Launch of the world’s first 7 T MR platform intended for clinical use (Siemens)

Erlangen, Germany, May 31, 2015 — Siemens announced at the Toronto ISMRM (International Society for Magnetic Resonance in Medicine) meeting the launch of the world’s first 7 T MR platform intended for clinical use. Important advances include a new, light, actively shielded magnet with zero helium boil-off and dual operating modes, enabling rapid switching between research […] [...]

Clinical Case: 3 Tesla MR Neurography-Guided Posterior Femoral Cutaneous Nerve Block

The high SNR available at 3T provides the ability to perform high-resolution MR neurography-guided perineural injections for highly accurate visualization of small nerve as well as needle targeting and perineural injection. This case report demonstrates how this techniques facilitates accurate targeting of the PFCN.  Download/View PDF [...]

Val M. Runge, MD – ASNR 2015 – Pearls and Pitfalls in Neuroradiology of Cerebrovascular Disease – The Essentials with MR and CT

This educational exhibit was presented at the ASNR 2015 meeting, with imaging performed on a 3 T Siemens Skyra MR system. The full reference for the exhibit is given below. Runge V, Smoker W, Valavanis A. Pearls and Pitfalls in Neuroradiology of Cerebrovascular Disease – The Essentials with MR and CT. ASNR 53rd Annual Meeting, […] [...]

Oligodendroglioma (WHO grade II)

A 30 year old man referred to Neurosurgery for a mass lesion (of the brain) revealed by imaging at an outside hospital. [...]

Medulloblastoma (posterior fossa PNET)

A 7 year-old boy who presents with nausea and vomiting. [...]

Val M. Runge, MD – ASNR 2015 – Simultaneous Multi-Slice (Slice Accelerated) Diffusion EPI

This educational exhibit was presented at the ASNR 2015 meeting, with imaging performed on a 3 T Siemens Skyra MR system. The full reference for the exhibit is given below. Runge V, Richter J, Beck T, Piccirelli M, Valavanis A. Simultaneous Multi-Slice (Slice Accelerated) Diffusion EPI. ASNR 53rd Annual Meeting, April 25-30, 2015, Chicago, Illinois […] [...]

Metastasis (breast carcinoma)

A 64 year-old woman with a history of breast cancer, presenting with weakness [...]

Pituitary microadenoma (prolactinoma, treated)

A 31 year-old woman with long-standing infertility, who prior to treatment presented with galactorrhea, now on cabergoline. [...]

Pituitary macroadenoma, with invasion of the left cavernous sinus

A 58 year old woman presenting with a visual field defect (bitemporal hemianopsia) [...]

Parenchymal hemorrhage, late subacute

A 68 year-old woman several weeks following a stroke. [...]

Periventricular leukomalacia

A 3 year-old girl, product of in vitro fertilization (with a normal twin), delivered by c-section at 30 weeks. She is mildly developmentally delayed, with spastic diplegic/triplegic cerebral palsy. [...]

Cavernous malformation

A 60 year-old woman with myelopathic symptoms, status/post cervical decompression, with follow-up cervical MR revealing a lesion in the pons. [...]

Subarachnoid hemorrhage

subarachnoid hemorrhage well seen on T2 fl2d coronal GRE, subarachnoid hemorrhage of unknown reason, may have small thrombosed cortical vein – very small, on pre-contrast T1, also likely small adjacent skull hemangioma, seen on both CT and MR Part of the on-line supplement to Neuroradiology – The Essentials with MR and CT (© 2015) [...]

Toxoplasmosis

A 30 year-old woman with HIV [...]

ACOM aneurysm

A flow void is noted in the region of the anterior communicating artery (ACOM) on an axial T2-weighted image, with signal intensity corresponding to arterial flow on an axial source image from a 3D TOF MRA. CE MRA images further confirm the aneurysm, with the right A1 segment of the ACA noted to be very […] [...]

ACA aneurysm

Note the prominent pulsation artifact in the first image (a FSE T1-weighted scan at 3 T), seen propagating in the left-right dimension. On the post-contrast image (a short TE GRE scan), the aneurysm is well depicted, other than partial volume effects (due to the 4 mm slice thickness). This 2D scan is relatively immune to […] [...]

Imaging of Diseases of the Cranial Nerves: Tips and Tricks

This article focuses on common problems and pitfalls in MRI of pathologies of cranial nerves. It provides an introduction to helpful sequences and post processing techniques. To familiarize the reader with cranial nerve imaging, examples of the normal anatomy as well as typical pathological cases are shown. [...]

Susceptibility-Weighted Imaging (syngo SWI) at 3T.

This is a pictorial review of susceptibility- weighted imaging (syngo SWI) using a MAGNETOM Trio system with software version syngo MR B15 and a 32-channel head coil at The Geelong Hospital, Victoria, Australia. syngo SWI is a 3D FLASH sequence that is flow compensated in slice, read and phase directions. [...]

Acute cerebellar hemorrhage

Acute cerebellar hemorrhage, hypertensive. A large acute parenchymal hemorrhage is seen in the left cerebellar hemisphere, on sagittal, axial, and coronal reformatted images from a non-contrast CT exam. Note the vasogenic edema circumferential to this hematoma. Hemorrhage is also seen in the fourth ventricle on the axial image, with interstitial edema and ventricular enlargement noted […] [...]

Germinoma

A 22 year-old woman presents with a suprasellar mass on CT [...]

Acute infarction of the caudate head and lentiform nucleus

Both structures are supplied by the lateral lenticulostriate arteries, which originate from the MCA. The caudate nucleus is also supplied by the medial lenticulostriate arteries, which arise from the ACA. The recurrent artery of Heubner, which supplies the anteromedial caudate nucleus and the anteroinferior internal capsule, is the largest of the medial lenticulostriate arteries, and […] [...]

Oligoastrocytoma (WHO grade 2)

A 23 year old man presenting with a mass lesion on CT [...]

Acute lacunar infarction, posterior limb of the internal capsule

The patient was hypertensive, and presented for CT (which was negative) with acute hypoesthesia involving the left side of the body. The MR was obtained 15 hours later, and reveals a small acute lacunar infarct in the internal capsule on the right. Due to the ability to detect cytotoxic edema, with diffusion weighted imaging, MR […] [...]

Posterior reversible encephalopathy syndrome (PRES), also known as acute hypertensive encephalopathy

A 25 year-old woman on chemotherapy, with hypertension and visual symptoms [...]

Acute medial medullary infarct

Abnormal hyperintensity is noted in the right medial medulla on both T2- and diffusion-weighted scans, which corresponds to vasogenic and cytotoxic edema, respectively. The medial medulla is most often described as being supplied by the anterior spinal artery. The medial medullary syndrome, also known as Dejerine syndrome, is caused by infarction of this region. It […] [...]

Acute parenchymal hemorrhage, due to an underlying AVM

Acute parenchymal hemorrhage, due to an underlying AVM. A large acute parenchymal hematoma is noted in the right frontal lobe. Post-contrast, there is tubular like enhancement within and immediately posterior to the hemorrhage, most consistent with acute extravasation of blood. The coronal thick MIP from the CTA study reveals a small nidus of arterial enhancement […] [...]

Septo-optic dysplasia

A five year-old boy with hydrocephalus and pituitary dysfunction [...]

Left temporal lobe arteriovenous malformation (AVM)

A 31 year old woman [...]

Glioblastoma Multiforme (left parietal)

A 57 year old man presents with a mass lesion on CT, with MR performed for differential diagnosis and better delineation of the lesion. [...]

Acute subarachnoid hemorrhage from a small ACOM aneurysm

The images presented include an axial unenhanced CT, a coronal MIP from the CTA, and a 3D magnified view of the aneurysm from the CTA, obtained using volume rendering technique (VRT). The latter shows the distal internal carotid artery, the two anterior cerebral arteries, and the small multi-lobulated aneurysm originating from the ACOM, near its […] [...]

Posterior cerebral artery infarct (early subacute)

A 79 year old man presents with symptoms of a cerebrovascular accident [...]

Acute superior cerebellar artery (SCA) infarction

Acute superior cerebellar artery (SCA) infarction, with an accompanying small unilateral pontine infarct. Hypodensity is seen on CT in a portion of the SCA territory, with hyperintensity on axial T2-weighted MR (and sagittal FLAIR), both due to vasogenic edema. The presence of restricted diffusion is confirmed on the ADC map, reconstructed from the diffusion scans. […] [...]

Acute subdural and parenchymal hemorrhage, from an underlying AVM

Acute subdural and parenchymal hemorrhage, from an underlying AVM, in a patient with fibromuscular dysplasia (FMD). Intracranial aneurysms are a well known associated finding in FMD, with the occurrence of intracranial arteriovenous malformations less common. On axial CT, both the acute subdural and parenchymal hematomas are well demonstrated, together with midline shift and compression of […] [...]

Multiple sclerosis (cervical spinal cord)

A 28 year old woman [...]

Left MCA trifurcation aneurysm

A 45 year old man with end-stage renal disease and a history of polycystic kidney disease [...]

Left middle cranial fossa arachnoid cyst

An incidental finding in a 46 year old man being evaluated for possible recent cerebral infarction (the brain MR was otherwise normal) [...]

Anaplastic astrocytoma (WHO grade III), CT and MR

A focal, mildly hyperdense, lesion is noted on CT in the right centrum semiovale, with restricted diffusion and no abnormal contrast enhancement. rCBV is mildly elevated. The hyperdensity on CT is unusual, with the diffusion restriction (confirmed on the ADC map, not shown) correctly suggesting a higher-grade lesion, with the lesion appearing on other scans […] [...]

Glioblastoma (WHO grade 4 astrocytoma), recurrent

A 55 year old man, with a previous partial tumor resection [...]

Anaplastic ependymoma (WHO grade III), in an 18 month old infant

There is a large enhancing extra-axial mass lying within the 4th ventricle and extending into the foramen of Luschka on the left. Heterogeneity of the lesion with cystic and necrotic areas is characteristic, along with the previously described findings. Most patients are one to five years in age, and present – as this child – […] [...]

Aneurysm, cavernous carotid artery

A small mass lesion is noted within the left cavernous sinus on both CT and MR (axial imaging), with CT revealing enhancement therein. MRA confirms this to be an aneurysm, with the DSA provided for comparison (from an initial balloon test occlusion study). This 12 mm aneurysm of the cavernous segment of the internal carotid […] [...]

B cell lymphoma

A hyperintense periventricular mass lesion with accompanying vasogenic edema is noted in the right occipital lobe. The mass is hyperintense on DWI, with disruption of the blood-brain barrier (enhancement) demonstrated post-contrast. The mass had restricted diffusion (reflected by the high SI on DWI), which is compatible with primary CNS lymphoma, a diagnosis confirmed at surgery. […] [...]

Brain metastases, melanoma

Pre- and post-contrast axial T1-weighted scans are illustrated. Pre-contrast, several small lesions in the frontal lobes, in particular on the left, demonstrate hyperintensity. Numerous small nodular enhancing lesions are noted post-contrast, all at the gray-white matter junction. Hemorrhagic metastases are seen in up to 15% of brain metastases. A mnemonic for the primary tumors that […] [...]

Calvarial metastasis from breast carcinoma, with hyperostosis frontalis interna

A large lytic skull lesion is noted on CT, along with benign thickening along the inner table of the frontal bone (an incidental finding). MR depicts well the soft tissue mass within the skull, which is slightly expansile and easily distinguished pre-contrast from the adjacent fatty marrow, with enhancement post-contrast. Part of the on-line supplement […] [...]

Cavernous malformation, with an associated developmental venous anomaly

On CT, a small, well delineated, hyperdense, round, focal lesion is seen pre-contrast, to the right and posterior to the fourth ventricle. On axial T2-weighted scans, a complete hemosiderin rim is demonstrated, together a “popcorn ball” appearance centrally, with mixed high and low signal intensity – all characteristic for a cavernous malformation. Just lateral and […] [...]

Cerebellar hemangioblastoma

Cerebellar hemangioblastoma on MR, von Hippel Lindau syndrome. Well seen on axial T2- and sagittal post-contrast T1-weighted scans is a cystic cerebellar lesion with an enhancing mural nodule. This lesion is also illustrated on CT in an accompanying figure. A solid enhancing nodule (along the periphery of the cyst) would be the most characteristic imaging […] [...]

Cerebellar hemangioblastoma on CT

Cerebellar hemangioblastoma on CT, von Hippel Lindau syndrome. Post-contrast scans in all three orthogonal planes reveal a cystic cerebellar lesion, with an enhancing mural nodule, the most common imaging presentation for a hemangioblastoma. Part of the on-line supplement to Neuroradiology – The Essentials with MR and CT (© 2015) [...]

Meningioma

An 87 year old male with anosmia and known diagnosis of meningioma. [...]

Cerebral abscess

A small lesion with a thin, uniform rim of contrast enhancement and moderate associated vasogenic edema is noted in the left postcentral gyrus. Note that the periphery of the lesion is slightly hypointense on the coronal FLAIR scan, which is characteristic of an abscess, together with restricted diffusion (well seen in this patient, but with […] [...]

Choroidal fissure cyst

These are considered a normal variant, and occur in the medial temporal lobe. They have a characteristic spindle shape on sagittal images (not illustrated), demonstrate CSF signal intensity, and expand slightly the choroidal fissure of the temporal lobe. Part of the on-line supplement to Neuroradiology – The Essentials with MR and CT (© 2015) [...]

Convexity meningioma

Axial, sagittal, and coronal images reveal a round extra-axial lesion, with a broad base along the dura of the convexity, and a small associated dural tail. Additional typical findings for the diagnosis include relative isointensity to brain on the T1-weighted scan, slight hyperintensity on T2-weighted scans, and homogeneous contrast enhancement. Part of the on-line supplement […] [...]

Right cerebellar hemangioblastoma

A 49 year old male with worsening headache, mostly in the posterior neck, and vertigo. [...]

Melanoma with brain metastases

A 77 year-old male with history of melanoma. [...]

Active Multiple Sclerosis

This is a 24-year-old male with left-sided weakness and numbness, headaches, and a clinical question of a recent stroke. [...]

Low Grade Astrocytoma

78 year old woman with symptoms of memory loss and dizziness for the past 6 months. She also has chronic headaches, confusion and ataxia. [...]

Right-sided vestibular schwannoma

This is a 46-year-old female who presented with a history of right ear tinnitus and right ear sensorineural hearing loss. [...]

Arachnoid Cyst

49 year old man with lung cancer for evaluation of metastatic disease after chemotherapy and radiation. No neurological symptoms. [...]

Brain abscess

Clinical History: This 5-year old boy presented with an acute headache and vomiting for 12 hours. The patient had a clinical history of cholesteatoma surgery in the recent past, involving the right mastoid.   Diagnosis: Brain abscess   MR Technique: Contrast-enhanced brain MR imaging was performed on a 3T system following an unenhanced CT scan […] [...]

Convexity meningioma with invasion of the superior sagittal sinus and the calvarium,CT

An enhancing lesion is identified along and to the left of the falx posteriorly, with occlusion of the superior sagittal sinus (diagnosed by the lack of enhancement). A portion of the sinus and adjacent draining cortical veins are identified along the anterior margin of the lesion. The calvarium is focally involved, with expansion, osteolysis and […] [...]

Convexity meningioma with invasion of the superior sagittal sinus and the calvarium,MR

In an accompanying figure, the CT findings in this case are presented. An extra-axial mass lesion is noted, adjacent to and to the left of the falx. The superior sagittal sinus is occluded. Meningiomas with restricted diffusion (hyperintensity on DWI), as in this example, tend to be malignant or highly atypical. The sagittal post-contrast exam […] [...]

Vestibular Schwannoma

68 year old man with bilateral hearing loss. [...]

Craniosynostosis

CT reveals a normal right coronal suture, with bony bridging of the suture on the left. The result is an abnormal shape to the skull, which is asymmetrical, and termed plagiocephaly (which can involve either the coronal suture, as in this patient, or the lambdoid suture). No gross structural abnormalities are noted involving the brain. […] [...]

Early subacute infarct along the lateral ventricle, in a patient with extensive chronic small vessel white matter ischemic disease

A large lacunar infarct is seen in the white matter of the corona radiata, immediately adjacent to the left lateral ventricle. The infarct demonstrates both vasogenic edema, seen with abnormal high signal intensity on the T2-weighted scan, and cytotoxic edema, seen as restricted diffusion (low intensity) on the ADC map. Thus, the lesion is early […] [...]

Chiari I Malformation

This is a 21-year-old male with recent headaches. The headaches are described as intermittent throbbing and result in numbness, tingling, and blurred vision. [...]

Early subacute pinpoint cortical infarct, left precentral gyrus

The patient presented 6 days prior to the MR exam with right arm and facial paralysis. NIHSS=3 (minor stroke), which improved to 0 (no stroke symptoms). CT at the time of symptom onset was negative. Multiple small focal areas of gliosis or edema (with high signal intensity) are seen on the coronal FLAIR, with a […] [...]

Falx meningioma, with interval growth

The first post-contrast coronal T1-weighted scan was obtained six years prior to the second exam, with coronal FLAIR and post-contrast T1-weighted scans illustrated from the second exam. There has been interval growth of the lesion, substantial when viewed from a volume perspective. The lesion was electively removed, prior to possible involvement of the superior sagittal […] [...]

Focal cortical dysplasia

There is focal cortical thickening and a relatively poorly defined transition between gray and white matter, seen in the left frontal lobe on axial and coronal scans, in this 18 month old with intractable seizures. Part of the on-line supplement to Neuroradiology – The Essentials with MR and CT (© 2015) [...]

Ganglioglioma (cystic)

Presenting with seizure,a small intra-axial mass lesion is noted in the posterior temporal lobe in this young adult male. There is a small amount of associated vasogenic edema. Post contrast, the enhancement is predominantly rim-like in character, with likely both a solid (posteriorly) and a cystic component to the lesion. Part of the on-line supplement […] [...]

Chiari II Malformation

This is an 11-year-old male being followed for loss of cognitive abilities and facial paralysis. [...]

Ganglioglioma (solid)

A relatively well defined intraaxial mass lesion is noted in the right temporal lobe, with low- and high signal intensity respectively on T1- and T2-weighted scans, and prominent enhancement. There is only mild accompanying vasogenic edema. Location in the temporal lobe is characteristic for this diagnosis, as was the patient’s age (13 years), with this […] [...]

Glioblastoma, right parietal in location

A relatively well-defined enhancing mass lesion is seen, with prominent accompanying vasogenic edema. Despite the absence of gross central necrosis, the abnormal high signal intensity on FLAIR extends within the splenium of the corpus callosum, and extended (on images not presented) to the left as well. This finding is consistent with infiltration of the corpus […] [...]