced on the right. The su...